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John Conolly and the historical interpretation of moral management Wood, Laura Christine 1985

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JOHN CONOLLY AND THE HISTORICAL INTERPRETATION OF MORAL MANAGEMENT By LAURA CHRISTINE WOOD B.A., The U n i v e r s i t y of B r i t i s h Columbia, 1978 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS i n THE FACULTY OF GRADUATE STUDIES (Department of Hi s t o r y ) We accept t h i s t h e s i s as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA December 1985 c Laura C h r i s t i n e Wood, 1985 In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. Department The University of British Columbia 1956 Main Mall Vancouver, Canada V6T 1Y3 DE-6(3/81) ABSTRACT A number of explanations have been o f f e r e d to account f o r the develop-ment and d e c l i n e of the movement to reform the care and treatment of the insane, which began i n B r i t a i n i n the l a t e eighteenth century, and was to f i n d i t s most complete expression i n the system known as moral management. The t r a d i t i o n a l or i n t e r n a l i s t school argues f i r s t l y , t hat humanitarianism was the m o t i v a t i n g f o r c e behind the changes i n the treatment of i n s a n i t y , and secondly, that c o n d i t i o n s f o r the mad improved because of a growth o f medi-c a l and s c i e n t i f i c knowledge. These views o f the reform of the treatment of i n s a n i t y were challenged by Michel Foucault, and other r e v i s i o n i s t h i s t o r i a n s who were a f f e c t e d by h i s i n s i g h t s . Andrew S c u l l has been a most i n f l u e n t i a l member of t h i s group. He viewed i n s a n i t y reform as having grown out of a s o c i o - p o l i t i c a l need to manage deviancy, which l e d p h y s i c i a n s to app r o p r i a t e a non-medical form of asylum management, known as moral treatment, and r e c a s t i t as a medical t h e r a p e u t i c r e q u i r i n g medical e x p e r t i s e f o r i t s a d m i n i s t r a -t i o n . This helped j u s t i f y t h e i r attempt to make themselves i n d i s p e n s a b l e i n the care and treatment of i n s a n i t y . Recently, S c u l l used t h i s approach i n a n a l y z i n g the career of John Conolly, a well-known asylum doctor of mid-nineteenth-century B r i t a i n , who i n s t i t u t e d , i n a l a r g e p u b l i c asylum, a form of moral management known as the n o n - r e s t r a i n t system. S c u l l described Conolly as an unsuccessful general p r a c t i t i o n e r who achieved renown and economic s e c u r i t y because of h i s p o s i t i o n as an asylum a d m i n i s t r a t o r , d e s p i t e h i s e a r l i e r c r i t i c i s m s of asylum care. In t h i s t h e s i s , I have examined Conolly's w r i t i n g s on the t h e o r i e s and p r a c t i c e s o f moral management, as w e l l as w r i t i n g s on those subjects by other important f i g u r e s of l a t e eighteenth- and nineteenth-century p s y c h i a t r y . I have drawn on the work of Robert C a s t e l , Roger Smith and K a r l F i g l i o i n order to demonstrate that the p r a c t i c e s of moral managers l i k e John Conolly are b e t t e r understood i n terms of a group of c o n c e p t s — the schema of s t i m u l a t e d motion, p r e d i s p o s i t i o n , and h i e r a r c h y — w h i c h developed out of a combination of medical, s o c i a l and p h i l o s o p h i c a l i n f l u -ences which were themselves generated i n an e p i s t e m o l o g i c a l framework c o n s t i t u t e d around the general p r i n c i p l e of o r g a n i z a t i o n . In a d d i t i o n , these concepts provided a r a t i o n a l e f o r regarding the t h e o r e t i c a l and p r a c t i c a l aspects of asylum medicine as i n t e g r a t e d . This conceptual analy-s i s helps e x p l a i n Conolly's adoption of the p r a c t i c e of moral management. Thus, h i s r o l e as advocate cannot be understood e x c l u s i v e l y i n S c u l l ' s terms, as an example of careerism, but i s b e t t e r understood as a p r a c t i c a l c o r o l l a r y of e x i s t i n g p s y c h i a t r i c theory and p r a c t i c e . i v TABLE OF CONTENTS Page ABSTRACT i i TABLE OF CONTENTS i v ACKNOWLEDGEMENTS v INTRODUCTION: THE HISTORICAL DEBATE ABOUT MORAL MANAGEMENT 1 CHAPTER ONE: THE HISTORY OF MORAL MANAGEMENT • . 14 CHAPTER TWO: DISEASES OF THE MIND AND STRATEGIES FOR CURE: THE STATE OF THE QUESTION 1770-1860 27 Part One 28 Part Two 36 Part Three 49 CHAPTER THREE: JOHN CONOLLY: FROM MORAL MANAGEMENT TO NON-RESTRAINT 60 Part One 60 Part Two 65 Part Three 88 CHAPTER FOUR: MORAL MANAGEMENT IN HISTORICAL PERSPECTIVE 93 CONCLUSION: MORAL MANAGEMENT AS A SOCIAL MEDICINE 115 FOOTNOTES .... ^  120 In t r o d u c t i o n 120 Chapter One 123 Chapter Two 126 Chapter Three 133 Chapter Four .. i i 141 Conclusion 147 SELECTED BIBLIOGRAPHY 148 V ACKNOWLEDGEMENTS I am very g r a t e f u l to my a d v i s o r , Dr. Harvey M i t c h e l l , f o r h i s patience and the h e l p f u l d i r e c t i o n he has given me throughout the w r i t i n g of t h i s t h e s i s . I would a l s o l i k e to thank the Department o f H i s t o r y f o r i t s support, the pro f e s s o r s who taught me, and the l i b r a r i a n s of Woodward L i b r a r y f o r t h e i r a s s i s t a n c e i n p r o v i d i n g me w i t h sources. L a s t l y , I am deeply g r a t e f u l to my f r i e n d s and my f a m i l y — e s p e c i a l l y my parents, B i l l and Cl a r a Wood—who have given me much help and endless encouragement. 1 INTRODUCTION THE HISTORICAL DEBATE ABOUT MORAL MANAGEMENT To t u r n from these horrors,and to record improvement and advance, and the triumph of kindness and judgement over s e v e r i t y and brute f o r c e , i s a r e l i e f to the mind. John Conolly Various explanations have been o f f e r e d to account f o r the development and d e c l i n e of the movement to reform the care and treatment of the insane which began i n B r i t a i n i n the l a t e eighteenth century and was to f i n d i t s most complete r e a l i z a t i o n i n the system known as moral management. Today, there i s a great d i v i d e between what might be described as a t r a d i t i o n a l , i n t e r -n a l i s t school (represented by w r i t e r s such as Leigh, Jones, Hunter and 2 MacAlpine), and a c r i t i c a l , r e v i s i o n i s t school .(represented ,by w r i t e r s such as Foucault, C a s t e l , and S c u l l ) S u c h a controversy i s not unusual i n the h i s t o r y of science and medicine. However, because contemporary s o c i a l c r i t i c s of p s y c h i a t r y such as Laing, Szasz, and Sedgwick are s a i d to be a l l i e d w i t h the r e v i s i o n i s t h i s t o r i a n s i n an att a c k against what has been termed the l i b e r a l e n t e r p r i s e of the l a s t two hundred years, the r e v i -s i o n i s t s ' c r i t i q u e of the i n t e r p r e t a t i v e " canons of t r a d i t i o n a l h i s t o r i c a l e x p l a n a t i o n i s e s p e c i a l l y worrisome to i t s defenders. Jones, Hunter and MacAlpine, and other h i s t o r i a n s devoted to the t r a d -t i o n a l stance, tend to advance two l i n e s of argument that are predicated upon the bas i c e p i s t e m o l o g i c a l assumption that madness i s an o b j e c t i v e e n t i t y . Taking the immutable s t a t u s of madness as a given, these h i s t o r i a n s of 2 p s y c h i a t r y argue f i r s t that humanitariahism was the m o t i v a t i n g f o r c e behind the reform i n the treatment of the insane i n nineteenth-century B r i t a i n . Humanitarianism i s presented as having grown out of the secularism and r a t i o n a l i s m of the Enlightenment, which made p o s s i b l e new and humane a t t i ^ tudes towards the a f f l i c t e d i n E n g l i s h s o c i e t y — t h e mad, c r i m i n a l s , the poor and weak i n general. These new conceptions of k i n d l y use and r a t i o n a l r e s p o n s i b i l i t y are evident i n such movements as the r e a c t i o n against c r u e l t y , the reforms of i n s t i t u t i o n s l i k e asylums, h o s p i t a l s , and p r i s o n s , and i n the economic realm, the enactment of l e g a l r e s t r a i n t s upon c a p i t a l i n i t s r e l a -t i o n s w i t h labour. The development of the tenets of moral therapy are thus seen as i n d i c a t i v e of the humanitarian sentiment which g r a d u a l l y gained medical and p u b l i c acceptance throughout the century, and which was r e s p o n -s i b l e f o r the development of e f f e c t i v e techniques of psychotherapy and the a m e l i o r a t i o n of ignorant, popular conceptions of mental i l l n e s s . The second l i n e of argument employed by h i s t o r i a n s l i k e Hunter and MacAlpine and Leigh invokes a growth of medical and s c i e n t i f i c enlightenment. According to t h e i r e x p l a n a t i o n , the improvement of t h e r a p e u t i c and i n s t i t u -t i o n a l p r a c t i c e s and the e l a b o r a t i o n of p s y c h o l o g i c a l theory i s c h r o n i c l e d i n terms of the a c q u i s i t i o n and u t i l i z a t i o n of an i n c r e a s i n g l y s c i e n t i f i c outlook. The o u t l i n e i s as f o l l o w s . In the l a t e eighteenth century, p h y s i c i a n s began to see i n s a n i t y as disease r a t h e r than as the product of o c c u l t f o r c e s and began to search f o r medical methods of t r e a t i n g i t . During the course of the nineteenth century, they discovered the unconscious, the r e a l symptoms of s p e c i f i c p s y c h i a t r i c d i s o r d e r s , and the p r i n c i p l e s of e f f e c t i v e psychotherapy. Moral management was thus the f i r s t attempt at e x p l i c a t i n g a humanistic psychotherapeutic system, but i t lacked the 3 i n t e l l e c t u a l r i g o u r of Freud's achievement, which was the c u l m i n a t i o n of the long process of uncovering the r e a l e n t i t i e s that compose the unconscious. Hunter was a n e u r o l o g i s t i n t e r e s t e d i n the development of modern methods of t r e a t i n g the insane, so he and MacAlpine focused t h e i r i n v e s t i g a t i o n s e s p e c i a l l y upon nineteenth-century advances i n the study of neurology, the enlargement and refinement of the pharmacopeia, and the dimunition i n the use of p h y s i c a l r e s t r a i n t . In the end, both the humanitarians and the i n t e r n a l - . i i s t s would r e t u r n to the a c q u i s i t i o n of a proper medical outlook by c e r t a i n g i f t e d p h y s i c i a n s whose innate humanitarian leanings prompted them to devote themselves to the insane, and who proceeded to educate the p u b l i c i n t o a b e t t e r understanding of mental i l l n e s s , an undertaking which was f a c i l i t a t e d by the i n f i l t r a t i o n of the humanitarian s e n s i b i l i t y and general s c i e n t i f i c knowledge throughout V i c t o r i a n s o c i e t y . In t h i s a n a l y s i s , the achievement of s c i e n t i f i c i l l u m i n a t i o n i s b e l i e v e d to be an a c t i v i t y which occurs without much i n t e r f e r e n c e from s o c i o - p o l i t i c a l and economic f a c t o r s . These h i s t o r i a n s admit the i n f l u e n c e of eighteenth-century secularism and n a t u r a l i s m and nineteenth-century humanitarianism, but they place more weight upon the a b i l i t y of i n d i v i d u a l p h y s i c i a n s to d i s -cern s c i e n t i f i c t r u t h through the development of an o b j e c t i v e methodology i n t h e i r research and treatment of what became "mental i l l n e s s " . The under-l y i n g p h i l o s o p h i c a l assumption i s that mental i l l n e s s e x i s t s as an o b j e c t i v e e n t i t y that i s e s s e n t i a l l y unchanging over time, and thus i s only i n c i d e n -t a l l y c o n d itioned by e x t e r n a l f a c t o r s . By the a c q u i s i t i o n of p s y c h i a t r i c s k i l l and understanding through the ages, "the t r u t h " about madness has been uncovered, t h i s t r u t h being that madness i s "mental i l l n e s s " . Some modern p s y c h i a t r i c h i s t o r i a n s are hard-pressed to f i t moral management i n t o t h i s p r ogressive model of s c i e n t i f i c advance, p a r t l y because the e a r l y proponents of moral management o f t e n made an i s s u e of t h e i r renun-c i a t i o n of more orthodox somatic t h e o r i e s and p r a c t i c e s . But the development of moral management f i t s h a n d i l y w i t h the humanitarianism t h e s i s ; indeed, at times i t seems that r a t h e r than being explained by humanitarianism, moral management ac t s as evidence f o r i t . I f moral treatment i s regarded as a precursor of, or as an e a r l y example of, contemporary t h e r a p e u t i c s t r a t e g i e s , then i t can be included as evidence of the m e d i c a l - s c i e n t i f i c theory as w e l l . What i s s i g n i f i c a n t about both the i n t e r n a l i s t and the humanitarianism h i s t o r i e s i s t h e i r undisguised adherence to a t e l e o l o g y of reform. In both cases, improvement i n the c o n d i t i o n s of p r a c t i c e are i n e v i t a b l e because the best way to go about t h i n g s l i e s out there w a i t i n g to be discovered. The s c i e n t i f i c school has, perhaps, a b e t t e r case f o r i t s p e r s i s t e n t Whiggism: i t i s hard to dispute concrete demonstrations of the f a c t s of b r a i n s t r u c t u r e and f u n c t i o n and n e u r o l o g i c a l disease. But even i n t h i s s i t u a t i o n , there i s a tendency to overlook or avoid the e x t r a - s c i e n t i f i c aspects of the growth of theory and p r a c t i c e ; indeed, there i s o f t e n an a c t i v e resentment of the i m p l i c a t i o n s of s o c i o - c u l t u r a l i n f l u e n c e s on the a c q u i s i t i o n o f knowledge. I t i s w i t h i n t h i s context of the d i s c u s s i o n t h a t Foucault's Madness and  C i v i l i z a t i o n should be seen. In t h i s work, Foucault not only questioned the k i n d l y s e n s i b i l i t i e s of the l a t e eighteenth-century p s y c h i a t r i c pioneers, (e.g. Tuke and P i n e l ) but a l s o cast aspersions on t h e i r i n t e l l e c t u a l enter-p r i s e by suggesting that even medical concepts about madness were a f f e c t e d k by s o c i o - c u l t u r a l f a c t o r s which were themselves h i s t o r i c a l l y c o n s t i t u t e d . Foucault wrote of the development of the asylum system as the enacting of the e x c l u s i o n of both the mad person and the f i g u r e of madness from the wider realm of s o c i a l and c u l t u r a l understanding. For him, the great 5 s i g n i f i c a n c e of both Tuke's and P i n e l ' s moral treatment i s that they t r i e d to combat madness by c r e a t i n g i n the l u n a t i c a sense of r e s p o n s i b i l i t y i n which h i s f a i l u r e to maintain acceptable l e v e l s of s e l f - c o n t r o l was to be a source of g u i l t which would spur him to moderate h i s behaviour. In e f f e c t , moral therapy was a d i r e c t attempt to i n c u l c a t e the s o c i a l norms of s e l f - h e l p and emotional r e s t r a i n t , of d i s c i p l i n e and o r d e r l i n e s s which were the essen-t i a l elements of the new h a b i t s of the i n d u s t r i a l i z e d f a c t o r y and workshop. I t was expressive of the wider s o c i a l tendency to move from e x t e r n a l coercion of the body to i n t e r n a l c oercion of the " s o u l " , which Foucault has described as t y p i c a l of the-.changes i n penal p r a c t i c e s of the same p e r i o d . ^ Foucault's approach has been a s t a r t i n g point f o r a number of h i s t o r i a n s of p s y c h i a t r y , the most prominent, i n the f i e l d of B r i t i s h h i s t o r y , being f Andrew S c u l l . S c u l l moves i n a d i f f e r e n t d i r e c t i o n from Foucault by t r a n s -forming the o l d e r o u t l i n e of the development of moral management and the asylum reform movement. Both of these, he analyzes i n r e l a t i o n to concurrent changes in. economic and s o c i a l s t r u c t u r e , and a l s o i n r e l a t i o n to a p a r t i c u l a r element of these changes: the process of medical p r o f e s s i o n a l i z a t i o n . S c u l l t r e a t s t h i s whole process as part of a l a r g e r movement toward the i n s t i t u t i o n a l i z a t i o n of the deviant. T h i s , he argues, became necessary as an i n c r e a s i n g l y i n d u s t r i a l s o c i e t y was organized around the market system, e s p e c i a l l y the labour market. He proposes t h a t , out of a need to manage s o c i a l l y d i s r u p t i v e elements, came the p r i v a t e asylum system of the e i g h t -eenth century, a network of f a c i l i t i e s which was e n t r e p r e n e u r i a l i n s p i r i t and not e s p e c i a l l y medical i n o r i e n t a t i o n . Doctors who were in f u s e d w i t h t h i s s p i r i t went i n t o the l u c r a t i v e madhouse business and discovered that i t was a f r u i t f u l f i e l d f o r the extension of t h e i r r e g u l a r p r a c t i c e s . The "moral" 6 methods of treatment, which became fa s h i o n a b l e as a r e s u l t of Tuke's book, were a d i r e c t challenge to the i n c r e a s i n g medical hegemony over the insane. This challenge was met by the growing number of s p e c i a l i s t s i n i n s a n i t y — "mad-doctors"—with the e l a b o r a t i o n of t h e o r e t i c a l and p h y s i c a l explanations about the nature of i n s a n i t y which confirmed i t as a disease. E v e n t u a l l y , they i n c o r p o r a t e d "moral treatment" i n t o t h e i r t h e r a p e u t i c regimen. By c r e a t i n g a f i e l d of e x p e r t i s e f o r themselves and pr o c l a i m i n g a high r a t e of cure, the "mad do c t o r s " were able to extend t h e i r i n f l u e n c e on the lunacy reform movement u n t i l i t became axiomatic that p h y s i c i a n s were necessary to the dis c o v e r y and management of t h i s e n t i t y that had come to be known as "mental i l l n e s s " . By the time the asylum had been revealed i n i t s i r r e -t r i e v a b l y c u s t o d i a l a c t u a l i t y , the mere existence of an i n s t i t u t i o n a l approach with expert management was an inducement to i t s perpetuation. S c u l l e x p l a i n s that the perceived incr e a s e i n the number of pauper insane a f t e r 1845 was, i n p a r t , a r e s u l t of the asylum i t s e l f . The poor discovered more i n s a n i t y among themselves when some r e l i e f from i t s burdens was provided. In S c u l l ' s view, medical theory about i n s a n i t y was formulated to accord w i t h the e x i s t i n g t h e r a p i e s , which i n t u r n , were e i t h e r borrowed from accepted medical techniques or were formed i n response to s o c i a l pressures or i n s t i t u t i o n a l c o n s t r a i n t s . The inadequacies of the medico-psychological explanations of madness and i t s treatment were more or l e s s obscured by the e a r l y p s y c h i a t r i s t s who wished to e s t a b l i s h t h e i r e x p e r t i s e . S c u l l voices s u s p i c i o n s of what he c a l l s "the r h e t o r i c of i n t e n t i o n s " , a phrase he uses Q to denote the expression of humanitarian motives by the asylum reformers. He i n t i m a t e s that these i n d i v i d u a l s may w e l l have been aware of the probable e f f e c t of t h e i r a c t i o n s , and suggests that t r a d i t i o n a l h i s t o r i a n s who 7 have been a l l too w i l l i n g to accept the reformers' explanations of t h e i r i n t e n t have c o n t r i b u t e d to a myth by d i s t o r t i n g the f a c t u a l evidence which c o n t r a d i c t s i t . The reformers d i d indeed profess to be actuated by a 'humane' concern w i t h the w e l l - b e i n g of the l u n a t i c . (I have yet to meet a reformer who conceded that h i s designs on the o b j e c t s of h i s a t t e n t i o n s were malevolent.) But whatever the V i c t o r i a n haute bourgeoisie's degree of sym-pathy w i t h the s u f f e r i n g s of the lower orders, and however convinced one may or may not be of the depth of t h e i r i n t e r e s t i n the l a t t e r s ' w e l f a r e , i t remains the case t h a t to present the outcome of reform as a triumphant and unproblematic expression of humanitarian concern i s to adopt a pe r s p e c t i v e which i s h o p e l e s s l y biased and i n a c -cur a t e : one which r e l i e s , of n e c e s s i t y , on a systematic neglect and d i s t o r t i o n of the a v a i l a b l e .evidence.... There would, I t h i n k , be a widespread consensus on the dearth of almost any r e a l knowledge base i n e a r l y nineteenth-century medicine which would have given the medical p r o f e s s i o n a r a t i o n a l l y d e f e n s i b l e c l a i m to s p e c i a l e x p e r t i s e v i s - a - v i s the insane. 9-This i s a f a i r indictment of the form of h i s t o r i c a l compliance which has permitted the p r o g r e s s i v e v e r s i o n of the development of p s y c h i a t r y to g a i n such currency. However, I t h i n k S c u l l i s not p r o p e r l y concerned w i t h the meanings that informed the a c t i o n s of the asylum reformers. Admittedly, meanings and i n t e n t i o n s are not i d e n t i c a l , but they may be r e l a t e d , and what S c u l l r e j e c t s as questionable i n the p r o f e s s i o n of humane motives may be considered as an expression of a complex c o n s t e l l a t i o n of t h e o r e t i c a l s t r u c t u r e s , s o c i a l a t t i t u d e s and personal b e l i e f s which were themselves the working out of an e p i s t e m o l o g i c a l framework that we need to understand i n order to best i n t e r p r e t nineteenth-century asylum p r a c t i c e s . S c u l l has one t h i n g i n common w i t h the t r a d i t i o n a l h i s t o r i a n s whose work he c r i t i c i z e s . L i k e them, he focuses upon the s p e c i f i c s of the a c t o r s because he wishes to expose t h e i r r h e t o r i c and i n t e n t i o n s . He too i s 8 concerned w i t h the problems of i n t e r p r e t i n g i n d i v i d u a l behaviour and i t s r e l a t i o n to s t a t e d understanding and observed e f f e c t s . A f i n a l important school of h i s t o r i o g r a p h y takes the same c r i t i c a l p o s i t i o n as Foucault and S c u l l but expresses i t s e l f i n an a n a l y s i s t h a t i s fundamentally d i f f e r e n t from that of S c u l l . I t i s indebted to Foucault's more recent work which i s concerned w i t h the d i s t r i b u t i o n of power throughout s o c i a l i n s t i t u t i o n s and which attempts to subordinate the i s s u e of "subjec-1 rv-t i v i t y " . This school i s represented by Roger C a s t e l , i n L'Ordre P s y c h i a t r i q u e , h i s extensive work on French p s y c h i a t r i c h i s t o r y , who empha-s i z e s the c o n s t i t u t i v e elements which both make p o s s i b l e and embody a range of p r a c t i c e s which are the l i m i t s and d e f i n i t i o n of p o s s i b i l i t y f o r the 11 i n d i v i d u a l i n a given h i s t o r i c a l s i t u a t i o n . P a r t i c u l a r behaviours and t h e i r meanings to the i n d i v i d u a l are not p r i v i l e g e d . Instead, he concentrates on the asylum as a meeting-ground f o r s e v e r a l s t r a t e g i e s o f c o n t r o l , espe-c i a l l y those of the b u r e a u c r a t i c a d m i n i s t r a t o r and the "compassion i n the form of pa t e r n a l i s m " of the p h i l a n t h r o p i s t , which, when combined, created an i n s t i t u t i o n that was not medical or t h e r a p e u t i c , but pedagogical i n e f f e c t . He a t t r i b u t e s the l i m i t e d explanatory power of those models of madness embraced by nineteenth-century medical p s y c h o l o g i s t s as n e c e s s a r i l y inade-quate from a s c i e n t i f i c standpoint because the asylum was more u s e f u l as a v e h i c l e f o r the development of e x p e r t i s e i n s o c i a l management. He a t t r i b u t e s the change i n s o c i a l a t t i t u d e s towards i n s a n i t y that i s c h a r a c t e r i s t i c of the eighteenth century to the advent of a bourgeois " c o n t r a c t u a l s o c i e t y " , i n which i n d i v i d u a l s e l f - r e s p o n s i b i l i t y i s r e q u i s i t e and paramount. Madness challenged t h i s c o n t r a c t — t h e mad were dangerous yet i n n o c e n t — a n d so had to be d e a l t w i t h i n a d i f f e r e n t s o c i a l and l e g a l framework, one that 9 encompassed a new " r e l a t i o n de t u t e l l a r i s a t i o n " . In a l i b e r a l s o c i e t y , t h i s meant " t r a n s l a t i n g the p o l i t i c a l d e s i r e to erase remnants of absolutism i n t o 1 2 a t e c h n i c a l problem with moral i m p l i c a t i o n s " . According to C a s t e l , P i n e l ' s great c o n t r i b u t i o n was to provide a s y n t h e s i s of three heterogeneous l i n e s of development: the f i r s t , t h e o r e t i c a l r e c l a s s i f i c a t i o n ; the second, reform of the i n s t i t u t i o n ; and the t h i r d , changes i n treatment. The moral treatment that he u t i l i z e d , when p r a c t i s e d w i t h i n a s p e c i f i c a l l y c l o s e d m i l i e u , was 13 the "paradigm of an a u t h o r i t a r i a n pedagogy". In the end, Peter M i l l e r describes C a s t e l ' s argument i n t h i s way: The formation of the 'synthese a s i l a i r e ' i s , however, not an unique h i s t o r i c a l 'event' and must be l o c a t e d i n s t e a d w i t h i n the formation of the ' s o c i a l ' . . . t h e s i t e at which a number of d i v e r s e s t r a t e g i e s i n t e r s e c t . . . . The formation, t h a t , of a multitude of governable or a d m i n i s t r a t a b l e s i t e s which i s a l s o the formation of the p o p u l a t i o n i t s e l f . C r u c i a l to t h i s process, and indeed a part of i t , i s the c o n s t i t u t i o n and r e c o g n i t i o n of the various a c t i v i t i e s of what C a s t e l terms as ' e x p e r t i s e ' . . . d o c t o r s , p s y c h i a t r i s t s . . . w h o s e e v a l u a t i o n s are founded on a technical,competence which imposes on c e r t a i n 'marginal' groups as a s t a t u s , one which has l e g a l value although i t i s c o n s t i t u t e d through t e c h n i c o - s c i e n t i f i c c r i -t e r i a . ...Such a c t i v i t i e s operate by h i e r a r c h i c a l l y d i s t r i b u t -i n g behaviours according to a norm e s t a b l i s h e d through the operation of v a r i o u s d i s c i p l i n e s . |Zt The ''social'-' i s not, however, co-extensive w i t h an " h i s t o r i a l epoch". I t should, i n s t e a d , be viewed as the i n v e s t i g a t i o n of the mode i n which a number of d i s t i n c t , yet at times overlapping and interdependent processes combine to produce an ensemble  which n e i t h e r exhausts ev e r y t h i n g which occurs w i t h i n i t s  domain nor operates simply as a grouping of contingent  occurrences. ^ Thus C a s t e l would r e s t r i c t the d e f i n i t i o n of the " c o n t r a c t u a l s o c i e t y " to "the i d e n t i f i c a t i o n of the ' j u r i d i c o - a d m i n i s t r a t i v e f i c t i o n ' on which the new 1 tS bourgeois order e s t a b l i s h e d i t s e l f . " I t i s , according to M i l l e r , a 10 n o m i n a l i s t p o s i t i o n , which d e s i r e s only to " l o c a t e the new technologies which f a s h i o n the web of s o c i a l r e l a t i o n s w i t h i n the p r i n c i p l e s of c o n t r a c t u a l 17 exchange." The advantage of C a s t e l ' s approach i s t h a t i t r e q u i r e s a balanced, d e t a i l e d and nuanced d i s c u s s i o n of a m u l t i p l i c i t y of f a c t o r s , and yet, as h i s work on P i n e l r e v e a l s , i t permits a n a l y s i s of an i n d i v i d u a l ' s t h e o r i e s and p r a c t i c e s , and adds depth to the a n a l y s i s by p r o v i d i n g a broad framework i n which the p a r t i c u l a r subject can be s i t u a t e d . At the same time, the meaning of the i n d i v i d u a l ' s a c t i o n s assumes l e s s importance, and i n t e n t i o n s are sub-sumed under a general category of s o c i a l undertakings. Once again, because I consider i t u n l i k e l y that meanings and i n t e n t i o n s are formulated independently of one another, i t may be p o s s i b l e to penetrate the " r h e t o r i c of i n t e n t i o n s " by a n a l y z i n g the f a c t o r s which operate i n an i n d i v i d u a l ' s understanding of h i s behaviour. In order to e f f e c t t h i s , I would embrace Roger Smith's statement that "meanings are not s u b j e c t i v e but 18 e x i s t o b j e c t i v e l y i n p r a c t i c e . " ' Smith takes the " d i s c o u r s e " of the medico-p s y c h o l o g i s t s as h i s c o n t r o l l i n g i n t e r p r e t a t i v e framework, r a t h e r than some-t h i n g as i n c l u s i v e as C a s t e l ' s " s o c i a l " . He i s c a r e f u l i n h i s use of the term: As I use the word, a discourse i s the a b s t r a c t source of f i r s t the language and b e l i e f which c o n s t i t u t e a v e r s i o n of r e a l i t y , and second, the corresponding d i s c i p l i n e s , i n s t i t u t i o n s , and p o l i t i c a l c h o i c e s . There i s a danger of t r e a t i n g the d i s -course i t s e l f as an o b j e c t , which i t i s not: r a t h e r , i t i s a group of r e l a t i o n s between p o s s i b l e objects....The discourse i s t h e r e f o r e the framework w i t h i n which p a r t i c u l a r statements 1.9 or judgements have v a l i d i t y . . . . '• This d e f i n i t i o n would seem to encompass most of the f a c t o r s which need to be considered when attempting to place John Conolly's a c t i v i t i e s i n the 11 development of nineteenth century p s y c h i a t r y . Again, s u b j e c t i v e meanings are i n c l u d e d , but they are not n e c e s s a r i l y p r i v i l e g e d , which, I t h i n k , i s a major weakness i n the approaches of both S c u l l and the t r a d i t i o n a l h i s -t o r i a n s when d i s c u s s i n g Conolly's c o n t r i b u t i o n to the phenomenon of moral management. John Conolly, the E n g l i s h p h y s i c i a n , achieved fame i n the f i r s t h a l f of the nineteenth century as a major spokesman f o r the moral management of the insane. He p u b l i c i z e d i t s t h e o r i e s and p r a c t i c e s from 1830 u n t i l h i s death i n 1866. By t h a t time, the i n s t i t u t i o n s which had been developed under i t s auspices were already r e t r e a t i n g from a f u l l implementation of i t s p r i n c i p l e s . While Conolly was a c t i v e , the B r i t i s h Government e s t a b l i s h e d standards of care f o r the insane that r e q u i r e d medical a t t e n t i o n and i n s t i t u t i o n a l i z a t i o n , government l i c e n s i n g and s u p e r v i s i o n of the f a c i l i t i e s and treatments employed i n the treatment of the insane. In a d d i t i o n , because madness had been conceptualized as disease, p h y s i c i a n s began to e x h i b i t a p r o f e s s i o n a l concern f o r i n s a n i t y that l e d to the establishment of a d i s t i n c t medical s p e c i a l i t y . I t h i n k that a more comprehensive study of moral management should be undertaken, one that attempts to l i n k t h e o r e t i c a l f a c t o r s and a d m i n i s t r a t i v e techniques. I t h i n k that John Conolly's w r i t i n g s are c h a r a c t e r i s t i c of nineteenth-century B r i t i s h p s y c h i a t r y and that h i s ideas about medical agency and mental f u n c t i o n i n g were i n t e g r a l to h i s understanding of asylum p r a c t i c e . Moreover, when the elements of moral management are considered i n r e l a t i o n to the deep-seated conceptual c a t e g o r i e s which I b e l i e v e to con-s t i t u t e the framework of nineteenth-century p s y c h i a t r y , the p i c t u r e of the reformed asylum and i t s physician-managers which emerges has a g r e a t e r coherence. 12 Both the question of John Conolly's r e p u t a t i o n and the question of i n t e r p r e t a t i o n which envelops the study of moral management can be understood best as two r e l a t e d problems i n h i s t o r i o g r a p h y . In order to address these problems, I w i l l begin w i t h a r e c a p i t u l a t i o n of the development of moral management. Next, I w i l l o u t l i n e the p r i n c i p a l f e a t u r e s of the t h e o r i e s of mental disease and treatment which were u t i l i z e d by the asylum d o c t o r s , and I w i l l show that Conolly was c l e a r l y w i t h i n the bounds of contemporary medico-psychological d i s c o u r s e . Then I w i l l d escribe the career and the w r i t i n g s that Conolly produced about moral management. L a s t l y , I w i l l sug-gest a d i f f e r e n t i n t e r p r e t a t i v e s t r a t e g y f o r the understanding of moral management, one which w i l l account f o r both theory and p r a c t i c e , as w e l l as the s o c i a l and i n t e l l e c t u a l i n f l u e n c e s on the asylum reform movement. In approaching these problems, I have i d e n t i f i e d a group of concepts that were employed by doctors i n v o l v e d i n asylum medicine. These can be c a t e g o r i z e d as the schema of st i m u l a t e d motion, p r e d i s p o s i t i o n , and h i e r -archy. These ideas had been developed out a combination of medical, p h i l o -s o p h i c a l and s o c i a l i n f l u e n c e s which were themselves generated i n a s p e c i f i c e p i s t e m o l o g i c a l framework c o n s t i t u t e d around the general p r i n c i p l e o f o r g a n i z a t i o n . The metaphor of o r g a n i z a t i o n was the c o n t r o l l i n g theme from which grew both s o c i e t a l responses and medical t h i n k i n g about i n s a n i t y . These three e s s e n t i a l i d e a s — s t i m u l a t e d motion, p r e d i s p o s i t i o n , and h i e r -a r c h y — p r o v i d e d an explanatory system which gave coherence to the t h e o r i e s of mental f u n c t i o n i n g and behavioural m o t i v a t i o n that were c e n t r a l to the moral managers' understanding of t h e i r e n t e r p r i s e . In a d d i t i o n , they pro-vided a r a t i o n a l e f o r regarding the t h e o r e t i c a l and p r a c t i c a l aspects of asylum medicine as i n t e g r a t e d . This k i n d of conceptual a n a l y s i s helps to 13 e x p l a i n Conolly's adoption of the p r a c t i c e of moral management. No longer can h i s r o l e as advocate be understood as a simple example of careerism. I t i s more f u l l y comprehended as a p r a c t i c a l c o r o l l a r y o f e x i s t i n g p s y c h i -a t r i c theory. In t h i s paper, I intend to g i v e an account of Conolly's work w i t h i n the l i m i t s of the discourse i n which i t had v a l i d i t y . I hope to c o n t r i b u t e to an understanding o f the c o n s t i t u t i o n of the " s o c i a l " i n which the d i s c u r s i v e s t r a t e g i e s of the moral managers had t h e i r place. That understanding can be fu r t h e r e d by c o n s i d e r i n g the metaphor of o r g a n i z a t i o n as a fundamental con-cept w i t h i n the s t r u c t u r e of the " s o c i a l " . The major explanatory systems u t i l z i e d by asylum doctors were informed by t h e i r r e l a t i o n to " o r g a n i z a t i o n " , which i n turn was a sub s t a n t i v e p r i n c i p l e w i t h i n p o l i t i c a l and socio-economic discourses as w e l l . "Organization" served to s i t u a t e the t h e o r i e s and p r a c t i c e s of the moral managers w i t h i n t h e i r e p i s t e m o l o g i c a l boundaries, and to permit the meanings that t h e i r e n t e r p r i s e had f o r them to be l o c a t e d a c c o r d i n g l y . In a n a l y z i n g the elements of moral management w i t h s p e c i a l reference to the e p i s t e m o l o g i c a l c o n f i g u r a t i o n s from which i t was c o n s t i t u t e d , t h i s t h e s i s i s not intended to supplant the " s o c i o l o g i c a l " type o f a n a l y s i s that has enriched our understanding of the asylum reform movement. I w i l l be arguing that an examination of the conceptual foundations of asylum medicine leads to a c l e a r e r p i c t u r e of nineteenth-century B r i t i s h p s y c h i a t r y as i t was understood and p r a c t i c e d by i t s physician-managers. 14 CHAPTER I THE HISTORY OF MORAL MANAGEMENT ...the outside w a l l s of an asylum were regarded w i t h awe; the sh r i e k s i s s u i n g from i t made night hideous; the f r a n t i c c r e -a t u r e s , i n c l o s e d i n t h e i r dens, f u r n i s h e d a p p a l l i n g subjects f o r the a r t i s t or n o v e l i s t ; squalor and d i r t , and famine and f e r o c i t y , were everywhere to be met wi t h . Now, a l l i s changed, or a l l i s changing. Asylums are h o s p i t a l s f o r d i s -ordered minds.... John Conolly The dimu n i t i o n of the use of p h y s i c a l c o e r c i o n a i n the care of the insane, w i t h the concomitant increa s e of a t t e n t i o n to s t r a t e g i e s f o r induc-i n g s e l f - c o n t r o l , and the i n t e r e s t i n methods of a f f e c t i n g the mind so as to r e s t r a i n behaviour, were a l l elements of the range of techniques known as moral management, or moral therapy. The development of t h i s system was i n e x t r i c a b l y l i n k e d w i t h the increase i n the number of asylums i n the e i g h t -eenth century and the extension of medical i n t e r e s t i n t o the area of mental i l l n e s s . The change from a p h y s i c a l l y c o e r c i v e to a morally c o n s t r u c t i v e b a s i s f o r treatment was concurrent w i t h s i m i l a r a l t e r a t i o n s i n the treatment of c r i m i n a l s ; because of t h i s s i m i l a r i t y , changes i n asylum care have been included w i t h i n s t u d i e s of the movement towards and the advocacy o f change i n the management of deviance. From the middle of the eighteenth century, there was a steady increas e i n the c o n s t r u c t i o n of h o s p i t a l s i n B r i t a i n , many of which included f a c i l i -2 t i e s f o r the insane. At the same time, there was an expansion of the 3 system of p r i v a t e asylums and a heightening of concern among the educated 4 e l i t e about the r e g u l a t i o n s that determined entry i n t o these i n s t i t u t i o n s . F urther, throughout the eighteenth century, the fund of l i t e r a t u r e about madness-medical, c u l t u r a l , a d m i n i s t r a t i v e , l e g i s l a t i v e , and s c i e n t i f i c — 15 was s t e a d i l y e n l a r g i n g . The i l l n e s s of George I I I a l s o s t i m u l a t e d i n t e r e s t i n the treatment of i n s a n i t y . By the 1780's, one or two asylum managers were beginning to speak about the e f f i c a c y of treatment through "moral" methods as an adjunct to p h y s i c a l means.' There was a growing b e l i e f i n the c u r a b i l i t y of mental disease which corresponded with the s h i f t to " p s y c h o l o g i c a l " methods of treatment. The idea of cure was i n d i c a t i v e of a r e d e f i n i t i o n of the nature of madness that embraced both l a y and medical c o n s t i t u e n c i e s . The e a r l i e r view of the luna-t i c as "other", as l e s s than human, because of h i s l a c k of reason, was i n o p p o s i t i o n to the s t i l l p revalent concept of the mind as the l o c a t i o n of the s o u l . Reason was e s s e n t i a l to the s o u l , and the s o u l could not be diseased because i t was beyond the reach of c o r r u p t i o n . I f the c o n d i t i o n of the l u n a t i c was absolute, then i t was i r r e v o c a b l e , i m p l y i n g corresponding l o s s 7 of s o u l , a view that could not be t o l e r a t e d t h e o l o g i c a l l y or morally. Hence, a view of the mind and b r a i n as a s e p a r a t e — w i t h the b r a i n a p o s s i b l e source of diseased mental f u n c t i o n i n g — w a s p r e f e r a b l e . ' This view permitted madness to be defined i n organic terms, (and hence, made i t t r e a t a b l e ) w i t h -out d i s c a r d i n g mental f a c t o r s , which could L'be a i teroc by outside i n f l u e n c e s and thus cured. For moral managers, i t was e s s e n t i a l that the u n d e r l y i n g causes of madness be p h y s i o l o g i c a l ; otherwise medical treatment could not be a p p l i e d ; at the same time, the t h e r a p e u t i c e f f i c a c y of t h e i r management pre-cepts had to be incorporated i n t o medical d i s c o u r s e . Moral management f i r s t began to a t t r a c t p u b l i c a t t e n t i o n i n the 1790's. Prompted by s e v e r a l s e n s a t i o n a l i n v e s t i g a t i o n s i n t o the c o n d i t i o n s i n p r i v a t e asylums, there was an e x p l o s i o n of p u b l i c concern about the t r e a t -ment of l u n a t i c s . This encouraged e a r l y nineteenth-century E n g l i s h doctors 16 i n t e r e s t e d i n asylum care to develop t h e r a p e u t i c r a t i o n a l e s that would per-mit them to employ the techniques of moral treatment while r e t a i n i n g t h e i r s e l f - c o n c e i v e d i d e n t i t y as s c i e n t i f i c men committed to a " s c i e n t i f i c " enter-p r i s e , the study of medicine. By the time John Conolly became a c t i v e i n the movement, moral methods were being advocated by doctors who could c l a i m a s p e c i a l e x p e r t i s e i n the treatment of l u n a t i c s . By 1845, Parliament decreed that p h y s i c i a n s must be i n charge of the treatment of a l l l u n a t i c s r e q u i r i n g confinement ( i n e f f e c t , t h i s i n c luded a l l the insane s i n c e the n e c e s s i t y f o r confinement was an axiom of moral management), and that these p h y s i c i a n s employ moral methods, as w e l l as pharmacologic and other s u i t a b l e forms of g "medical" or " p h y s i c a l " therapy. The b a s i c elements of moral management as i t was p r a c t i s e d i n the l a t e eighteenth century began with the l i m i t e d use of mechanical r e s t r a i n t s and an emphasis upon order and t r a n q u i l l i t y t hat was founded upon the expecta-t i o n of nonviolent behaviour among asylum attendants. E q u a l l y important was the c u l t i v a t i o n of a "domestic" atmosphere, with a t t e n t i o n to clean and well-maintained accommodation, c l o t h i n g , and food, the p r o v i s i o n of employ-ment of occupation, and some forms of entertainment. Two assumptions deter-mined a l l contact w i t h the mentally i l l : the f i r s t , t hat the insane were unfortunate v i c t i m s of a disease, and second, that the goal of care was to i n c u l c a t e i n the p a t i e n t a c a p a c i t y f o r s e l f - c o n t r o l . The watchwords of treatment were kindness and gentleness because such forbearance set an example of s e l f - r e s t r a i n t f o r the insane. P h y s i c a l means of r e s t r a i n t were discouraged because they a c t i v e l y undermined the m o t i v a t i o n f o r the l u n a t i c ' s a c q u i s i t i o n of the c a p a c i t y f o r s e l f - c o n t r o l . Several other techniques were intended to approach the madman through h i s mental f u n c t i o n s . These included 17 t h r e a t s of p h y s i c a l r e s t r a i n t to induce f e a r , o s t e n t a t i o u s d i s p l a y s of dominating character by phys i c i a n s to create awe, and the use of p u n i t i v e p h y s i c a l t h e r a p i e s , such as r o t a t i n g c h a i r s , to ensure compliance. The two men whose work i s most c l o s e l y a s s o c i a t e d with the e a r l y period of moral management are P h i l l i p e P i n e l i n France and W i l l i a m Tuke i n England. Both entered the f i e l d of asylum management i n 1792 with a new approach to treatment, one that was i n l i n e w i t h some of the change of the previous f i f t e e n years, and yet, s u f f i c i e n t l y unorthodox so as to create much controversy. Because P i n e l was a p h y s i c i a n , h i s reforming e f f o r t s are u s u a l l y considered to have been a response to perceived medical problems. Tuke, a Quaker layman, i s seen as having constructed a new s t y l e o f adminis-t r a t i o n as a challenge to the p h y s i c a l l y p u n i t i v e methods employed i n other i n s t i t u t i o n s . A myth developed around P i n e l ' s management of the B i c e t r e , a P a r i s i a n h o s p i t a l f o r the insane, to which he was appointed i n the e a r l y years of the Republic. He i s supposed to have become so d i s t u r b e d by the ravings of a f u r i o u s maniac that he ordered the ward attendants to remove the man's Q chains, whereupon the l u n a t i c became q u i t e composed. A c t u a l l y , a form of moral treatment had already been introduced by the l a y managers of some French asylums, and P i n e l decided to employ s i m i l a r methods when h i s p o s i t i o n was e s t a b l i s h e d . From h i s observations, P i n e l drew the c o n c l u s i o n t h a t too much p h y s i c a l r e s t r a i n t exacerbated the f e r o c i t y of maniacal behaviour. He argued that v i o l e n t treatment of the insane was i n d i c a t i v e of an inadequate understanding of the nature of mental i l l n e s s and i t s prognosis. The o l d b e l i e f that i n s a n i t y was caused by a l e s i o n of the b r a i n had l e d to the no t i o n t h a t i n s a n i t y was i n c u r a b l e , and hence that t h e r a p e u t i c measures were 18 u s e l e s s . On the b a s i s of observation and experiment, P i n e l reported that a s u b s t a n t i a l improvement i n the behaviour of maniacal p a t i e n t s might occur when they were t r e a t e d more k i n d l y and w i t h only moderate p h y s i c a l c o e r c i o n . He reasoned, as had John F e r r i a r , an E n g l i s h p h y s i c i a n , that by making the l u n a t i c p a r t i a l l y r e s p o n s i b l e f o r h i s behaviour, he might be induced to con-10 t r o l i t b e t t e r . Thus the use of punishment schemes and appeals to f e e l i n g s of shame of fe a r as techniques f o r p a t i e n t management were j u s t i f i e d . P i n e l claimed that h i s methods were more p h i l o s o p h i c a l s i n c e they i n v o l v e d not only an appeal to the mind of the p a t i e n t , but were a l s o grounded i n a common-sense empiricism t h a t permitted the p h y s i c i a n to d i s -card elements of o l d e r programs f o r treatment as having no a p p r e c i a b l e e f f e c t s . He was s k e p t i c a l of the e f f i c a c y of many of the standard medical remedies, and advocated an increased r e l i a n c e on aspects of regimen, such as d i e t and a c t i v i t y . He a l s o b e l i e v e d that the t r u l y s c i e n t i f i c treatment of i n s a n i t y , which was h i s g o a l , could be achieved only w i t h an a t t e n t i o n to proper n o s o l o g i c a l p r i n c i p l e s , since c o r r e c t c l a s s i f i c a t i o n was a p r e r e q u i -s i t e f o r appopriate treatment. A l l of these ideas were discussed i n h i s Traite^medico-philosophique d ' a l i e n a t i o n mental of 1803 ( t r a n s l a t e d in', 1806 by Donald Davies under the t i t l e , A T r e a t i s e on: I n s a n i t y ) . ^'^  By t h i s time, there was a r i s i n g t i d e of enthusiasm i n England f o r the approach to t r e a t -ment that P i n e l c a l l e d "moral", thus, h i s work was r e c e i v e d w i t h great i n t e r e s t and soon was used to b o l s t e r the movement f o r asylum reform. The groundwork f o r t h i s encouraging E n g l i s h response to P i n e l had been l a i d by W i l l i a m Tuke, who had e s t a b l i s h e d an a l t e r n a t e asylum, c a l l e d the Retreat, i n the c i t y of York i n 1792. His i n t e n t i o n to t r e a t Quaker lu n a -t i c s under new p r i n c i p l e s was a r e a c t i o n to the unexplained death of a Friend 19 placed i n the York asylum by- her f a m i l y who were then denied access to her. When she d i e d , an i n q u i r y found considerable abuse o f p a t i e n t s . Tuke 12 decided that d i f f e r e n t methods of treatment could, and should, be pursued. Tuke's Retreat was arranged upon a domestic plan i n which the p a t i e n t s , attendants, and p h y s i c i a n s were to regard themselves as a f a m i l y . Only mi l d forms of p h y s i c a l r e s t r a i n t were to be employed, and the general tone of the establishment, i n keeping w i t h Quaker precepts, was to be k i n d l y , g e n t l e and f i r m , w i t h much emphasis on personal r e s p o n s i b i l i t y f o r behaviour. The p a t i e n t s were to be regarded as wayward c h i l d r e n who would respond to pleasant treatment mixed w i t h a wholesome fear of r i d i c u l e or punishment. In t h i s s e t t i n g , i t was found that the inmates were n o t i c e a b l y l e s s v i o l e n t and unmanageable. Care was l a r g e l y i n the hands of non-medical personnel, the superintendency having passed from Tuke to a p h y s i c i a n who, despi t e h i s p r o f e s s i o n a l background, was content to r e l i n q u i s h most of the recommended medical t h e r a p i e s since Tuke was s u s p i c i o u s of the aggressive p h y s i c a l t r e a t -ments c h a r a c t e r i s t i c of the per i o d . The Retreat was v i s i t e d by s e v e r a l p h y s i c i a n s who were eager to pub-13 l i c i z e i t s e f f o r t s , but i t s g r e a t e s t impact came a f t e r the 1813 p u b l i c a t i o n of the D e s c r i p t i o n of the Retreat, w r i t t e n by Samuel Tuke, William's grand-14 son. As described i n Tuke's book, the procedures at the Retreat contrasted v i v i d l y w i t h the p r a c t i c e s at Bethlehem H o s p i t a l which were then being s c r u t i n i z e d by the Parliamentary i n q u i r y of 1815, where W i l l i a m Tuke was 15 c a l l e d as a witness. Although some members of the medical p r o f e s s i o n were s u s p i c i o u s and r e s e n t f u l , an i n f l u e n t i a l segment of the l a y e l i t e , w i t h a number of reform-minded doctors, set about p o p u l a r i z i n g the philosophy o f moral management with i t s c o n c e n t r a t i o n on l i m i t e d r e s t r a i n t and k i n d l y 20 treatment. Along w i t h t h i s went a commitment to the idea of the asylum as a c u r a t i v e agent, and, thanks to medical l o b b y i n g , to the p h y s i c i a n as the c e n t r a l f i g u r e i n the p r o v i s i o n of and medical treatment w i t h i n and without 1 fy the i n s t i t u t i o n . P u b l i c concern about the care o f the insane can be traced through developments i n two r e l a t e d areas. F i r s t , the asylum system was expanded and reformed. Second, l e g i s l a t i o n was enacted e s t a b l i s h i n g standards of care, admission and c e r t i f i c a t i o n , and p u b l i c r e s p o n s i b i l i t y f o r the p r o v i s i o n of i n s t i t u t i o n s . Both of these movements can be s a i d to have peaked i n the year 1845 when Parliament made the c o n s t r u c t i o n of p u b l i c asylums, t h e i r main-tenance and i n s p e c t i o n i n a l l counties,compulsory. G u i d e l i n e s f o r proper 17 management were set out i n the Act. Throughout the eighteenth century, there had i n f a c t been a c o n t i n u a l increase i n the establishment of p r i v a t e asylums f o r the insane, p a r a l l e l e d by the growth of s u b s c r i p t i o n h o s p i t a l s , s e v e r a l of which were soon to designate c e r t a i n areas f o r l u n a t i c care. In 1714, a Vagrancy Act i n s t r u c t e d l o c a l magistrates to see that dangerous madmen were cared f o r , and t h i s was expanded i n a 1744 Vagrancy Act to s p e c i f y the need f o r t h e r a p e u t i c a t t e n -18 t i o n . Most l a y concern was focused on the c e r t i f i c a t i o n i s s u e , however. Thus, the l e g i s l a t i o n of 1744 e s t a b l i s h e d the need f o r a doctor and two magistrates to order confinement, and a l s o regulated the l i c e n s i n g of p r i v a t e 19 houses and made i n t e r n a l i n s p e c t i o n compulsory. This growing i n t e r e s t i n the treatment o f lunacy was r e f l e c t e d i n the 20' burgeoning of medical l i t e r a t u r e on the su b j e c t . T h i s , i n t u r n , c o n t r i - u buted to the increased awareness of reform-minded i n d i v i d u a l s such as Lord Ashley, l a t e r the 7th E a r l of Shaftesbury. By the f i r s t decade of the 21 nineteenth century, t h e i r r e c e p t i v i t y to i n n o v a t i o n was profound, as demon-s t r a t e d by the p u b l i c i t y generated by Parliament's i n v e s t i g a t i o n i n t o Bethlehem H o s p i t a l i n 1815. The Parliamentary Commission showed i t s e l f 2(1 sympathetic to the p r i n c i p l e s of moral management. Attempts were then made to e s t a b l i s h p u b l i c asylums f o r pauper l u n a t i c s . In the 1828 Act, concerned 22 wit h i n s p e c t i o n and c e r t i f i c a t i o n , there was a l s o a recommendation t h a t county asylums be constructed. However, the energy of the reformers was s t i l l d i r e c t e d l a r g e l y towards r e g u l a t i n g p r a c t i c e s i n p r i v a t e asylums, s i n c e most l u n a t i c s , whatever t h e i r f i n a n c i a l c a p a b i l i t i e s , were confined i n such p l a c e s . By 1838, the i n f l u e n t i a l p h y s i c i a n , George Mann Burrows, was moved to i n c l u d e a d i s c u s s i o n of methods of moral management i n h i s lengthy work, 23 the Commentaries upon I n s a n i t y . . . However, moral management seems to have been a l l things to a l l men at t h i s time. I t could be defined simply as non-24 p u n i t i v e treatment, ' or as the complete absence of p h y s i c a l r e s t r a i n t which 25 Robert Gardiner H i l l would do i n 1836 at the L i n c o l n Asylum. I t i s d i f f i c u l t to e s t a b l i s h how much the standards of care had a c t u a l l y changed by 1830. Nineteenth-century h i s t o r i a n s of p s y c h i a t r y such as Daniel Hack Tuke declared t h a t i n p u b l i c asylums and h o s p i t a l s , and i n a few good p r i v a t e ones, moral therapy along the l i n e s of the Retreat was being prac-t i s e d , but that the m a j o r i t y of the p r i v a t e houses remained sunk i n degrada-26 t i o n . I t i s more l i k e l y t h a t , while d e t a i l s of regimen had probably improved i n most i n s t i t u t i o n s , and excessive use of p h y s i c a l r e s t r a i n t had l a r g e l y disappeared, the i d y l l i c domestic atmosphere of the Retreat was r a r e indeed, e s p e c i a l l y i n p u b l i c i n s t i t u t i o n s . 22 Besides the requirements of l e s s r e s t r a i n t , b e t t e r food, and cleaner accommodation, the only other f a c e t of moral management to meet w i t h evident enthusiasm i n p u b l i c asylums was the i n t r o d u c t i o n of p r o f i t a b l e employment. The idea of the s e l f - s u s t a i n i n g asylum was very popular, because by the mid-1820 's i t was becoming apparent that the number of people declared insane was i n c r e a s i n g , and because most treatment was o b l i g a t o r y f o r the pauper insane. Since the costs of care were to be supported by a system of assessments, there was considerable i n t e r e s t i n a r e d u c t i o n of expenses to make the asylums more s e l f - s u p p o r t i n g . Class d i v i s i o n s i n treatment had long e x i s t e d , of course, but the medi-^ c a i l i t e r a t u r e on the nature of mental i l l n e s s , as w e l l as the p r e f e r r e d treatment, tended to emphasize u n i f o r m i t y . Thus, a l l insane, r e g a r d l e s s of a b i l i t y to pay, r e q u r i e d confinement and treatment according to the new enlightened p r i n c i p l e s of the moral managers, who were convinced that occupa-t i o n had a d i s t i n c t i v e l y c u r a t i v e e f f e c t . The w e a l t h i e r insane "occupied'!'' themselves at r i d i n g or walking or needlework, while the poor laboured i n the gardens, ki t c h e n s and l a u n d r i e s . The need f o r the e r e c t i o n of p u b l i c asylums was i n t e n s i f y i n g , e s p e c i a l l y a f t e r the new Poor Law of 1834, but so were e f f o r t s to reduce the f i n a n c i a l burden of i n s t i t u t i o n a l i z a t i o n . By 1835, a number of observers had r e d e f i n e d the philosophy of moral management i n response to the new d o c t r i n e of n o n - r e s t r a i n t . This was deemed the l o g i c a l extension of the p r i n c i p l e s of moral therapy by i t s two 28 p r i n c i p a l advocates, Robert Gardiner H i l l and John Conolly. N o n - r e s t r a i n t r e q u i r e d the a b o l i t i o n of a l l forms of p h y s i c a l c o e r c i o n i n the asylum. When some r e s t r i c t i o n of behaviour was necessary, a s e c l u s i o n room was u t i l i z e d . H i l l f i r s t began to reduce the amount of r e s t r a i n t at L i n c o l n 23 Asylum i n 1836, and the success of h i s venture was p u b l i c i z e d i n a l e c t u r e 29 he gave to the Mechanics' I n s t i t u t e i n 1838, which was l a t e r published. The reform-minded press a l s o complied i n p u b l i c i z i n g the regime at L i n c o l n , Mr. Sergeant Adams being e s p e c i a l l y h e l p f u l , as he was l a t e r to be to Conolly. Conolly v i s i t e d L i n c o l n i n 1838, and when he took over Hanwell on 30 June 1, 1939, he immediately put H i l l ' s system i n t o p r a c t i c e . As i t s advocates c o n s i s t e n t l y r e i t e r a t e d , the n o n - r e s t r a i n t system could only be e s t a b l i s h e d i n asylums where a l l the other p r i n c i p l e s of moral manage-ment were i n place. I t was e s s e n t i a l that the i n s t i t u t i o n be b u i l t along t h e r a p e u t i c a l l y - d e s i g n e d s p e c i f i c a t i o n s ; that i t be w e l l s t a f f e d w i t h ade-quately paid and p r o p e r l y t r a i n e d attendants who were c a r e f u l l y s e l e c t e d f o r t h e i r i m p e r t u r b a b i l i t y and moral s t r e n g t h ; that the p a t i e n t s be w e l l fed and c l o t h e d , and occupied, both u s e f u l l y and e n t e r t a i n i n g l y , i n congenial pur-s u i t s ; and that a l l aspects of asylum management be under the c o n t r o l of a p h y s i c i a n f a m i l i a r w i t h the l a t e s t and most pro g r e s s i v e ideas and p r a c t i c e s i n medical psychology. Above a l l , , the commitment to non-coercive management had to be absolute. I t was t h i s l a s t requirement that met w i t h the g r e a t e s t amount; of d i s -31 agreement i n England and abroad. While the B r i t i s h and c o n t i n e n t a l doctors were w i l l i n g to give t h e i r consent to the i d e a l of t o t a l n o n - r e s t r a i n t , they were not prepared to r e l i n q u i s h t h e i r need f o r g e n t l e p h y s i c a l c o e r c i o n , to be used only when e n t i r e l y unavoidable. American p h y s i c i a n s were more v o c i -ferous i n t h e i r o p p o s i t i o n : not only d i d they c l a i m that t o t a l n o n - r e s t r a i n t was i m p r a c t i c a b l e (a frequent c r i t i c i s m of t h e i r B r i t i s h counterparts as w e l l ) , i t was a l s o non-therapeutic.. R e s t r a i n t s helped cure i n some cases, and, besides, s e c l u s i o n or s o l i t a r y confinement, as they named i t , was f a r 24 more damaging. They argued that i t was b e t t e r to be confined i n t o a r e s t r a i n -i n g c h a i r or t i e d i n a s t r a i t waistcoat i n the company of one's f e l l o w s than to be locked i n an empty room by onese l f f o r an indeterminate time. The proponents of n o n - r e s t r a i n t argued that p h y s i c a l c o e r c i o n demoralized p a t i e n t s and attendants a l i k e , that i t decreased the need f o r s e l f - c o n t r o l i n both p a r t i e s , and that i t increased the l e v e l of f r u s t r a t i o n i n the p a t i e n t to the point that i t would worsen h i s c o n d i t i o n . They defended the use of s e c l u s i o n rooms by denying that the p r a c t i c e had any r e a l i d e n t i t y w i t h the pr i s o n ' s s o l i t a r y confinement: s e c l u s i o n was f o r short periods only, i t was monitored 32 by s t a f f and was to be explained to the p a t i e n t as non-punitive i n i n t e n t . The debate about n o n - r e s t r a i n t found i t s way r a p i d l y i n t o the p u b l i c realm, and p a r t i c u l a r l y i n t o the Parliamentary Commissions. The Report of the Commissioners of 1847 expressed approval of moral treatment as a therapy 33 i n consonance with medical treatment and a l s o endorsed n o n - r e s t r a i n t . Although the Commissioners refused to make i t compulsory, they d i d l a y down c a r e f u l r e g u l a t i o n s to ensure proper r e p o r t i n g of a l l i n c i d e n t s r e q u i r i n g r e s t r a i n t . The argument about t o t a l n o n - r e s t r a i n t d i d not end at t h i s p o i n t , however. I t was to continue w e l l i n t o the 1860's, w i t h Conolly f i g h t i n g what seems to have been a rearguard a c t i o n against the reappearance of p h y s i c a l l y c o e r c i v e devices i n the asylum w i t h a s e r i e s of a r t i c l e s i n the Medical 34 Times and Gazette of 1862. By t h i s time, most other commentators had 35 adopted a modified n o n - r e s t r a i n t posture. I r o n i c a l l y , the Act of 1845, which made o b l i g a t o r y the c o n s t r u c t i o n and maintenance of p u b l i c l u n a t i c asylums at the county's expense, d e a l t the death blow to the n o n - r e s t r a i n t i d e a l . Asylum governors were a c u t e l y con-scious of the cost of keeping l u n a t i c s . Nineteenth-century reformers 25 complained c o n s t a n t l y t h a t , although they accepted the n o t i o n of the c u r a t i v e asylum, i n p r a c t i c e the governors had a tendency to handle i t s expenditures astthcough i t were simply a c u s t o d i a l device. Most asylum boards simply refused to h i r e the number of s t a f f that the moral managers had declared were necessary to prevent recourse to r e s t r a i n t and lapses i n hy g i e n i c s t a n -dards. As the population of the newly b u i l t i n s t i t u t i o n s continued to climb throughout the mid-century, the boards of governors made i n c r e a s i n g l y u t i l i -t a r i a n a d d i t i o n s onto e x i s t i n g f a c i l i t i e s and l a t e r even l o b b i e d f o r a two-t i e r e d system of acute and chronic i n s t i t u t i o n s i n order to accommodate the 37 l a r g e r p r o p o r t i o n of the mentally i l l who were i d e n t i f i e d as i n c u r a b l e . Since moral management was intended as much to reduce the i n a c t i v i t y of the attendants as to counteract t h e i r b r u t a l i t y , the i n c r e a s i n g l y c u s t o d i a l q u a l i t i e s of the p u b l i c asylums were d i r e c t l y a n t i t h e t i c a l to moral therapy, as the n o n - r e s t r a i n t promoters recognized. Passive attendants used r e s t r a i n t s to maintain order, and a c t i v i t y was almost impossible i n a s e t t i n g i n f e c t e d by i n c u r a b i l i t y . The uneconomic demands of n o n - r e s t r a i n t made i t i n c r e a s -i n g l y i m p r a c t i c a l , and i t s s t r i d e n t moralism seemed somehow l e s s s u i t a b l e i n an age which regarded i t s e l f as having advanced s o c i a l l y and s c i e n t i f i c a l l y s i n c e the e a r l y days of asylum mismanagement. 38 "The chimera of the c u r a t i v e asylum" was exposed i n the second h a l f of the nineteenth century, and the l a c k of strong s c i e n t i f i c i n f o r m a t i o n about e i t h e r the nature of madness or the e f f i c a c y of treatment continued to be a major stumbling block to i n t r a : - p r o f e s s i o n a l advance, as w e l l as to improved p a t i e n t care. However, t h i s d i d not a d v e r s e l y a f f e c t the medical-psycholo-g i s t s ' claims to e x p e r t i s e i n the f i e l d . The second part of the century saw an increased a t t e n t i o n to preventative measures i n the form o f the mental 26 hygiene movement. This movement developed out of the r e c o g n i t i o n o f low c u r a b i l i t y and from adherence to two c a r d i n a l b e l i e f s of nineteenth-century p s y c h i a t r y : the f i r s t , that i n s a n i t y was e s s e n t i a l l y a p h y s i c a l d i s o r d e r though i t was o f t e n the r e s u l t of immorality; and the second, that i t was i n h e r i t a b l e and t h a t , indeed, a p h y s i c a l p r e d i s p o s i t i o n or tendency towards degeneracy must be present f o r the disease to manifest i t s e l f . " At the same time, the asylums grew l a r g e r and more crowded, and t h e i r f u n c t i o n became i n c r e a s i n g l y c u s t o d i a l . As the p o s s i b i l i t y of cure i n the asylum became l e s s l i k e l y , the emphasis i n medical psychology s h i f t e d from a concern w i t h the treatment of mental disease t o a preoccupation w i t h the prevention of i n s a n i t y . 27-CHAPTER I I DISEASES OF THE MIND AND STRATEGIES FOR CURE: THE STATE OF THE QUESTION, 1770-1860 We do not comprehend the nature of the movements or a c t i o n s on which mental m a n i f e s t a t i o n s depend;...but we know the phe-nomena which r e s u l t from these movements...and can p l a i n l y d i s c e r n that they are wrought through the agency of c o r p o r e a l organs. ^ John Conolly Richard Hunter and Ida MacAlpine had a tendency to regard l a t e e i g h t -eenth-century and e a r l y nineteenth-century s p e c u l a t i o n s about the mind and mental i l l n e s s as a sourcebook f o r twentieth-century p s y c h i a t r i c b e l i e f s and 2 p r a c t i c e s . S c u l l challenges them w i t h the theory t h a t V i c t o r i a n b e l i e f s about moral management were developed i n order to j u s t i f y a set of i n s t i t u -t i o n a l p r a c t i c e s f o r c o n t r o l l i n g mad behaviour t h a t were already i n place. This tends to d i m i n i s h i n t e r e s t i n the content of the t h e o r i e s themselves, i n s o f a r as they seem an ideology r a t h e r than a set of d e f i n i t i o n s , a super-s t r u c t u r e of b e l i e f s which d i s g u i s e the techniques of management which are the r e a l subject of d i s c u s s i o n . Recently, s e v e r a l other h i s t o r i a n s — m o s t notably Roger Smith and Michael C l a r k — h a v e examined aspects of nineteenth-century medico-psychological t h i n k i n g w i t h i n the framework of contemporary medicine and s o c i a l b e l i e f s . In t h i s chapter, I s h a l l attempt to give an overview of the major f a c e t s of the "body of knowledge" that informed the p r a c t i c e s of the asylum doctors. I w i l l use a developmental scheme that w i l l r e l a t e v a r i o u s aspects of the conceptual s t r u c t u r e s to one of the deep-seated i n t e l l e c t u a l c o n f l i c t s i n which the moral managers found themselves. I w i l l concentrate on the w r i t i n g s of s e v e r a l p h y s i c i a n s whose work was considered by most nineteenth-century asylum doctors to have been of e s p e c i a l i n t e r e s t and of p a r t i c u l a r i n f l u e n c e i n the f i e l d of medical psychology. 28 I The t h e o r e t i c a l underpinnings of moral management can be s t u d i e d under three headings. The f i r s t deals w i t h the supposed operations of the mind and t h e i r r e l a t i o n to the body. The second i s concerned w i t h the d e f i n i t i o n and causes of i n s a n i t y . The t h i r d purports to e s t a b l i s h proper modes of t r e a t -ment. The roots of moral management t h e o r i e s s t r e t c h back i n t o the e a r l y eighteenth century, but probably the most comprehensive e a r l y d i s c u s s i o n of the s t r u c t u r e of the mind and the causes and treatment of madness could be found i n the work of W i l l i a m C u l l e n , who taught chemistry, medicine, and the p r a c t i c e of physic at Edinburgh U n i v e r s i t y between 1775 and h i s death i n 1790. His works, F i r s t L i nes on the P r a c t i c e of Physic (1784) and Nosology (1772) were two of the p r i n c i p a l medical t e x t s to which many B r i t i s h and French p h y s i c i a n s of the l a t e eighteenth century and e a r l y nineteenth century 5 r e f e r r e d . His summary of the r e l a t i o n between the mind and body set out the boundaries of the problem f o r the next hundred years. In C u l l e n ' s view, man possessed an immaterial t h i n k i n g substance, or mind, c o n s t a n t l y present and connected w i t h the m a t e r i a l and c o r p o r e a l part o f him, and p a r t i c u l a r l y w i t h the nervous system; thus, motions e x c i t e d i n i t gave r i s e to thought, and thought, however occasioned, l e d to new motions i n the nervous system. This much could be a s c e r t a i n e d to observation and experience, although the process by which i t operated was unknown. C u l l e n concluded that thought must be caused by an immaterial s u b s t a n c e — t h e a u t h o r i t y f o r t h i s b e l i e f being the w r i t i n g s o f " d i v i n e s and metaphysicians". While some philosophers had adopted explanations that were mechanistic and m a t e r i a l i s t i c , p h y s i c i a n s chose to remain orthodox and admit the s o u l . An e a r l i e r a u t h o r i t y f o r t h i s d e c i s i o n was Robert Whytt, who had demonstrated the n e c e s s i t y of the soul as a s e n t i e n t p r i n c i p l e , necessary to motion, but 29 not r a t i o n a l . The mutual i n f l u e n c e of the s o u l and body must take place by p h y s i c a l n e c e s s i t y , but "there i s nothing a r b i t r a r y i n the power of the 1 s o u l . The interdependence of body and mind or s o u l was described again i n C u l l e n ' s treatment of the f u n c t i o n s of the b r a i n . The b r a i n was the seat of the s o u l , the organ of v o l i t i o n and sensation. The soul acted by means of the b r a i n , but the body could be independent, governed by mechanical a c t i o n s of the nervous system. These a c t i o n s of the b r a i n could be e x c i t e d by such i n f l u e n c e s as the w i l l , the passions and emotions, and a p p e t i t e s or d e s i r e s , as w e l l as the impulse to procure g r a t i f i c a t i o n or avoid p a i n : i n other words, by s e n s a t i o n . The v i t a l a c t i o n of the b r a i n was dependent upon a c e r t a i n f o r c e i n the flow of blood to that organ, which i n f l u e n c e d the l e v e l of the nervous f l u i d — t h a t power by which the nerves were e x e r c i s e d — s o that the nervous power could be e i t h e r " e x c i t e d " as i n mania, or i n a s t a t e of 7 c o l l a p s e as i n coma. In t u r n , the operations of the i n t e l l e c t — j u d g e m e n t , v o l i t i o n , memory, att e n t i o n — d e p e n d e d upon the motions of the b r a i n , although such motions had never been seen or l o c a t e d i n the b r a i n . Those motions occurred because of the movements of a f l u i d which was a substance i n the b r a i n and nerves. I t t r a v e l l e d around the nervous system from the s e n t i e n t e x t r e m i t i e s to the b r a i n causing s e n s a t i o n . When added to v o l i t i o n , i t caused motion to be t r a n s m i t t e d from the b r a i n to the muscles. The proper e x e r c i s e of these i n t e l l e c t u a l f u n c t i o n s was dependent upon the excitement of the b r a i n being complete and equal i n every p a r t . Mental disturbance was occasioned by an 8 i n e q u a l i t y of that excitement. 30 Thus, the b a s i c elements of the mind-body r e l a t i o n were e s t a b l i s h e d : an immaterial t h i n k i n g substance connected by some unknown process t o the c o r p o r e a l b r a i n , which d i r e c t e d a l l p h y s i c a l motions and i n which a l l i n t e l -l e c t u a l a c t i v i t y had a corresponding p h y s i o l o g i c a l m a n i f e s t a t i o n . The operations of the mind were given a separate, semi-organic s t a t u s , and the whole apparatus—mind, b r a i n , body and thought—was mediated by the move-ments of a f l u i d . The importance of a continuum between mental events and p h y s i c a l conse-quences was r e i t e r a t e d by George Mann Burrows, whose Commentaries Upon the Causes, Forms, Symptoms, and Treatment, Moral and Medical of I n s a n i t y (1828) Q was the f i r s t comprehensive textbook of i n s a n i t y . Burrow's object seems to have been to i n c o r p o r a t e i n t o medical d i s c o u r s e , i n i t s e n t i r e t y , the d e f i n i -t i o n and treatment of lunacy, w i t h i t s u n d e r l y i n g unresolved problem of the mind-body r e l a t i o n . Burrows proclaimed emphatically that experience con-firmed "that the operations of the mind are wonderfully i n f l u e n c e d by our 10 c o r p o r e a l movements,...and that the i n f l u e n c e i s r e c i p r o c a l . " He continued w i t h a concise d e s c r i p t i o n of the connection between the immaterial mind and p h y s i o l o g i c a l processes. Every impression on the sensorium through the e x t e r n a l senses, and every passion i n e x c e s s v i c e s , a l s o , which occasion changes i n the p h y s i c a l c o n s t i t u t i o n , . . . a l l impressions t h a t a f f e c t the f e e l i n g s are conveyed to the sensorium, and operate according to the degree of c o n s t i t u t i o n a l s u s c e p t i b i l i t y , and the nature and f o r c e of the impression, and r e - a c t s on the b r a i n and nervous system. Hence, there are two impressions: the one p r i m i t i v e , a f f e c t i n g the sensorium; the other, con-s e c u t i v e , but simultaneously a f f e c t i n g the heart. Thus the nervous and v a s c u l a r systems are both i m p l i c a t e d . " ^ Impressions, which were ideas formed from se n s a t i o n s , and passions, were mediated i n a location.knownas the sensorium, which t r a n s f e r r e d t h e i r e f f e c t s to the b r a i n and nervous system and thus to the r e s t of the body. 31 I t was not s u f f i c i e n t , Burrows argued, to attempt to deal w i t h the mad by a t t e n d i n g e x c l u s i v e l y to mental symptoms, because the mental and p h y s i c a l 12' were interdependent.„ Even James Cowles P r i c h a r d , who attempted to speak only of mental processes, used a language of p h y s i c a l a c t i o n and p h y s i c a l disease t h a t undermined h i s i n i t i a l purpose. Author of an important reference book, 13 A T r e a t i s e on I n s a n i t y (1835), ..Prichard was p r i m a r i l y concerned w i t h the r e l a t i o n s between va r i o u s mental a t t r i b u t e s i n the production of madness. He u t i l i z e d the i n t e r m i n g l e d languages of p h y s i c a l i l l n e s s and mental d i s o r d e r . . . . i t i s easy to conceive t h a t when any morbid change has ensued i n the connecting f a c u l t y , by which the i d e a s , i f we may so speak, cohere, when they become d i s j o i n e d and i n c o -herent, no longer f o l l o w each other i n t h e i r n a t u r a l order of suggestion, the mind lo s e s the power of reasoning through the shattered c o n d i t i o n of i t s instruments."^ When he came to disc u s s t h e r a p e u t i c techniques, h i s dependence upon the e s t a b l i s h e d formulae of the mind-body r e l a t i o n became apparent. The moral treatment of the insane comprehends a l l the means which are known to e x e r c i s e immediately on the mind an i n f l u e n c e tending to r e s t o r e the healthy and n a t u r a l s t a t e of i t s operations. The medical or t h e r a p e u t i c a l t r e a t -ment in c l u d e s the use of remedies which act upon the body and are designed to remove the d i s o r d e r of c e r e b r a l or other f u n c t i o n s , known or b e l i e v e d to be the cause of derangement i n the mind, or at l e a s t to be i n t i m a t e l y con-nected w i t h i t s m a n i f e s t a t i o n s . ^ 16 M a r s h a l l H a l l , the famous nineteenth-century neuro-anatomist, a l s o adhered to the orthodox ex p l a n a t i o n of the r e l a t i o n s h i p between mind and b r a i n . He d i v i d e d the nervous system i n t o three p a r t s : the f i r s t being the c e r e b r a l or s e n t i e n t and v o l u n t a r y ; the second being the t r u e s p i n a l or 17. excito-motory; and t h i r d , the g a n g l i o n i c or n u t r i e n t and s e c r e t o r y . The c e r e b r a l s u b d i v i s i o n incorporated s e n s a t i o n , p e r c e p t i o n , judgement, v o l i t i o n and v o l u n t a r y motion. These f u n c t i o n s c o n s t i t u t e d "the animus, 32 the s o u l " , and were p s y c h i c a l . "The true s p i n a l f u n c t i o n s appear to be 18 e n t i r e l y of a v i t a l k i n d , d i s t i n g u i s h e d from p s y c h i c a l or s e n s a t i o n a l . . . " He thought i t important to d i s t i n g u i s h between these s p i n a l and p h y s i c a l func-t i o n s because " t h i s i s the only view of the subject according to which the 19 i n d i v i d u a l i t y of the s e n t i e n t being can be maintained." He was more e x p l i c i t about the r e l a t i o n s h i p between f a c u l t i e s and anatomical s t r u c t u r e s i n a l a t e r work: ...the seat of v o l i t i o n i s the cerebrum, and that i t s a c t i o n i s along the f i b r e s which decussate i n the medulla oblongata; and that the seat of emotion i s below t h a t of v o l i t i o n and that i t a c t s along f i b r e s which probably do not decussate... In these respects the e f f e c t s of emotion resemble those of r e s p i r a -t i o n , as seen i n yawning. This f u n c t i o n i s known to act i n a d i r e c t manner...volition has an o b j e c t , an aim. Emotion and the v i s nervosa, however subdued to c e r t a i n laws impressed the Creator, and destined to s p e c i a l purposes, are aimless on the part of the i n d i v i d u a l , nay f r e q u e n t l y opposed to h i s v o l i t i o n . . . These agents act upon d i f f e r e n t i n s t r u m e n t s — v o l i t i o n along the i n t r a v e r t e b r a l cord of the c e r e b r a l nerves; emotion^ and the v i s  nervosa, upon the f i b r e s of the true s p i n a l marrow. : Some changes can be a s c e r t a i n e d i n the development of theory between C u l l e n and H a l l . The f l u i d which had acted i n the nerve substance f o r C u l l e n has been discarded, although i t does not seem that n e u r o p h y s i o l o g i s t s had yet discovered any p h y s i c a l agent to take i t s place. The various func-t i o n s of the mind were now l o c a t e d i n s p e c i f i c s t r u c t u r e s of the b r a i n , not simply r e l a y e d by a sensorium. However, the l a c k of p r e c i s e knowledge about the nature of e i t h e r the p s y c h i c a l or the p h y s i o l o g i c a l proceses described by H a l l remained a s e r i o u s problem f o r p h y s i c i a n s who were engaged i n t r e a t i n g and w r i t i n g about i n s a n i t y . Even i n 1858, when J.R. B u c k n i l l and D.H. Tuke published t h e i r new 2'1 d e f i n i t i v e textbook, A Manual of P s y c h o l o g i c a l Medicine, the chapter on 33 the pathology of i n s a n i t y opened w i t h an apology f o r the pa u c i t y of r e l i a b l e p h y s i o l o g i c a l i n f o r m a t i o n about the b r a i n . An agglomeration of d e l i c a t e c e l l s i n i n t i m a t e connection w i t h minute tubes or f i l a m e n t s , which communicate impressions made upon the c e l l s at one end, to those c e l l s which l i e at t h e i r other e x t r e m i t i e s ; t h i s i s the nervous apparatus. I t s modus  operandi i s , and probably always w i l l be u t t e r l y unknown to us... the connection between nerve-function and ner v e - o r g a n i z a t i o n i s a mystery which remains v e i l e d from our most anxious s c r u t i n y . . . I t was ther e f o r e necessary to proceed on p r i n c i p l e s o f l o g i c a l thought i n s o -f a r as the mechanisms of i n s a n i t y were concerned. Thus B u c k n i l l , who wrote t h i s chapter, was able to use the analogy of a stomach u l c e r t o construct 23 a defence f o r the prevalent methods of t h e o r i z i n g about b r a i n f u n c t i o n . Thus i t was p o s s i b l e to observe that the seat of i n t e l l e c t and i n s t i n c t l a y i n the convolutions of the cerebrum, and that disease must e x i s t i n that area of the b r a i n . A l l disease was o r g a n i c — t h e r e s u l t of a l t e r e d chemical composition. The b r a i n was a congerie o f organs, and any cause d i s t u r b i n g the p h y s i o l o g i c a l c o n d i t i o n s might concentrate on one emotion or property, e s p e c i a l l y a well-developed one. However, a p r e d i s p o s i t i o n or c o n s t i t u -t i o n a l weakness must have been present i n the b r a i n and the development of 2.4 i t s f a c u l t i e s f o r i n s a n i t y to have a r i s e n . John Conolly a l s o wrote on the nature of the mind and i t s r e l a t i o n to the body, e s p e c i a l l y i n the In q u i r y and i n s e v e r a l s h o r t e r papers and 25 addresses he gave to medical groups. His ideas were i n complete accordance w i t h the general t h e o r i e s o u t l i n e d by C u l l e n and Burrows. Conolly defined "the mind" as "such mental a c t i o n s which are the most separate and p l a i n , those which a l l men may perceive i n themselves, and which, i n morbid s t a t e s of mind, are v i s i b l y a f f e c t e d i n degrees which i n d i c a t e t h e i r d i s t i n c t n e s s . " ^ ' The p r i n c i p a l "mental a c t i o n s " which he d i s t i n g u i s h e d were sensation, 34 a t t e n t i o n , memory, and comparison. By means of the f i v e senses, the mind "becomes impressed w i t h the idea of c e r t a i n p r o p e r t i e s e x i s t i n g , or deemed to e x i s t , i n surrounding o b j e c t s , " and these ideas are then c o r r e l a t e d w i t h the common experience of mankind. "Each of the senses e x c i t e s the s t a t e of mind which i s c a l l e d a t t e n t i v e . . . a n d we possess the a b i l i t y through the w i l l of f i x i n g our a t t e n t i o n f o r long periods of time i n order to understand some-t h i n g . " We a l s o n o t i c e the f u n c t i o n s of memory, "the wonderful power of r e c a l l i n g both the impression made by the sensation, and by the object which e x c i t e d i t , i n the absence of such o b j e c t s . " F i n a l l y , when "we r e c e i v e new impressions from other o b j e c t s , and sensations e i t h e r resembling those e x p e r i -ences, before, or d i f f e r i n g from them we can pay an a l t e r n a t e a t t e n t i o n to 27 • the new s e n s a t i o n . . . t h i s a l t e r n a t e a t t e n t i o n c o n s t i t u t e s comparison." He included a l i m i t e d r o l e f o r the f a c u l t y of imagination i n r e c a l l i n g impressions w i t h the memory, so that they "not o n l y . . . r e v i v e past impres-s i o n s . . . but successive images i n a long s e r i e s ; " a process which i s sometimes i n v o l u n t a r y , but can a l s o be d i r e c t e d by the e x e r c i s e of the w i l l . In these processes, we see what appears to be a c o n j o i n t o f f i c e of the memory and 28 imagination, which has been sometimes c a l l e d the a s s o c i a t i o n of ideas." Because of the importance of the a s s o c i a t i o n of id e a s , Conolly e v e n t u a l l y decided that a t t e n t i o n , memory, imagination, and comparison were "the great a t t r i b u t e s of human understanding...Reasoning i s nothing more than succes-s i v e or c o n t r o l l e d e x e r c i s e ; and what we c a l l reason i s but the product of t h i s e x e r c i s e . " Conolly went on to account f o r the production of other aspects of the mind, such as the a f f e c t i o n s . Sensations are stored and c a l l e d up as r e c o l l e c t i o n s which i n t u r n , evoke pleasure or pain, the pleasure and pain 35 caused "by c e r t a i n i n f l u e n c e s o p e r a t i n g on the nervous system i n a manner we cannot e x p l a i n , " any more than we can e x p l a i n the process of e x t e r n a l s e n s a t i o n . But the a s s o c i a t i o n which i s formed between c e r t a i n o bjects and c e r t a i n ideas of pleasure and pain becomes the source o f . . . t h e a f f e c t i o n s , each a f f e c t i o n being i n r e a l i t y i n the f i r s t i n stance founded upon emotions of pleasure or emotions of pain, and even afterwards guided by a judgement or o p i n i o n e f f e c t e d by the use of the i n t e l l e c t u a l f a c u l t i e s . ^ Passion i s simply the degree of vehemence with which we experience sensations or emotions, and the w i l l to act springs immediately from.the a f f e c t i o n s , emotions or the sens a t i o n s , "a property or f a c u l t y of our being, d i s t i n c t from the understanding, but e v i d e n t l y not independent of i t ; and i n a w e l l -3T regulated c o n s t i t u t i o n i t i s governed by i t . " C onolly b e l i e v e d that the i n t e r a c t i o n between the f a c u l t i e s and the emotions c o n s t i t u t e d and defined the c h a r a c t e r . In t h i s way, " i t i s evident that the character of an i n d i v i d u a l must depend upon the degree i n which the n a t u r a l or acquired s t r e n g t h of h i s mental f a c u l t i e s i s able to c o n t r o l h i s n a t u r a l s e n s i b i l i t y to emotions and to the impressions of sense." As a • r e s u l t , he argued, there e x i s t e d a h i e r a r c h y o f human types: ...those lowest on the human s c a l e are wholly given up to the passions and a p p e t i t e s ; many f a r above these are yet the sport of every emotion and a f f e c t i o n ; others more f o r t u n a t e l y con-s t r u c t e d , or who have been guided and d i s c i p l i n e d to b e t t e r ^ ends, acquire v a r i o u s degrees o f command over these impulses... But whatever may be the g i f t s of mind with which an i n d i v i d u a l might be endowed, the a t t r i b u t e s of mental l i f e were dependent upon the development of h i s b r a i n . Thus, the mind, "out of reach of p h y s i c a l injury...works by p h y s i c a l instruments, and the exactness of i t s operations depends upon the growth, m a t u r i t y , i n t e g r i t y and vigour of i t s instruments, which are the 33 b r a i n and nerves." The most important f a c u l t y i n the d e f i n i t i o n o f sound 36 mind was the c a p a c i t y f o r comparison. I t was e s s e n t i a l that the property of comparison be i n t a c t and powerful, because i t provided " a l l exact know-ledge" and without i t , no judgement could be e x e r c i s e d and "the wisest are 34 ha r d l y more than i n s t i n c t i v e . " I I The second major theme of the asylum p h y s i c i a n s who wrote on moral management was concerned w i t h the nature of madness and i t s causes. By the l a s t quarter of the eighteenth century, a broad d e f i n i t i o n of lunacy had been formulated, and a number of agencies which were b e l i e v e d to be respon-s i b l e f o r i t s advent had been i d e n t i f i e d and grouped i n t o , two c a t e g o r i e s , the moral and the p h y s i c a l . Moral i n t h i s sense r e f e r r e d to the f u n c t i o n s o f the mind and such events or a c t i v i t i e s which most d i r e c t l y , i n f l u e n c e d or were expressed through the e x e r c i s e of mental f a c u l t i e s . P h y s i c a l causes encom-passed not only b o d i l y i l l s and a c c i d e n t s and the e f f e c t s of h e r e d i t y , but a l s o the b a s i c s t r e n g t h or weakness of the i n d i v i d u a l ' s whole being. Despite the d i s t i n c t i o n between moral and p h y s i c a l causes, each was b e l i e v e d to be able to extend i t s e f f e c t s i n t o the realm of the other, so that mental events might have p h y s i o l o g i c a l outcomes and v i c e versa. W i l l i a m C u l l e n endorsed moral causation i n a l a r g e number of cases of mental disturbance. HfijSfcated that passions and emotions, i n promoting the v i o l e n t e x e r c i s e of the b r a i n , could e i t h e r i n c r e a s e or decrease the energy 35 of that organ. V i o l e n t emotions were t h e r e f o r e a cause of mania, and a n x i e t y and fea r could provoke melancholia. Moral causation i m p l i e d a recog-n i t i o n that mental events could provoke somatic events: that p h y s i o l o g i c a l changes i n b r a i n substance which were the r e s u l t o f v i o l e n t emotions.or 37 e r r o r s of judgement could be reversed or, at l e a s t , p a l l i a t e d by a combina-36 t i o n of p h y s i c a l and mental t h e r a p i e s . C u l l e n ' s idea of "temperament", which appears to have been derived from the humoral typology of medieval medicine, postulated a psycho-physiologic continuum of mind and body th a t he b e l i e v e d had a great impact upon the s o r t of derangement any i n d i v i d u a l might 37 e x h i b i t . P i n e l ' s d e c i s i o n to devote much a t t e n t i o n to moral causation and t r e a t -ment was i n part a r e s u l t of h i s a p p r e c i a t i o n of C u l l e n ' s work. In many cases of madness, P i n e l perceived that the i l l n e s s was c h a r a c t e r i z e d by a d i s o r d e r of the passions, the judgement, or the i n t e l l e c t . At the same time, he i d e n t i f i e d the a c t i o n of nervous excitement i n provoking the unpre-d i c t a b l e and u n s a t i s f a c t o r y behaviour of those he regarded as l u n a t i c s . A coarse and unenlightened mind considers the v i o l e n t expres-s i o n s , v o c i f e r a t i o n and r i o t o u s demeanor of maniacs as m a l i c i o u s and i n t e n t i o n a l i n s u l t s . . . A man of b e t t e r f e e l i n g sees i n those effervescences...the necessary e f f e c t s of a nervous e x c i t e m e n t . ^ He had observed that "any cause of f e a r or t e n s i o n may produce a h a b i t u a l s u s c e p t i b i l i t y to those emotions, and, by undermining the c o n s t i t u t i o n , may 39 induce dangerous d e b i l i t y and death." P i n e l ' s emphasis upon the somatic aspects of mental d i s o r d e r was e s p e c i a l l y apparent i n h i s u t i l i z a t i o n of the concept of the " v i s conserva-t r i x " or nature's own method of t e r m i n a t i n g i n s a n i t y . He r e f e r r e d to S t a h l ' s " p r i n c i p l e o f c o n s e r v a t r i x , whose o f f i c e i t i s to r e p e l any a t t a c k upon the system" and asked i f t h i s p r i n c i p l e was not a l s o a p p l i c a b l e to t h e o r i e s of i n s a n i t y . He i d e n t i f i e d the source of mental derangement as an uneasy sensation i n the e p i g a s t r i c r e g i o n , "symptomatic i t would appear of some great commotion i n the center of the system;" which e x c i t e d a general 38 r e a c t i o n whose stre n g t h was dependent upon the s e n s i t i v i t y of the i n d i v i d u a l . P h y s i c a l signs of t h i s r e a c t i o n were l i s t e d . In the end, "the g a s t r i c and abdominal a f f e c t i o n s , o f t e n having continued some time, cease. A calm suc-40 ceeds and brings w i t h i t a recovery more or l e s s permanent." But i f the paroxysm had not r i s e n to the degree of energy necessary, the same c i r c l e of a c t i o n was repeated and continued p e r i o d i c a l l y , d i m i n i s h i n g g r a d u a l l y i n v i o l e n c e , u n t i l a complete recovery was e s t a b l i s h e d . I f t h i s gradual termina-t i o n was not achieved, and the v i o l e n c e of the a t t a c k s had heightened u n t i l death supervened, then i t was p o s s i b l e that "the general and s a l u t a r y laws of the v i s c o n s e r v a t r i x , were impeded i n t h e i r a c t i o n by some organic l e s i o n 41 of the nervous system." Thus, when i n s a n i t y manifested i t s e l f as paroxys-mal, the course of the disease and i t s outcome might w e l l have been dependent upon a n a t u r a l p h y s i o l o g i c a l progression. George Mann Burrows a l s o endorsed the p r e v a i l i n g b e l i e f that a s e r i e s of somatic or psychic events, such as episodes o f passion, or sudden changes i n fortune l e a d i n g to a l t e r e d l i v i n g arrangements, could so a f f e c t the sub-stance of the body as to cause l e s i o n s i n the b r a i n . This was the f a m i l i a r e t i o l o g i c a l t e r r i t o r y of the eighteenth-century p h y s i c i a n — p a s s i o n s , emo-t i o n s , sudden shocks, v i c i o u s h a b i t s . However, Burrows extended the reach of causation f u r t h e r . Burrows b e l i e v e d that l i v i n g i n c i v i l i z e d s o c i e t y could p r e c i p i t a t e derangement. I t had long been b e l i e v e d that over-use of the i n t e l l e c t u a l f a c u l t i e s , e s p e c i a l l y those a s s o c i a t e d w i t h a r t i s t i c endeavours, could cause i l l n e s s . Burrows went f u r t h e r to say that a l l aspects of modern l i f e , even the development of e t h i c s and r e l i g i o n , were p o s s i b l e antecedents of lunacy. C i v i l i z e d l i f e could induce mental disease l a r g e l y through i t s 39 c a p a c i t y f o r p r o v i d i n g avenues f o r the indulgence of " v i c i o u s " p r o p e n s i t i e s . Thus, the r i c h were s u s c e p t i b l e because of t h e i r g r e a t e r refinement and t h e i r h a b i t s of l u x u r y , while the poor "unhappily provoke i t by t h e i r excesses; and thus v o l u n t a r i l y i n g r a f t on themselves the e v i l s which, from t h e i r con-42 '. •' d i t i o n , they might otherwise escape." There was a d i s t i n c t problem a s s o c i a t e d w i t h the expanded r o l e of c i v i l i z e d s o c i e t y i n the causation of mental i l l n e s s . I f the good e f f e c t s of organized or a r t i f i c i a l l i f e were p o t e n t i a l l y p a t h o l o g i c a l , then i t might seem necessary to account f o r a l l the people who were not mad, and d i d not s u f f e r i l l consequences from the s t r a i n s of t h i s complex l i f e . Burrows emphasized the v o l u n t a r y and excessive indulgences of both r i c h and poor as a major f a c t o r i n t h e i r s u s c e p t i b i l i t y . Another response was to look to " o r g a n i z a t i o n " , to p r e d i s p o s i t i o n and p h y s i o l o g i c a l processes f o r the source of the s p e c i f i c determinants of derangement. He d e c r i e d the "long p r e v a i l i n g e r r o r of studying the mental to the neglect of those c o r p o r e a l phenomena which are almost always co g n i z a b l e , " f o r men are created to work p e r f e c t l y , and i f impairment occurs, i t must be the r e s u l t of "accident or that a r t i -43 f i c i a l c o n d i t i o n of s o c i e t y which begets d i s e a s e . " The f u n c t i o n s of the b r a i n seemed to be subject to the same general laws as the f u n c t i o n s of other organs, i n other words, they developed and d e t e r i o r a t e d w i t h age, they could be modified by h a b i t , gender, temperament, and, of course, c e r t a i n processes that were i n e x p l i c a b l e . B r a i n disease could be s t r u c t u r a l or f u n c t i o n a l , and, indeed, derangement that began i n the f u n c t i o n s would, over time, exact i t s t o l l i n the form of i d e n t i f i a b l e p h y s i c a l l e s i o n s , as post-44 mortem s t u d i e s had demonstrated. 40 Another element of " o r g a n i z a t i o n " was the d o c t r i n e of sympathies. "Although we know not the causes, nor the mode by which sympathies a c t , yet we have abundant proof of t h e i r o p e ration i n . o r i g i n a t i n g disease which r e c i -p r o c a l l y a c t s on the mind." Thus, i t was p o s s i b l e to account f o r the derangement that o f t e n accompanied hepatic or g a s t r i c disturbance, or that which followed blows on.-the head, intemperance, or u t e r i n e a c t i v i t y . P r e d i s p o s i t i o n could be both temperamental and h e r e d i t a r y . Burrows observed that "most of the sanguine and nervous temperaments are maniacal, 46 and of the b i l i o u s and melancholic melancholy." But f a m i l i a l i n h e r i t a n c e of a p r e d i s p o s i t i o n towards derangement was of g r e a t e r s i g n i f i c a n c e . "Every disease that assumes a c o n s t i t u t i o n a l character can, John Hunter s a i d , be given to a c h i l d ; and i t then becomes what i s c a l l e d h e r e d i t a r y . There i s , however, no such t h i n g as an h e r e d i t a r y disease; but there i s an h e r e d i t a r y p r e d i s p o s i t i o n f o r a disease." The experience of a l l ages confirmed the l i a b i l i t y of v a r i o u s forms of derangement to pass through f a m i l i e s , although i t was not always the s p e c i f i c type which was propagated, as w i t h s u i c i d e or hypochondriasis; i t was as l i k e l y to be a general tendency towards d i s -turbance. Burrows had observed that s i x out of seven of h i s p a t i e n t s had an h e r e d i t a r y p r e d i s p o s i t i o n and those cases that were exempt had a sympathetic 47 derangement o r i g i n a t i n g i n another organ, as w i t h puerperal i n s a n i t y . The f i n a l p h y s i c a l propensity towards mental disease l a y i n basic p h y s i o l o g i c a l f u n c t i o n i n g . Burrows argued t h a t i t was necessary to have a balance of the nervous and v a s c u l a r systems f o r p e r f e c t h e a l t h : i f e i t h e r predominated, disease ensued. But the two systems were so c l o s e l y connected both by p r o p i n q u i t y and sympathy that any impression causing i r r i t a t i o n to one would spread to the other. I t appeared that l i f e i t s e l f and the 41 f u n c t i o n i n g of the mind were more dependent upon the c i r c u l a t o r y system than the nerves. However i t was e q u a l l y c e r t a i n that nervous a c t i v i t y 48 impinged upon the movement of the blood. Concepts l i k e c i v i l i z a t i o n , o r g a n i z a t i o n , p r e d i s p o s i t i o n and a balance of nervous and v a s c u l a r f u n c t i o n i n g were a l l causes of i n s a n i t y i n which moral and p h y s i c a l causes were intermeshed. Elements of each could be d i s -t i n g u i s h e d , but t h e i r o v e r a l l e f f e c t s were continuous throughout the mental and p h y s i c a l realms. Burrows's.use of more complex c a t e g o r i e s o f causation was expressive of a growing need to accommodate the m u l t i f a r o u s symptoms of madness, as w e l l as a d e s i r e to place the m a n i f e s t a t i o n s of mental disturbance f i r m l y w i t h i n the grasp of the p h y s i c i a n by l i n k i n g together p h y s i o l o g i c a l processes and mental events. The tendency towards i n c r e a s i n g l y f o r m a l i z e d and elaborate medical explanations of i n s a n i t y i s demonstrated i n E s q u i r o l ' s Mental Maladies, a work which was a major s t a r t i n g - p o i n t f o r many E n g l i s h p s y c h i a t r i s t s from 49 the 1820's u n t i l the l a t e r part of the century. E s q u i r o l ' s system of c a u s a t i o n emphasized moral events to a l a r g e extent, and i t gave f i r s t place to the psyche; but i t was f u l l y grounded "on a p h y s i c a l model of the operation of mental events, so that "moral impressions determined a movement, a k i n d of shock i n the f i b r e s : the fo r c e s are modified; and the organs acquire an 50 a c t i o n , adequate to the s o l u t i o n of the maladies." In the end, a l l that could be s a i d of the a c t u a l character of i n s a n i t y was that i t "depends upon 51 an unknown m o d i f i c a t i o n of the b r a i n , " which might w e l l be f u n c t i o n a l i n i t s o r i g i n , but would o f t e n r e s u l t i n s t r u c t u r a l change. The causes of mental i l l n e s s could sometimes f a i l to act on the b r a i n at a l l , beginning t h e i r work on the remote organs, and a p r e d i s p o s i t i o n could act with so much energy as to produce derangement without an e x c i t i n g cause.^2 42 E s q u i r o l ' s emphasis upon the p h y s i c a l aspects of mental disease was not intended to di m i n i s h the importance of moral or psychic i n f l u e n c e s . How-ever, i t i s i n d i c a t i v e of a co n t i n u i n g confusion w i t h i n the t h e o r e t i c a l f o r m u l a t i o n s of the moral managers, because they b e l i e v e d t h a t , although mental f a c t o r s might be of grea t e r i n t e r e s t , the p h y s i o l o g i c a l e f f e c t s of t h e i r presence were more e a s i l y monitored and described. The i n e x t r i c a b l e tangle of moral and p h y s i c a l causes, e f f e c t s , and remedies could not be untied e a s i l y . Even Benjamin Brodie, the nineteenth-century p h y s i o l o g i s t , discussed h y s t e r i a as "one of the severest p e n a l t i e s of high c i v i l i z a t i o n , " whose causes can only'be p h y s i c a l , as w i t h a l o c a l i n j u r y , or the imperfect develop-ment of the nervous system, and moral, as i n the e f f e c t s of a bad education 53 of l a x h a b i t s of e a r l y l i f e . In a d d i t i o n , he i d e n t i f i e d a h e r e d i t a r y f a c -t o r which created a p r e d i s p o s i t i o n towards a d e c l i n e of p h y s i c a l power i n the system. Given the growing co n c e n t r a t i o n upon somatic causation i n B r i t i s h p s y c h o l o g i c a l medicine, J.C. Pri c h a r d ' s i n t e r e s t i n the moral f a c t o r s of mental disease might appear to be i n d i c a t i v e of a major break with the accepted t r a d i t i o n . P r i c h a r d began h i s T r e a t i s e w i t h a d i v i s i o n of i n s a n i t y i n t o two types, the f i r s t being moral i n s a n i t y , the second i n t e l l e c t u a l . Moral i n s a n i t y , he defined as a d i s o r d e r of the f e e l i n g s , passions, or w i l l that manifests i t s e l f without a corresponding d i s r u p t i o n of the t h i n k i n g f a c u l t i e s . This category was a l s o found i n P i n e l and E s q u i r o l . P r i c h a r d f e l t t hat moral i n s a n i t y was o f t e n an exaggeration of a character t r a i t or a type of d i s p o s i t i o n , as i n the case of a woman who e x h i b i t e d mental e x c i t e -ment which developed i n t o female immodesty. Broadly defined moral i n s a n i t y was seen as the working-out of innate moral p e r v e r s i t y , which suggested the e x istence of a strong n a t u r a l p r e d i s p o s i t i o n . 43 P r i c h a r d followed w i t h a d i s c u s s i o n of i n t e l l e c t u a l i n s a n i t y , but h i s nomenclature reverted to the time-honoured c l a s s i f i c a t i o n s of monomania or melancholy, mania and dementia. In these cases, he o u t l i n e d a progress from p a r t i a l to almost complete derangement of the understanding. He described melancholy only i n terms of i t s mental m a n i f e s t a t i o n s , but when he discussed mania he reported that a l l b o d i l y f u n c t i o n s would be deranged. However, h i s a t t e n t i o n was concentrated on the s t a t e of the i n t e l l e c t u a l f a c u l t i e s , and the passions and w i l l as they were i n v o l v e d i n the various types of mental 55 disease. P r i c h a r d ' s d i s c u s s i o n of i n s a n i t y appears to be t r u l y m e n t a l i s t . How-ever, he a l s o argued that lunacy must a r i s e from "a c o n g e n i t a l i m p e r f e c t i o n , [ r a t h e r ] than a disease r e s u l t i n g from e x t e r n a l impressions." A p r e d i s p o s i -t i o n must have been inbred i n t o the c o n s t i t u t i o n . I f i t was not i n h e r i t e d , then i t was an i n d i v i d u a l p e c u l i a r i t y of o r g a n i z a t i o n , which would become h e r e d i t a r y . "Thus, both i d i o t s and l u n a t i c s are persons born with a defec-56 t i v e s t r u c t u r e of the b r a i n . " He came to t h i s c o n c l u s i o n not through an understanding of n e u r o l o g i c a l research, but from an a n a l y s i s of the impact of c i v i l i z a t i o n upon mental processes and emotional expressions,, as w e l l as the increase of pauper lunacy. The e f f e c t s of the greater complexity of European s o c i e t y were so ubiquitous that madness should be epidemic, unless the insane could be d i s t i n g u i s h e d by some innate i m p e r f e c t i o n of o r g a n i z a t i o n which rendered them e s p e c i a l l y v u l n e r a b l e to e x t e r n a l i n f l u e n c e s . An increase i n the numbers of the insane must th e r e f o r e be r e l a t e d to h e r e d i t a r y t r a n s m i s s i o n of t h i s inherent weakness. The r e l a t i v e absence of i n s a n i t y among savages was a product of t h e i r l a c k of a c o n g e n i t a l p r e d i s p o s i t i o n as w e l l as t h e i r possession of d i f f e r e n t b r a i n s t r u c t u r e s which had developed 44 along a l t e r n a t e l i n e s , because the savages ex e r c i s e d a d i f f e r e n t s e r i e s of 57 mental f a c u l t i e s . P r i c h a r d was unsure about the a c t u a l morbid c o n d i t i o n of the b r a i n , but he seemed to lean towards an inflammation theory based on increased v a s c u l a r i t y of the t i s s u e s which was productive of i r r e g u l a r mental excitement. However confident p h y s i c i a n s such as Burrows, Brodie and P r i c h a r d might have appeared to be i n . t h e i r i n c r e a s i n g l y complex d i s c u s s i o n s of the p h y s i c a l causes of madness, they continued to be plagued by a s e r i o u s l a c k of hard i n f o r m a t i o n about the p h y s i o l o g i c a l processes i n v o l v e d . Moreover, an e n t i t y l i k e moral i n s a n i t y acquired g r e a t e r s i g n i f i c a n c e p r e c i s e l y because i t could not be explained except- as a " l e s i o n " of the w i l l ; and yet no such l e s i o n could be i d e n t i f i e d by b r a i n d i s s e c t i o n s . Therefore, t h e o r i s t s of psycho-l o g i c a l medicine attended more c l o s e l y to moral causes and to an i n c r e a s i n g l y d e t a i l e d examination of the various symptoms of more s p e c i a l i z e d disease c a t e g o r i e s . In a d d i t i o n , p h y s i c i a n s such as B u c k n i l l and Tuke, attempted t c u t i l i z e general s c i e n t i f i c p r i n c i p l e s to e s t a b l i s h a process by which i n s a n i t y could be i d e n t i f i e d and then described. I t was a comfort to remember that the mind had laws, which were as " r e g u l a r as any other n a t u r a l laws," and which were a s c e r t a i n a b l e by the t r a i n e d p h y s i c i a n , who must be both a doctor and "a metaphysician...in that b e t t e r sense which designates a l o v e r of t r u t h , seeking to a s c e r t a i n , not the essence of mind or any other u n a t t a i n a b l e 58 a b s t r a c t i o n , but the laws of the mind..." For the r u l e s which governed mental f u n c t i o n i n g , the medico-psychologist could r e l y upon the c a t e g o r i e s of i n t e l l e c t l a i d down i n the eighteenth century: the f u n c t i o n s of judgement, comparison, a t t e n t i o n and memory, the process of a s s o c i a t i o n of ideas, and t h e i r i n t e r a c t i o n w i t h the w i l l , and "the passions of the s o u l . " ^ 9 45 A working d e f i n i t i o n of me n t a l . i l l n e s s was provided by Dr. Combe: I t i s a prolonged departure, and without an adequate e x t e r n a l cause, from the s t a t e of f e e l i n g and modes of t h i n k i n g usual to the i n d i v i d u a l who i s i n h e a l t h . . . ^ This d e f i n i t i o n "has the meri t , however, of making the mind of the i n d i v i d u a l h i m s e l f , and not that of the p h y s i c i a n , the standard of comparison by which 61 to determine h i s i n s a n i t y . " The v a r i e t i e s o f madness could be d i v i d e d i n t o those corresponding to a disturbance of the i n t e l l e c t , the emotions and the w i l l . The language of diagnosis and treatment.remained that of mania, melancholy, monomania, dementia and i d i o c y . Methods of treatment were to be a p p l i e d according to the type of i l l n e s s , i t s s e v e r i t y , and i t s p e c u l i -a r i t i e s . A most i n t e r e s t i n g example of the way i n which p h y s i o l o g i c a l knowledge was put to the s e r v i c e of the enduring m e n t a l i s t explanations of the func-t i o n s of the mind and the d i s o r d e r s of the insane i s found i n Daniel Tuke's d i s c u s s i o n of moral i n s a n i t y . He accepted E s q u i r o l ' s d i v i s i o n of that disease i n t o two c a t e g o r i e s : f i r s t , the a f f e c t i v e monomania, in.which reason remains i n t a c t but the a f f e c t i o n s and d i s p o s i t i o n are perverted; the second, i n s t i n c -t i v e monomania, i n which the madman commits i n v o l u n t a r y a c t s , which " n e i t h e r 6 2 reason nor sentiment determines." In t h i s l a t t e r form were found o r i g i n a l l e s i o n s of the w i l l , w h i l e other monomanias begin w i t h l e s i o n s o f the i n t e l l e c t or the a f f e c t i o n s which subjugate the w i l l . The importance of the d i s t i n c t i o n l a y w i t h the e v a l u a t i o n of r e s p o n s i b i l i t y ; Thus, then, i t i s h i g h l y important to remember, that a l l examples of what are c a l l e d moral i n s a n i t y are not n e c e s s a r i l y i n s t i n c t i v e , i m p u l s i v e , i r r e s i s t i b l e . For although, ( i n a loose use of the word) the man morally mad may be s a i d to be i r r e s i s t i b l y so that i s , h i s c o n d i t i o n of mind i s not v o l u n t a r y , — t h e examples of i r r e s i s t i b l e impulse belong to q u i t e a d i f f e r e n t c l a s s . ^ 46 I t i s s i g n i f i c a n t that t h i s attempt to l o c a t e r e s p o n s i b i l i t y i s r e f e r r e d to the recent d e s c r i p t i o n s of the r e f l e x : Modern physiology teaches that there i s a r e f l e x a c t i o n of the cerebrum, as w e l l as of the s p i n a l cord; and thus s a t i s f a c -t o r i l y e x p l a i n s the existence o f the automatic or i n s t i n c t i v e a c t s . To such cases Dr. Carpenter a l l u d e s when he says, "So f a r as the d i r e c t i n g i n f l u e n c e of the w i l l over the current of thought i s suspended, the i n d i v i d u a l becomes a t h i n k i n g automaton, d e s t i t u t e o f the power to withdraw h i s a t t e n t i o n from any idea or f e e l i n g by which h i s mind may be possessed, and i s as i r r e s i s t i b l y i m p e l l e d , t h e r e f o r e , to act i n accordance w i t h t h i s , as the lower animals are to act i n accordance w i t h t h e i r i n s t i n c t s . Conolly a l s o adhered to a conventional d i v i s i o n of the causes of i n s a n i t y i n t o the c a t e g o r i e s of moral and p h y s i c a l . He was more l i k e l y to a s s i g n cause to moral i n f l u e n c e s , because i t was h i s experience that few cases of mania could be c l e a r l y shown to be dependent upon any b o d i l y d i s -order, and the p h y s i c a l problems which appear to be connected to melancholia were g e n e r a l l y r e s t r i c t e d to " p e c u l i a r s t a t e s of the l i v e r , stomach, and 65 bowels." Women were more o f t e n a f f e c t e d by p h y s i c a l causes because of the 66 d i s r u p t i v e e f f e c t s of menstruation, c h i l d b i r t h and menopause. P h y s i c a l r<-7 d e b i l i t y was a frequent cause of mental i l l n e s s . However, i n most cases, Conolly "...tended to a s c r i b e the onset of the d i s o r d e r to a combination of moral e f f e c t s and a c o n s t i t u t i o n a l p r e d i s p o s i -t i o n , ^ " i l n a case of melancholia, one might f i n d " i n a b r a i n h e r e d i t a r i l y predisposed to disturbance, the depressing e f f e c t of fea r and a n x i e t y i s 69 w i t h d i f f i c u l t y r e s i s t e d , and has a tendency to become permanent." Strength and weakness of the various f a c u l t i e s , s u s c e p t i b i l i t y to the emo-t i o n s and a f f e c t i o n s and to e x t e r n a l s t i m u l i a l l appeared to be c o n s t i t u -70 t i o n a l , although they were amenable to education and t r a i n i n g . C o n s t i t u t i o n a l i n f i r m i t i e s , when combined with "the v i o l e n t emotions and 47 passions of the mind, and p r o p e n s i t i e s rendered masterly by indulgence, and the undue employment of c e r t a i n i n t e l l e c t u a l f a c u l t i e s , tend to produce 71 disturbances i n the f u n c t i o n s of the b r a i n . . . " Other moral causes were s i t u a t i o n a l : domestic problems, the a n x i e t y produced by poverty or i l l n e s s , the mental shock r e s u l t i n g from sudden g a i n or l o s s of wealth, g r i e f and sorrow from death of loved ones. In these cases, i t would be assumed that the p e r n i c i o u s e f f e c t of the experience l a y i n t h e i r p o t e n t i a l f o r i n d u c i n g or augmenting v i o l e n t emotions which increased b r a i n excitement and d i s -turbed the balance of f a c u l t i e s . Despite the emphasis on the d i s o r d e r of the f a c u l t i e s as a s i g n of mental i l l n e s s , Conolly b e l i e v e d t h a t , at bottom, i n s a n i t y was b r a i n disease. There was a d i f f i c u l t y i n accounting f o r the connections between mad beha-v i o u r and p h y s i c a l i l l n e s s because of the p a u c i t y of r e a l p h y s i o l o g i c a l knowledge. The p h y s i o l o g i s t r e q u i r e s a deeper i n s i g h t than i s yet accorded to him i n t o the f o u n t a i n of nervous actions...He must yet i n q u i r e i f the j u s t measure of s e n s a t i o n , and of p r o p e n s i t i e s , the sentiments, and the power of the i n t e l l e c t , i s a s s o c i a t e d w i t h i n t e l l i g i b l e c o n d i t i o n s of the b r a i n or the nerve i n t h e i r minute s t r u c t u r e s , or the power or agency, whatever i t i s , that l i e s w i t h i n that p o r t i o n of our systems, and appears i n d i s p e n s a b l e to the possession and e x e r c i s e of the f u n c t i o n s of animal l i f e . To whatever extent p h y s i c i a n s were capable of a s c e r t a i n i n g the pro-cesses by which i n s a n i t y was expressed i n the b r a i n , the c o n c l u s i o n appeared to be that nervous energy was unbalanced, as a r e s u l t of disturbances i n the c i r c u l a t o r y system. We mainly ask what the s t a t e of t h e . b r a i n may be which thus detaches a l i v i n g and reasoning being from r e a l i t y , and ceases him to dwell i n a land of shadows and of unreal t h i n g s . Some p o r t i o n s only of the b r a i n may be s t i m u l a t e d , or may be i n a c t i v e , f u l l e r of blood than n a t u r a l , or anaemic; too e n e r g e t i c , or impeded, and the judgement v i t i a t e d . 48 He sounded most convinced about p h y s i c a l m a n i f e s t a t i o n s i n comments before the Royal I n s t i t u t i o n : I t may perhaps be s t r i c t l y s a i d that a l l the forms of mental d i s o r d e r are dependent on one of three s t a t e s of the Nervous System—a s t a t e of increased, or a s t a t e of diminished, or a s t a t e of unequal excitement of that system. There i s almost always an accompanying d i s o r d e r of some of the b o d i l y f u n c t i o n s . Throughout h i s work, Conolly had no choice but to avoid p r e c i s e s t a t e -ments about the p h y s i o l o g i c a l m a n i f e s t a t i o n s of mental i l l n e s s , because he f e l t that v e r i f i a b l e knowledge on t h i s subject was very l i m i t e d i n scope, and because he b e l i e v e d that treatment could be a p p l i e d to d i s o r d e r s on the b a s i s of t h e i r c l i n i c a l s i g n s , combined with a due a t t e n t i o n to the f u n c t i o n s of the mind as they have been o u t l i n e d . Conolly's c o n c l u s i o n might appear to be a s u p e r f i c i a l s y n t h e s i s of an incoherent bundle of d o c t r i n e , s p e c u l a t i o n and rudimentary physiology; but i t would seem that most of the important w r i t e r s on moral management were e q u a l l y unable to unravel the c o m p l e x i t i e s of the mind-body r e l a t i o n or d e r i v e much b e n e f i t from the emergent neuro-physiology. The nineteenth-century asylum p h y s i c i a n s began w i t h long-standing b e l i e f s about the c o n s t i t u -t i o n of the mind and the nature of madness, and combined these w i t h whatever pieces of i n f o r m a t i o n could be gleaned from anatomists and other researchers i n v e s t i g a t i n g the p h y s i c a l workings of the body and b r a i n . The concepts formed out of those elements were a l s o i n f l u e n c e d by the growing body of i n f o r m a t i o n about the e f f i c a c y of v a r i o u s forms of treatments. 49 I I I Moral management was i n i t i a l l y judged by e m p i r i c a l standards, but from i t s i n c e p t i o n , i n the hands of the p h y s i c i a n P i n e l and the layman Tuke, moral treatment was informed by a number of t h e o r e t i c a l p r o p o s i t i o n s that had been developed out of the ideas of mental f u n c t i o n i n g and moral and 75 p h y s i c a l causations o u t l i n e d above. Just as the. moral managers had attempted to g i v e some somatic grounding to t h e i r p r i m a r i l y psychic concerns, i n order to e x p l a i n what was evident but s c i e n t i f i c a l l y i n e x p l i c a b l e — t h e obvious connection between mental and p h y s i c a l p r o c e s s e s — s o they a l s o laboured to provide a foundation f o r the e m p i r i c a l l y sound but i n t e l l e c t u a l l y unprovable c l a i m that changes i n p h y s i c a l treatment could a l t e r mental d i s -turbance, and that a p p l i c a t i o n s d i r e c t e d towards psychic f u n c t i o n s could be r e f l e c t e d i n b o d i l y changes. The theory of moral treatment possessed a strong somatic element, based i n l a r g e measure upon the w e l l - e s t a b l i s h e d n o t i o n of the necessary e q u i l i b r i u m of b r a i n and nervous a c t i v i t y . C u l len's p r o v i s i o n s f o r treatment were r e l a t e d to a scheme of unequal b r a i n excitement. In mania, when the excitement was g e n e r a l i z e d and i n t e n s e , p h y s i c a l r e s t r a i n t and confinement w i t h few o b j e c t s w i t h i n s i g h t and hearing were necessary. I t was b e l i e v e d that f e a r could be e f f e c t i v e l y used i n treatment because i t was thought to decrease excitement. This was combined wi t h a low d i e t w i t h evacuants to d i m i n i s h , and purges to reduce, f u l l n e s s of b r a i n v e s s e l s . The shaving of the head to promote p e r s p i r a t i o n , and 76 constant hard labour as a d i v e r s i o n , were part of the treatment. Melan-c h o l i e s might need some r e s t r a i n t but w i t h l e s s f o r c e than maniacs. Some b l o o d l e t t i n g , purging and e f f o r t s to produce i n the p a t i e n t an emotion l i k e 50 awe completed the t h e r a p e u t i c regimen. Melancholia was dependent upon the pre-existence of a s u i t a b l e temperament of the body i n which there e x i s t e d a degree of torpor i n the motion of the nervous power w i t h respect to sensa-t i o n and v o l i t i o n . This torpor was probably the r e s u l t of a d r i e r and f i r m e r 77 t e x t u r e i n the medullary substance of the b r a i n . A c e r t a i n amount of d i v e r s i o n might a l s o be u s e f u l w i t h melancholies who e x h i b i t e d p a r t i a l d e l u s i o n s . I t was a l s o u s e f u l f o r hypochondriacs. C u l l e n ' s t h e r a p e u t i c regimens blended conventional medical nostrums w i t h examples of the e a r l y v a r i a n t s of moral treatment. C u l l e n ' s advice was imbued with p h y s i o l o g i c a l r a t i o n a l e s ; the medical remedies and the moral agencies he p r e s c r i b e d were expected to have an e f f e c t on b r a i n excitement and o v e r a l l b o d i l y energy. In P i n e l ' s work, by c o n t r a s t , there was a g r e a t e r emphasis upon and refinement of the moral aspects, w i t h s p e c i a l concentra-t i o n upon the d e l e t e r i o u s e f f e c t s of heavy p h y s i c a l r e s t r a i n t . P i n e l argued that madness which was manifested i n a d i s o r d e r of the passions was r e c e p t i v e to the manipulation of other emotions and the use of d i v e r s i o n and employ-78 ment. L i k e C u l l e n , he held that part of the c u r a t i v e e f f e c t of labour was i t s c a p a c i t y to "prevent the determination of blood to the head by ren-d e r i n g the c i r c u l a t i o n more uniform, and [inducing] t r a n q u i l and r e f r e s h i n g 79 sleep. Passions, emotion and i n t e l l e c t u a l d i s o r d e r s had c l e a r connections w i t h p h y s i c a l processes, although i t was very d i f f i c u l t to demonstrate organic disease i n most cases of derangement. Moreover, m a n i f e s t a t i o n s of mind were aspects of the disease that could be d i r e c t l y i n f l u e n c e d . A new note was sounded i n P i n e l ' s work: "the.happy e f f e c t s of i n t i m i d a t i o n , without 51 s e v e r i t y ; of oppression, without v i o l e n c e ; and of triumph, without outrage" 80 permit "an i r r e s i s t i b l e c o n t r o l " to be e x e r c i s e d over the p a t i e n t . Moral treatment was p r e f e r a b l e because i t produced a compliance that was i n t e r n a l as w e l l as e x t e r n a l , and i t was, t h e r e f o r e , more complete. P i n e l ' s work s t r e s s e d the importance of the medical c o n t r o l i n t r e a t -81 ment of the insane. This f a c t o r was to play a major r o l e i n Burrows's ideas about therapy. Burrows's h i g h l y m e d i c a l i z e d view of i n s a n i t y caused him to i d e n t i f y three d i s t i n c t stages: the i n c i p i e n t , the a c t i v e or con-firmed, and the convalescent or d e c l i n i n g . He r e f e r r e d to t h i s as a " s c i e n -82 t i f i c " system of c l a s s i f i c a t i o n which was a p r e r e q u i s i t e of good treatment, and h i s t h e r a p e u t i c p r o v i s i o n s centered around t h i s d i v i s i o n of symptoms. In l i g h t of h i s experience, Burrows set out a program f o r accurate d i a g n o s i s based upon observation and d e t a i l e d h i s t o r y - t a k i n g , followed by the a p p l i c a t i o n of s p e c i f i c a l l y medical remedies i n the i n i t i a l stages. Only i n the t h i r d stage of the i l l n e s s was moral treatment to become the primary focus. In the f i r s t two stages, d e s p i t e the f a c t that the derangement was probably f u n c t i o n a l r a t h e r than s t r u c t u r a l , the p h y s i c a l symptoms of e x c i t e -ment, w i t h the attendant v a s c u l a r and nervous i r r e g u l a r i t i e s , were to be d e a l t w i t h , and only a f t e r these p h y s i c a l problems had subsided could moral management be considered as an a i d . I t was a l s o p o s s i b l e that i n c e r t a i n cases no corporeal aspect of the mental derangement could be a s c e r t a i n e d . In such s i t u a t i o n s the h e r e d i t a r y p r e d i s p o s i t i o n was e s p e c i a l l y strong and 83 here, too, moral treatment might be a more appropriate remedy. Despite these l i m i t a t i o n s on the e x e r c i s e of moral methods, Burrows i n s i s t e d upon the unique r o l e of the p h y s i c i a n i n i t s a p p l i c a t i o n . "The t a c t of the p h y s i c i a n , however, i s , i n t h i s p a r t i c u l a r , the p i v o t on which 52 e v e r y t h i n g moves. I t i s an a r t , i n f a c t , that cannot be taught. The q u a l i -f i c a t i o n s are i n t u i t i v e , not acquired: they may be e l i c i t e d by a c c i d e n t , 84 and then can only be perfected by experience." The s k i l l of the p h y s i c i a n i s e s p e c i a l l y important i n d i s c e r n i n g the e a r l y symptoms of convalescence, so t h a t immediate t r i a l of moral p r i n c i p l e s can begin. Such symptoms were obscure, and r e q u i r e d a l l h i s experience and t r a i n i n g to be e l i c i t e d . Then, the doctor must e x e r c i s e a l l the a t t r i b u t e s of h i s c h a r a c t e r . He has not only to e x e r c i s e a sound judgement, to encourage every dawning s i g n of r e t u r n i n g sense, and to reason w i t h h i s p a t i e n t , ( f o r reasoning now i s h i g h l y u s e f u l i n removing weakened and decaying i l l u s i o n s ) but he must add the soothing voice of f r i e n d s h i p . . . ^ In t h i s way, Burrows advanced the c l a i m of medical e x p e r t i s e i n the conduct of a l l aspects of the treatment of the insane. Medical d e f i n i t i o n s of the causes and progress of the disease l a i d a foundation f o r the argument that the p h y s i c i a n ' s mind, was properly s u i t e d to d e a l i n g s w i t h "a n a t u r a l l y f i n e and w e l l - c u l t i v a t e d mind [which] r e q u i r e s t a c t , d e l i c a c y , and d i s c r i m i n a -„86 t i o n . . . " The importance of the p h y s i c i a n ' s r o l e i n the a p p l i c a t i o n of moral remedies was taken f u r t h e r by E s q u i r o l . F o l l o w i n g P i n e l very c l o s e l y , E s q u i r o l argued that the p r i n c i p a l c u r a t i v e f e a t u r e of an asylum was the a u t h o r i t y which emanated from a s o l e and undisputed Head, from whose per-s o n a l i t y and power flowed the confidence which was e s s e n t i a l to the cure of derangement. A d i v i d e d a u t h o r i t y would a l l o w f o r a s p i r i t of independence and a l a c k of obedience among the p a t i e n t s , which would r e t a r d t h e i r pro-87 gress s i n c e they were but "grown up c h i l d r e n " i n need of d i r e c t i o n . The attendants must set the example f o r deference and obedience which would prevent a need f o r the use of f o r c e . Dependency encouraged a r e c o g n i t i o n of the existence of i l l n e s s , and that i n i t s e l f was conducive to cure. 5 3 Another f a c t o r i n E s q u i r o l ' s t h e r a p e u t i c program, a l s o borrowed from P i n e l , was the use of the passions i n o p p o s i t i o n to one another. This was to help break the t r a i n of ideas which had overtaken the l u n a t i c ' s reason. S u b j e c t i o n and r e p r e s s i o n of some p a t i e n t s might be necessary, and thus a 88 c o l d bath (the douche) was advocated. Evacuants caused the p a t i e n t to experience a sense of unease i n the stomach which rendered him d o c i l e and, hence, more amenable to i n s t r u c t i o n . Other p h y s i c a l remedies suggested by E s q u i r o l i ncluded n a r c o t i c s and the r o t a r y c h a i r . In a d d i t i o n , s p e c i f i c d i s o r d e r s , such as lypemania, monomania and mania, as w e l l as pueperal d i s -turbances, would r e q u i r e the a d m i n i s t r a t i o n of o r d i n a r y medical agents, such QQ as bleedings, p u r g a t i v e s , emetics, c a u t e r i e s , and drugs. In E s q u i r o l ' s work, the interdependence of moral and p h y s i c a l treatments becomes more transparent than ever. Fear reduced b r a i n i r r i t a t i o n and so would decrease the symptoms of mania. Lypemania, or melancholy, was best t r e a t e d w i t h conventional medical remedies, as w e l l as passion s u b s t i t u t i o n . This combination of th e r a p i e s i s a l s o evident i n P r i c h a r d ' s T r e a t i s e . P r i c h a r d r e s t r i c t e d the term "moral treatment" to such techniques as were d i r e c t e d p r i m a r i l y at mental symptoms, but h i s general plan f o r the medical management of lunacy made i t c l e a r that appeals to moral e n t i t i e s s t i l l e x i s t i n g i n the minds of l u n a t i c s were at the b a s i s of any plan of care. The f i r s t p r i n c i p l e of treatment was to remove or reduce t h i s diseased c o n d i t i o n of the b r a i n , and f o r t h i s he p r e s c r i b e d the usual p u r g a t i v e s , b l o o d l e t t i n g , baths and c e r t a i n drugs, as w e l l as the r o t a r y swing. The second p r i n c i p l e was to r e s t o r e or maintain the n a t u r a l f u n c t i o n s , and, to t h i s end, he advocated both p h y s i c a l remedies, e s p e c i a l l y those that would r e a c t i v a t e the e x c r e t o r y processes, and the mental th e r a p i e s t h a t were 54 in v o l v e d i n the a p p l i c a t i o n of moral management techniques. His d i s -c u s s i o n of moral management followed the e s t a b l i s h e d l i n e s : the n e c e s s i t y of confinement, the c o n t r o l l e d environment, and the achievement of s e l f -respect through the e x e r c i s e of vo l u n t a r y c o n t r o l s o f d i s r u p t i v e behaviour. He perceived t h a t moral d i s c i p l i n e , e s p e c i a l l y i n the form of k i n d l y d i r e c -t i o n , had an impact on l u n a t i c s comparable to i t s i n f l u e n c e on healthy i n d i v i d u a l s , and thus i t should not be neglected. Employment was a powerful th e r a p e u t i c device, and he i l l u s t r a t e d i t s p o t e n t i a l by r e f e r r i n g to a German p h y s i c i a n who harnessed a number of inmates to a c a r t laden w i t h wood and had them p u l l i t around a designated t r a c k i n the asylum grounds f o r s e v e r a l 91 hours each day. He a l s o approved of harmless methods of i n t i m i d a t i o n , such as t h r e a t s of recourse to s t r a i t - j a c k e t s or the use of c o l d showers. B u c k n i l l and Tuke agreed with P r i c h a r d ' s system o f treatment. The f i r s t object i n c a r i n g f o r acute cases was to remove a l l causes of excitement through the a p p l i c a t i o n of e s t a b l i s h e d p r i n c i p l e s of hygiene and the occa-s i o n a l medicinal agent. Only i n l a t e r stages were s p e c i f i c a l l y moral tech-niques u s e f u l , e s p e c i a l l y i n connection with a t o n i c regimen and "the 92 d i l i g e n t a p p l i c a t i o n of c o u n t e r - i r r i t a n t s to the s c a l p . . . " Once again,. the combination of medical remedies and moral treatment was taken f o r granted. Indeed, i n B u c k n i l l and Tuke, the d i s t i n c t i o n between moral and p h y s i c a l treatment becomes d i f f i c u l t to d i s t i n g u i s h because they were so determined to c l a i m p h y s i o l o g i c a l e f f e c t s from manipulation of psychic f a c t o r s , and mental 93 improvement from the a p p l i c a t i o n of p h y s i c a l remedies. This b l u r r i n g o f the d e f i n i t i o n o f what c o n s t i t u t e d moral treatment l e d B u c k n i l l and Tuke to advocate a form of management th a t was more a c t i v e and i n t e r v e n t i o n i s t . They argued that "to remove the causes of c e r e b r a l 55 excitement i s not moral treatment; and even to be kind and g e n t l e i n word and deed to the insane, cannot r i g h t l y be c a l l e d moral, but p h y s i o l o g i c a l t r e a t -ment." Thus, t r u l y moral means had to be defined as the i n d i v i d u a l i z e d 94 treatment "recommended by the wise and experienced p h y s i c i a n of Hanwell." What i s t h i s i n d i v i d u a l i z e d treatment...but the i n f l u e n c e of a sane mind p e c u l i a r l y apt to express i t s e l f b e n e f i c i a l l y upon the insane mind, that i s , moral treatment, or more s t r i c t l y speaking, i n t e l l e c t u a l and moral treatment...any o f f i c e r , who i s s u c c e s s f u l i n the management of the insane, who d a i l y impresses upon them the i n f l u e n c e of h i s own character to t h e i r improvement, undoubtedly p r a c t i s e s moral t r e a t m e n t . ^ The c u r a t i v e e f f e c t was derived from the q u a l i t y of the sane mind which made the impression. Thus the person wishing to embark on such a program of care had to possess a h i g h l y developed character and powers of i n s i g h t and personal d i s c i p l i n e i n order to make c o r r e c t e s t i m a t i o n s of the type and extent of i n s a n i t y he was approaching, as w e l l as s u f f i c i e n t i n t u i t i o n to know which emotions to encourage or develop, and which should be discouraged by d i s t r a c t i o n or r e p r e s s i o n . A f a c u l t y of seeing that which i s passing i n the minds of men i s the f i r s t requirement of moral power and d i s c i p l i n e , whether i n asylums, schools, parishes or elsewhere. Add to t h i s a f i r m w i l l , the f a c u l t y of s e l f c o n t r o l , a sympathising d i s t r e s s at moral pain, a strong d e s i r e to remove i t ; and that f a s c i n a t i n g b i o l o g i z i n g power i s e l i c i t e d , which enables men to domineer f o r good purposes over the minds of others. Without these q u a l i t i e s , no man can be p e r s o n a l l y s u c c e s s f u l i n the moral treatment of the insane... That so much of i t can be so w e l l done v i c a r i o u s l y by o r d e r l y attendants i s a most happy circumstance f o r mental s u f f e r e r s , and proves that the possession, at l e a s t i n a moderate degree, of the q u a l i t i e s i n d i s c u s s i o n , are c o n s i s t e n t w i t h a defec-t i v e education and a lowly s o c i a l rank. Moral treatment " i s education a p p l i e d to a f i e l d of mental phenomena extend-97 i n g beyond the normal s i z e by the breaking down of a l l the usual l i m i t s . " I t r e q u i r e d the s p e c i a l f a c i l i t y of an i n s p i r e d medical p s y c h o l o g i s t to be e f f i c i e n t l y and e f f e c t i v e l y employed. 56 B u c k n i l l and Tuke closed t h e i r d i s c u s s i o n o f treatment procedures w i t h some remarks on r e s t r a i n t . They suggested that i t should only be used i n e x c e p t i o n a l and desperate cases; i t was a barbarous remedy, l i k e cautery, 98 which could not be discarded. This r e l u c t a n c e to e l i m i n a t e recourse to r e s t r a i n t was an expression of contemporary o p i n i o n that t o t a l n o n - r e s t r a i n t was a p r a c t i c a l a l t e r n a t i v e , but no methods of p a t i e n t c o n t r o l , e s p e c i a l l y i f i t might s t i l l be j u s t i f i e d as t h e r a p e u t i c , should be discard e d . The r a t i o n a l e of moral treatment was based on a b e l i e f t h a t emotions r e c e i v e d reinforcement from t h e i r expression, so that i f they were repressed, the emotions would weaken and d i s s i p a t e . I t was t h e o r e t i c a l l y p o s s i b l e that p h y s i c a l r e s t r a i n t was an e f f i c a c i o u s methods of in d u c i n g emotional c o n t r o l . S t i l l , B u c k n i l l and Tuke appear to have been more e n t h u s i a s t i c about ' the t h e r a p e u t i c e f f e c t of n o n - r e s t r a i n t . P h y s i c a l r e s t r a i n t i n v o l v e d an appeal to fear which was to be considered the lowest motive of the insane. I t s a b o l i t i o n r e q u i r e d an appeal to higher impulses. " I t was the b r u t a l i s -i n g i n f l u e n c e of f e a r , and the degrading sense of shame, which c o n s t i t u t e d 99 the true v i r u s of mechanical r e s t r a i n t . " B u c k n i l l and Tuke's opinions on the use of r e s t r a i n t are r e p r e s e n t a t i v e of the main body of asylum p h y s i c i a n s p r a c t i s i n g i n m i d - V i c t o r i a n England. N o n - r e s t r a i n t was an i d e a l , perhaps achievable i n a l a r g e number of s i t u -a t i o n s , but i m p r a c t i c a b l e when d e a l i n g w i t h the r e f r a c t o r y p a t i e n t . A n o t i o n of h i e r a r c h y d i d o b t a i n i n t h e i r t h i n k i n g : B u c k n i l l and Tuke recog-n i z e d Conolly's basic p r i n c i p l e that the highest and best behaviour could only be produced by the most r e f i n e d forms o f treatment. A f f e c t i o n was a b e t t e r motivator than f e a r , and g r a t i t u d e more e f f e c t i v e than resentment. However, even by 1858, i t was c l e a r that the l e v e l s of s t a f f i n g which were 57 necessary to the f u l f i l l m e n t of the n o n - r e s t r a i n t system were not forthcoming, and B u c k n i l l and Tuke r e f l e c t e d a p r o f e s s i o n a l consensus that order and acquiescence could only be maintained at some cost to the emotional w e l l -being of the p a t i e n t s . I t may have been a d e s i r e to compensate f o r t h e i r descent towards prag-matics which induced B u c k n i l l and Tuke to wax so elo q u e n t l y on the personal requirements of the p h y s i c i a n - a d m i n i s t r a t o r . The c e n t r a l p o s i t i o n o f the asylum doctor had been an axiom of medical psychology s i n c e P i n e l , and, no doubt, the p e r s i s t e n c e of the theme i n the l i t e r a t u r e of moral management owed something to the d e s i r e of l u n a c y - s p e c i a l i s t s to l a y c l a i m to the f r u i t s of the e x p e r t i s e . By 1858, doctors were i n f i r m c o n t r o l of most i n s t i t u t i o n s devoted to the care of the insane, and, because of the growth of the inspec-t o r a t e , p h y s i c i a n s were overseeing the treatment of l u n a t i c s i n v i r t u a l l y a l l l o c a t i o n s i n which they were to be found."""^ B u c k n i l l and Tuke's paean to the i n e s t i m a b l e character of the moral manager cannot be accounted f o r s o l e l y on the grounds of p r o f e s s i o n a l advan-tage. In a d d i t i o n , i t would seem to have been an expression of a fundamental element of moral management theory, which was that a l l men l e a r n by example, and that the asylum was at i t s best l i k e an organism, d i r e c t e d from the top by a mind and heart w e l l - t r a i n e d and s p e c i f i c a l l y equipped f o r the enter-p r i s e . Just as the mind and body of the madman were to be renewed i n a harmonious co n j u n c t i o n by the e f f e c t s of the whole range of asylum t h e r a -p e u t i c s , so the i n s t i t u t i o n i t s e l f was to demonstrate the i n f l u e n c e of c h a r a c t e r , breeding, and education over i t s e s s e n t i a l but less-endowed members. Conolly transformed the e m p i r i c a l r e s u l t s of Gardiner H i l l ' s w e l l - i n t e n t i o n e d experiment i n t o the apotheosis of moral management by making 58 c l e a r the connection between t o t a l n o n - r e s t r a i n t and the i n s p i r a t i o n a l , a l l - e m b r a c i n g f i g u r e of the p h y s i c i a n - a d m i n i s t r a t o r , whose personal q u a l i t i e s of forbearance, wisdom, and s e l f - c o n t r o l were to s u b s t i t u t e f o r manacles and s t r a i t - j a c k e t s . The asylum p h y s i c i a n s of the f i r s t h a l f of the nineteenth century have been c r i t i c i z e d f o r having manufactured a t h e o r e t i c a l system i n order t o j u s t i f y t h e i r u t i l i z a t i o n of a s e r i e s of management techniques which lacked p r i o r i n t e l l e c t u a l content. However, t h i s survey of w r i t e r s on lunacy and i t s treatment suggests that moral management theory and p r a c t i c e developed i n connection w i t h one another, that the refinement of the a d m i n i s t r a t i v e aspects was penetrated by the i n c r e a s i n g l y complex formulations about the i n e x p l i c a b l e mental and p h y s i c a l phenomena which comprised the o b j e c t s of c o n t r o l and r e v i s i o n . I t i s p o s s i b l e to recognize i n these w r i t i n g s at l e a s t a rudimentary interdependence between t h e o r i e s of disease and treatment and the recorded asylum p r a c t i c e s , based as they were upon an unresolvable conundrum concerning the r e a l character of the mind and the body. The meshing of mental and p h y s i c a l i n the t h e o r e t i c a l d i s c u s s i o n mir-rored the i n t e r p e n e t r a t i o n of the p s y c h o l o g i c a l and the p r a c t i c a l w i t h i n moral management. However, the dichotomies between the moral and the p h y s i c a l , and mind and body, at the b a s i s of the t h e o r e t i c a l framework, were i n the end i n s o l u b l e . V i c t o r i a n p h y s i c i a n s were entranced by a disease l i k e the general p a r a l y s i s of the insane, which provided them w i t h an apparent connection between progressive motor and mental degeneration and s p e c i f i c 101 organic l e s i o n s which were manifest upon autopsy. Most of the time, they were forced to deal w i t h a nebulous e n t i t y l i k e moral i n s a n i t y , which had to be a t t r i b u t e d to a " l e s i o n of the w i l l " , a f o r m u l a t i o n i n which moral 59 and p h y s i c a l c a t e g o r i e s were mixed but not c l a r i f i e d . I t i s p o s s i b l e , sometimes, to describe the language of the moral managers used i n the con-s t r u c t i o n of t h e i r t h e o r i e s as metaphorical; i t was, at the very l e a s t , analogous and l e s s o f t e n as e m p i r i c a l as they d e s i r e d i t should be. This was i n keeping w i t h the s o c i a l nature of t h e i r program, which r e q u i r e d that the theory and p r a c t i c e remain ambiguous to a degree because such i n d e t e r -minancy provided a space by which s p e c u l a t i o n and i m p r o v i s a t i o n could occur. This o u t l i n e of the t h e o r e t i c a l background of the asylum p h y s i c i a n s explored three elements which helped to make up the discourse o f moral management. The discourse of the moral managers was c o n s t i t u t e d i n part by the i n t e r r e l a t i o n s h i p s between the d e f i n i t i o n of the mind-body connection, the d e l i n e a t i o n of moral and p h y s i c a l c a u s a t i o n , and the p r o v i s i o n s f o r treatment which were devised by asylum doctors such as Burrows and E s q u i r o l . John Conolly's most exhaustive c o n t r i b u t i o n s to that discourse are found i n h i s w r i t i n g s on asylum management, which w i l l be explored i n more d e t a i l i n the next chapter. 60 CHAPTER I I I JOHN CONOLLY: FROM MORAL MANAGEMENT TO NON-RESTRAINT . . . r e s t r a i n t v i t i a t e s e v e r y t h i n g , n e u t r a l i z e s a l l moral t r e a t -ment.... I t i s not so where the p a t i e n t s are t r e a t e d w i t h uniform k i n d n e s s — I would say l i k e c h i l d r e n ; but I ought r a t h e r to say l i k e human beings. ^ John Conolly John Conolly's achievements i n asylum management were h i g h l y regarded during h i s l i f e t i m e , and they have continued to occupy an eminent p o s i t i o n i n t r a d i t i o n a l c h r o n i c l e s of the care of the insane. Less n o t i c e has been taken of h i s w r i t i n g s on asylum o r g a n i z a t i o n or h i s t h e o r i e s of mental f u n c t i o n i n g . Recently, Andrew S c u l l produced a lengthy c r i t i q u e of Conolly as an advocate of moral management, f o c u s i n g upon some of h i s e a r l y w r i t i n g s and c o n t r a s t i n g these w i t h h i s l a t e r a c t i v i t i e s . S c u l l ' s approach has l i m i t a t i o n s which w i l l be explored i n a s e c t i o n of t h i s chapter, but because h i s argument i s based l a r g e l y upon an examination of Conolly's career, i t i s important to begin w i t h a short biography and then proceed w i t h an o u t l i n e of Conolly's 2 p r i n c i p a l works seen i n r e l a t i o n to the major events of h i s career. In a d d i t i o n , h i s approach to moral management must be considered i n r e l a t i o n to the d i s c u r s i v e s t r a t e g i e s o u t l i n e d p r e v i o u s l y , from which h i s understanding of moral treatment was c o n s t i t u t e d . I John Conolly was born i n Market Rasen, L i n c o l n s h i r e , i n 1794, the second son of an impoverished I r i s h gentleman who died s h o r t l y a f t e r John's b i r t h . Conolly's mother, a member of the Tennyson f a m i l y before her marriage, was l e f t d e s t i t u t e , and as a r e s u l t she allowed her e l d e s t son to be adopted 61 by h i s grandmother. John remained w i t h her u n t i l he was sent to school i n H u l l at the age of s i x , and he described h i s e a r l y education as miserable and inadequate. However, at age t h i r t e e n , he was able to r e t u r n t o h i s mother who had married again, t h i s time to an emigre Scot from France who p e r s o n a l l y supervised Conolly's s c h o o l i n g . During the next f i v e years, Conolly read widely i n the c l a s s i c s and i n French and E n g l i s h philosophy and l i t e r a t u r e . In 1812, he took a commission i n the Cambridgeshire m i l i t i a and spent the next four years with h i s u n i t t r a v e l l i n g throughout the B r i t i s h I s l e s . A f t e r h i s marriage to E l i z a C o l l i n s , the daughter of a Royal Navy c a p t a i n , in'i.T>816, the couple spent a year or two i n France w i t h Conolly's brother, W i l l i a m , a p h y s i c i a n w i t h a p r a c t i c e i n the L o i r e r e g i o n . In 1818, having decided to make medicine h i s p r o f e s s i o n , Conolly e n r o l l e d i n the u n i v e r s i t y medical school i n Glasgow. During h i s year i n the c i t y , he v i s i t e d Glasgow Royal Asylum and read Samuel Tuke's famous account of the founding of a F r i e n d s ' Asylum at York, The D e s c r i p t i o n of the Retreat. In 1822, he completed h i s education at Edinburgh U n i v e r s i t y , w i t h a graduating essay e n t i t l e d De S t a t u .Mentis-in Insania et Melancholia. While i n Edinburgh, he was drawn to the p h i l o s o p h i c a l works of Dugald Stewart, one of Adam Smith's fervent admirers. Stewart was to remain a major reference f o r Conolly. In a d d i t i o n , Conolly was introduced to the p h r e n o l o g i s t s , George and Andrew Combe, whose t h e o r i e s about c e r e b r a l and mental f u n c t i o n i n g played an important r o l e i n the formation of h i s a t t i t u d e s towards lunacy and i t s treatment. Conolly f i r s t attempted to set up a p r a c t i c e at Lewes, but he was unsuc-c e s s f u l and moved to Chichester i n 1823. There he became a f r i e n d o f John Forbes, w i t h whom he shared the e d i t o r s h i p of p u b l i c a t i o n s l i k e the B r i t i s h 62 and Foreign Medical Review and the Cyclopedia of P r a c t i c a l Medicine. Since there was a l a c k of s u f f i c i e n t employment f o r two p h y s i c i a n s i n C h i c h e s t e r , he moved again to S t r a t f o r d . There he appears to have been w e l l - r e s p e c t e d . He was twice mayor, he e s t a b l i s h e d a dispensary, l e c t u r e d to the Mechanics' I n s t i t u t e , and was engaged as a v i s i t i n g i n s p e c t o r to the p r i v a t e asylums of Warwickshire. Conolly was not pleased by the c o n d i t i o n s he found i n the l o c a l f a c i l i t i e s , but he recognized that they were t y p i c a l of the standard of care that could be expected i n such i n s t i t u t i o n s at that time. During h i s residence i n S t r a t f o r d , he made the acquaintance of Dr. George 3 Birkbeck, who introduced Conolly to the Mechanics' I n s t i t u t e movement and to Lord Brougham, the great Whig p o l i t i c i a n who was deeply i n v o l v e d i n s o c i a l improvement a c t i v i t i e s . One of Brougham's most important p r o j e c t s i n the 1820's concerned the establishment'of a non-sectarian u n i v e r s i t y i n London, which came to f r u i t i o n i n the l a t e 1820's. A medical school was i n c l u d e d i n t h i s venture, and because of h i s acquaintance w i t h Brougham, Conolly was given the p o s i t i o n as L e c t u r e r i n C l i n i c a l Medicine. In p r e p a r a t i o n f o r h i s l e c t u r e s h i p , Conolly made a tour of French medical schools and a l s o v i s i t e d the asylum at Charenton, where E s q u i r o l was the c h i e f p h y s i c i a n . He returned to London i n 1827 and devoted h i m s e l f to h i s teaching, l e a v i n g no time to maintain an a c t i v e p r a c t i c e . He was able to continue w r i t i n g f o r the S o c i e t y f o r the D i f f u s i o n of Useful Knowledge, and through them c o n t r i b u t e d some a r t i c l e s to the Penny Magazine and another of t h e i r p u b l i c a t i o n s , the Working Mens' Companion of which Charles Knight, the e d i t o r of the Penny  Magazine, thought h i g h l y . Conolly a l s o formed a c l o s e f r i e n d s h i p with Thomas Coates, then the s e c r e t a r y of the SDUK. 63 Conolly's a s s o c i a t i o n w i t h London U n i v e r s i t y ended with h i s r e s i g n a t i o n i n 1831. The e a r l y years of the i n s t i t u t i o n were overshadowed by endemic i n t e r n e c i n e squabbling, and Conolly became embroiled i n a number of disputes 5 w i t h the governing c o u n c i l . He was a l s o very f r u s t r a t e d by the u n w i l l i n g -ness of the u n i v e r s i t y to make a v a i l a b l e adequate f a c i l i t i e s f o r c l i n i c a l t e aching, as w e l l as by i t s f a i l u r e to respond to h i s o f f e r to l e c t u r e on the subject of i n s a n i t y . Conolly's other problems were f i n a n c i a l : because he d i d not e s t a b l i s h an independent p r a c t i c e , h i s income was confined to the per c a p i t a payments of the students, and these were i n s u f f i c i e n t to support h i s growing f a m i l y . In 1831, Conolly moved to Warwick, where he was to remain u n t i l 1839. While the f i n a n c i a l gains of h i s p r a c t i c e were adequate but not outstanding, the l o s s of much i n t e l l e c t u a l and s o c i a l s t i m u l a t i o n consequent upon h i s move from London made him r a t h e r despondent. Thus, i n 1838, when a vacancy occurred i n the post of a t t e n d i n g p h y s i c i a n at Hanwell, the p u b l i c asylum i n Middlesex which had been founded i n 1831, he a p p l i e d f o r the p o s i t i o n , I t was awarded in s t e a d to John M i l l i n g e n , an ex-army surgeon, but h i s super-intendency was so d i s r u p t i v e that he l a s t e d only one year, and Conolly's second a p p l i c a t i o n was accepted. To prepare f o r h i s new job, Conolly v i s i t e d Robert Gardiner H i l l , the a t t e n d i n g surgeon at the small p r i v a t e asylum at L i n c o l n H i l l , who had stopped us i n g p h y s i c a l r e s t r a i n t i n h i s asylum some two years p r e v i o u s l y , and who was enjoying c o n s i d e r a b l e success i n h i s new system of management. A few months a f t e r t a k i n g up h i s post at Hanwell on June 1, 1839, i n h i s f i r s t r eport to the County Quarter Session i n September, he declared that no form of p h y s i c a l r e s t r a i n t had been used on any p a t i e n t f o r over two 64 months. This remained the standard of care f o r a l l p a t i e n t s throughout Conolly's a s s o c i a t i o n with Hanwell. Because of h i s connections i n London, e s p e c i a l l y w i t h Thomas Wakley, e d i t o r of the Lancet, and the advocacy o f Mr. Sergeant Adams, the governor of Hanwell, the p u b l i c was soon made aware of Conolly's achievement. For the next f i v e years, w h i l e he remained the super-intendent of the asylum, he worked to expand the e d u c a t i o n a l , v o c a t i o n a l , and r e c r e a t i o n a l f a c i l i t i e s of the i n s t i t u t i o n . He began a s e r i e s o f l e c t u r e s to medical students considered to be one of the e a r l i e s t courses i n mental science ever given. His plan of care f o r the insane d i d not meet w i t h com-p l e t e p r o f e s s i o n a l acceptance, but i t s p r i n c i p l e s were endorsed by the Par-liamentary Committees of 1844 and were made part of the b i l l r egarding p r o v i s i o n of care and the e r e c t i o n of asylums which was passed i n 1848. This b i l l was the l e g a l foundation of the p u b l i c asylum system. A f t e r 1844, an a d m i n i s t r a t i v e r e o r g a n i z a t i o n by the governors r e s u l t e d i n the removal of Conolly from d i r e c t c o n t r o l over asylum maintenance although he continued on as v i s i t i n g p h y s i c i a n . In th a t c a p a c i t y , he v i s i t e d the wards and gave advice on treatment and management, and he continued to f i g u r e i n the re p o r t s to the magistrates as an advocate of expanded s e r v i c e s . He a l s o began to l e c t u r e and w r i t e again p r o l i f i c a l l y , and the second of h i s books, The Construction and Government of Lu n a t i c Asylums, a very s p e c i f i c and d e t a i l e d a d m i n i s t r a t i v e t r e a t i s e , complete with a r c h i t e c t u r a l drawings of model asylums, was published i n 1847. A s e r i e s of c l i n i c a l l e c t u r e s on i n s a n i t y was featured by the Lancet i n 1845 and 1846, and, i n 1848, he gave the Croonian Lectures to the RCP. Toward the end of t h i s p e r i o d , h i s h e a l t h began to f a i l , and he r e t i r e d to the p o s i t i o n of c o n s u l t i n g p h y s i c i a n to Hanwell, which e f f e c t i v e l y ended h i s d i r e c t involvement w i t h that i n s t i t u t i o n . 65 For the l a s t f i f t e e n years of h i s l i f e , Conolly continued to be i n the p u b l i c eye, p u b l i s h i n g i n 1856, another book, T r e a t i s e on the Treatment of the Insane Without Mechanical R e s t r a i n t s , which argued powerfully f o r the r e j e c t i o n of methods of p h y s i c a l r e s t r a i n t . This was i n r e a c t i o n to h i s perception of an increase i n the use of these methods. He t e s t i f i e d i n s e v e r a l famous c r i m i n a l i n s a n i t y t r i a l s and was featured i n a number of dubious c e r t i f i c a t i o n d i s p u t e s . He a l s o published f r e q u e n t l y i n medical j o u r n a l s and wrote e x t e n s i v e l y f o r the p u b l i c . He was made the subject of 7 s a t i r e i n Charles Reade's Hard Cash. At the same time, Conolly was the r e c i p i e n t of p u b l i c and p r o f e s s i o n a l t e s t i m o n i a l s to h i s achievement, most notably from Lord Ashley. He maintained an extensive c o n s u l t i n g p r a c t i c e , and i t i s i n t h i s l a t e r period of h i s l i f e t h a t he became as s o c i a t e d w i t h the p r i v a t e asylum system, both i n p a r t n e r s h i p w i t h h i s brother i n one house at Hayes Park and a l s o t a k i n g p r i v a t e p a t i e n t s i n t o h i s care a t Lawn House. I I Conolly's a c t u a l experience as a moral manager began when he was already well-advanced i n years. In the years a f t e r 1839, Conolly was always to be i n v o l v e d , to at l e a s t some degree, i n asylum management; h i s most a c t i v e period as a moral manager was confined to h i s f i r s t f i v e years at Hanwell. This l a t e a r r i v a l i n the f i e l d of asylum medicine i s a key f a c t o r i n Andrew S c u l l ' s a n a l y s i s of Conolly's career. S c u l l argues that Conolly's acceptance of the superintendancy at Hanwell was provoked by personal concerns (espe-Q c i a l l y f i n a n c i a l ) , r a t h e r than p r o f e s s i o n a l i n c l i n a t i o n . Much of the b a s i s f o r S c u l l ' s contention l i e s i n h i s examination of Conolly's 1830 p u b l i c a t i o n , the I n q u i r y Concerning the .In d i c a t i o n s 'of I n s a n i t y , w r i t t e n during h i s tenure .at 66 London U n i v e r s i t y . However, i t should be remembered t h a t , i n Conolly's works, there i s ample evidence of a l i f e l o n g preoccupation w i t h the treatment of i n s a n i t y . The most r e v e a l i n g i n d i c a t i o n of h i s e a r l y concern with lunacy i s Conolly's graduating essay from Edinburgh, w r i t t e n i n 1822 and e n t i t l e d De  S t a t u Mentis i n Insania et Melancholia. This document deserves some a t t e n t i o n as a precursor of the I n q u i r y as i t touches on s e v e r a l themes which prove to be c h a r a c t e r i s t i c of Conolly's mature approach to questions about mental f u n c t i o n i n g and t h e r a p e u t i c technqiue. The t i t l e page of Conolly's essay h i g h l i g h t e d a quote from P i n e l : Dans c e t t e maladie comme dans beaucoup d'autres, . l ' h a b i l i t e du medecin c o n s i s t e moins dans 1 'usage re'pe'te' des remedes, que dans l ' a r t profondernent combine'd'en user a propos ou de s'en a b s t e n i r . ^ 1 By appending such a remark from P i n e l , Conolly showed h i s sympathy with one of the major tenets of moral management—that treatment of i n s a n i t y should not c o n s i s t p r i m a r i l y of the a d m i n i s t r a t i o n of time-honoured nostrums s e l e c t e d i n accordance w i t h an out-dated understanding of mental disease. Instead, the p h y s i c i a n must be s e n s i t i v e to the p a r t i c u l a r f a c e t s of the i l l n e s s as i t was manifested i n i n d i v i d u a l p a t i e n t s . The quotation seems to endorse a conservative approach to t h e r a p e u t i c technique f o r a l l i l l n e s s e s . Conolly favoured t h i s view throughout h i s p r o f e s s i o n a l career. Conolly began w i t h a b r i e f statement d e s c r i b i n g the method he con-s i d e r e d to be the most productive f o r the understanding of i n s a n i t y . Just as any p h y s i c i a n would base h i s understanding of a p h y s i c a l i l l n e s s upon h i s knowledge of the workings of the healthy body, so should a doctor con-cerned w i t h "the m a l f u n c t i o n i n g of the mind" begin w i t h a c o n s i d e r a t i o n of i t s h ealthy s t a t e . A c c o r d i n g l y , Conolly proceeded to o u t l i n e what he 67 conceived to be the e s s e n t i a l f u n c t i o n s of s a n i t y . These included memory, the a b i l i t y to perceive e x t e r n a l s e n s a t i o n s , the a b i l i t y to conceive new id e a s , to compare and d i f f e r e n t i a t e between sensations, and to "judge w e l l , 12 and [ i n so doingj] to act with wisdom." He then acknowledged that the human mind develops throughout l i f e and o u t l i n e d the successive changes which could be expected to take place as an i n d i v i d u a l matured. He concluded that a s o r t of mental r e s t r a i n t was necessary f o r s a n i t y , so that when such c o n t r o l was l o s t , lunacy was manifested. Conolly was concerned that mental disease not be regarded as a s i n g l e e n t i t y , absolute i n i t s d i f f e r e n c e from mental h e a l t h . Symptoms of s a n i t y and i n s a n i t y could c o e x i s t i n the same person, and many l u n a t i c s were not continuously insane. Geographical f a c t o r s could i n f l u e n c e the mind. As examples, he suggested the frequency o f i n s a n i t y i n c o u n t r i e s where d i s a s t e r s had occurred or where people are encouraged to be emotionally e x c i t a b l e . He declared that i n s a n i t y was ra r e i n c o u n t r i e s where s t r e s s was placed upon the c u l t i v a t i o n of the mind. Conolly then provided a n o s o l o g i c a l t a b l e which he described as being of h i s own d e v i s i n g , but which can be seen to have drawn upon the incidence of impairment of the major mental f a c u l t i e s , comprising Imagination, Memory, Judgement, and A t t e n t i o n . These were standard terms u t i l i z e d throughout the eighteenth century when speaking of the f a c u l t i e s . In a d d i t i o n , he employed the conventional d i v i s i o n of types of i n s a n i t y i n t o mania and melancholia, using W i l l i a m C u l l e n as a source f o r h i s d i s c u s s i o n of melancholia but o m i t t i n g mania almost e n t i r e l y f o r want of space. The f i n a l s e c t i o n of h i s essay discussed methods o f t r e a t i n g the insane. He began by r e f e r r i n g to the obvious but poorly-understood r e l a t i o n between mental i l l n e s s and the s t a t e of the body, and went on to endorse e x p l i c i t l y 68 the techniques employed at the Retreat. He emphasized the importance of the ph y s i c i a n ' s r o l e i n the p r o v i s i o n of moral treatment: he must be a man of humanity, mental h e a l t h , d i s t i n g u i s h e d c h a r a c t e r , and good judgement. Conolly emphasized "how much [could] be accomplished through a t t e n t i o n to the a b i l i t i e s of the mind," c i t i n g cases from the Retreat, and concluding that "insane people can o f t e n r e s t r a i n themselves, and t h e r e f o r e we should a s s i d u -13 ously urge and encourage them to do so." Conolly had l i t t l e to say about the c o n d i t i o n s of asylum l i f e as he had observed them, but quoted one of E s q u i r o l ' s remarks which described the asylum as a place where " l e s l i e n s sociaux sont b r i s e s , l e s ami t i e s cessent, l a confiance est d e t r u i t e , l e s / / / habitudes sont changees; on a g i t sans bienseance, on ob e i t par c r a i n t e , on n u i t sans haine; chacun a ses idees, ses pense'es, ses a f f e c t i o n s , son langage, / 14 chacun v i t pour s o i , l'egoisme i s o l e t o u t . " On the ba s i s of these remarks, Conolly suggested that convalescents should be removed from the asylum i n order to complete t h e i r recovery. His l a s t remarks r e f e r r e d to the importance of proper education f o r c h i l d r e n s u s c e p t i b l e to h e r e d i t a r y i n s a n i t y , as i t was p o s s i b l e to i d e n t i f y i n t h e i r e a r l y forms the signs of i n c i p i e n t madness, and the e a r l i e r the i l l n e s s could be t r e a t e d , the b e t t e r the chance f o r recovery. Insania et Melancholia can be seen as an e a r l y expression o f s e v e r a l t h e o r e t i c a l and th e r a p e u t i c p r i n c i p l e s to which Conolly adhered throughout h i s l i f e t i m e . His understanding of mental f u n c t i o n i n g remained s t r u c t u r e d around a model o f f a c u l t i e s i n a l l of h i s l a t e r work, whether d i a g n o s t i c or e x p o s i t o r y . He always argued that madness was, i n some fundamental way, a p h y s i c a l disease, although i t s causes and ma n i f e s t a t i o n s might be only i d e n t i f i a b l e as p s y c h o l o g i c a l , and that e f f e c t i v e treatment must combine 69 a t t e n t i o n to mental and p h y s i o l o g i c a l d i s o r d e r s . He r e t a i n e d a commitment to the e f f i c a c y and the "humanity" of the p r a c t i c e s at the Retreat and the tenets upon which i t was based. Above a l l , C o nolly continued to emphasize the c e n t r a l i t y of the p h y s i c i a n as guide and model i n the c u r a t i v e process. Conolly's next major work on i n s a n i t y was the Inquiry Concerning the I n d i -•15 c a t i o n s of. I n s a n i t y , .published i n 1830. I t begins, w i t h the f u l l e s t - t r e a t m e n t of human psychology that Conolly produced, d e l i n e a t e d i n the context o f a problem of d i a g n o s t i c p r a c t i c e r e l a t i n g to confinement. I t a l s o contains some notable animadversions on the subject of the asylum. In b r i e f , Conolly made i t c l e a r that he considered an insane asylum to be no place f o r a curable l u n a t i c . Thus consigned, the madman was deprived of any i n f l u e n c e from healthy minds, and h i s i l l n e s s would only i n t e n s i f y with prolonged contact with other diseased minds. Not only would he adopt new forms of aberrant behaviour that he had acquired by obse r v a t i o n , but, i n Conolly's view, the d i s o r d e r l y atmosphere of the asylum i t s e l f augmented h i s i n t e r i o r d i s o r g a n i z a -t i o n and f u r t h e r weakened h i s w i l l to r e s i s t those i n f l u e n c e s . I f , by some chance, he should begin to recover, the l i k e l i h o o d was very great of h i s wi t n e s s i n g some h o r r i b l e outburst that would upset what tenuous hold h i s reason had resumed, and he would d e t e r i o r a t e even f u r t h e r . Worst of a l l , he might recover but have h i s recovery ignored because the p h y s i c i a n v i s i t e d the asylum so i n f r e q u e n t l y . Thus h i s confinement would be prolonged, h i s per-manent h e a l t h impaired, and c e r t a i n l y h i s moral and l e g a l r i g h t to freedom 16 would continue to be abrogated. According to Conolly, the "lamentable" s t a t e of asylum management was at the root of these problems. Contemporary care of the insane was i t s e l f d e r ived from "erroneous" views of mental d i s o r d e r . For Conolly, the most 70 important defect i n current asylum p r a c t i c e was that treatment was gener-a l i z e d when i t should have been s p e c i f i c . Each i n d i v i d u a l l u n a t i c must be seen to d i f f e r , j u s t as healthy i n d i v i d u a l s d i f f e r — i n t h e i r c h a r a c t e r s , h a b i t s , and b e l i e f s , and those elements were ignored i n or d i n a r y asylum prac-t i c e s . A l l p a t i e n t s were subjected to the same regimen, a regimen which was e s p e c i a l l y abhorrent to Conolly. The p a t i e n t s were ble d , s t r a i t - j a c k e t e d , and had t h e i r heads shaved. They were purged, subjected to c o l d shower-bathing, fed a minimal d i e t , and kept i n darkness. " S t a r v a t i o n , imprisonment, l o n e l i n e s s , and t h r e a t s are then r e s o r t e d t o ; or i f the p r o p r i e t o r happens to be very alert...some u n j u s t i f i a b l e experiment i s t r i e d ; w h i r l i n g round upon a h o r i z o n t a l wheel, i n t o x i c a t i o n , or some strange method of a s t o n i s h i n g 17 the p a t i e n t . . . . " The l u n a t i c , Conolly argued, might w e l l respond to t h i s abuse by l e a r n i n g to d i s g u i s e h i s i l l n e s s so as to avoid treatment. Furthermore, s i n c e p a t i e n t s i n a l l degrees and types of d i s o r d e r were grouped together, the l e s s deranged and convalescent were subject to the i n f l u e n c e of the i n c u r a b l y maniacal. There was, he emphasized, l i t t l e i n the way of a c t u a l mental therapy, which would n e c e s s i t a t e c a r e f u l a t t e n t i o n to remaining f u n c t i o n s . In h i s view, the attendants were i l l - e d u c a t e d , rough, and unsympathetic. Often medical attendance was perfunctory: the p r o p r i -e t o r s had an i n t e r e s t i n mai n t a i n i n g the i l l n e s s so as t o keep a paying p a t i e n t i n the asylum. Moreover, he argued, the accommodations were o f t e n inadequate and unsuited to the care of the insane. Not only d i d a l l t r e a t -ment of lunacy i n v o l v e r e s t r a i n t i n the form of confinement i n an asylum, but i t a l s o depended upon the a p p l i c a t i o n of p h y s i c a l methods of c o n t r o l which were o f t e n unnecessary or prolonged beyond the poi n t of u t i l i t y . Conolly argued that a l l these f a u l t s would p e r s i s t u n t i l p h y s i c i a n s began to study 71 the mind and i t s c o r p o r e a l seat, the b r a i n , i n order to discover the a c t u a l c o n s t i t u e n t s of mental i l l n e s s from which a r a t i o n a l t h e r a p e u t i c could be c o n s t r u c t e d . ^ The Inquiry was remarkable c h i e f l y f o r i t s condemnation o f the asylum as a th e r a p e u t i c i n s t i t u t i o n . That i t was unusual, indeed unfashionable, f o r e a r l y nineteenth-century p h y s i c i a n s i n t e r e s t e d i n lunacy treatment to denigrate asylum care i s j u s t one of the s u r p r i s i n g features of Conolly's r e a c t i o n . I m p l i c i t i n h i s argument was a d i s t r u s t o f the contemporary prac-t i c e of medicine i n r e l a t i o n to the insane, and a r a d i c a l s k e p t i c i s m regard-i n g the s o c i a l a t t i t u d e s which c o n t r i b u t e d to the d e f i n i t i o n s of i n s a n i t y and which shaped the accepted modes of treatment. However, i t should be r e c a l l e d that Conolly had e s t a b l i s h e d the context f o r h i s c r i t i c a l a t t i t u d e . He expressed d i s g u s t w i t h the asylum as i t was then being managed; he b e l i e v e d that c o n d i t i o n s w i t h i n the i n s t i t u t i o n made i t u n f i t as a t h e r a p e u t i c s i t e . Nowhere d i d Conolly deny the importance o f medical attendance f o r the insane; he asserted the c u r a b i l i t y of many d i s -orders and considered medical and moral treatment to be e f f i c a c i o u s . Where co n d i t i o n s permitted, the asylum could be a th e r a p e u t i c t o o l : thus, he included the o u t l i n e s of c o r r e c t asylum management at the end of the 19 I n q u i r y . He would s t i l l have p r e f e r r e d that any person s u f f e r i n g from a mental d i s o r d e r be cared f o r s i n g l y , under the d i r e c t i o n of a p h y s i c i a n , and according to a p a r t i c u l a r i z e d regimen; but f o r those who could not pay, con- . finement i n the asylum need not be the c o n f i r m a t i o n of t h e i r i n c u r a b i l i t y . The c r i t i q u e that Conolly o f f e r e d i s a reverse o u t l i n e of the measures which he adopted a f t e r he became superintendent at Hanwell. In r e a c t i o n to current p r a c t i c e s , he adopted and then r e f i n e d the " n o n - r e s t r a i n t system".- I t 72 became a complete b l u e p r i n t f o r the care and cure of the insane which Conolly spent the remainder of h i s l i f e p u b l i c i z i n g and defending. The asylum was c e n t r a l to t h i s scheme, but f o r a s p e c i f i c reason, and i t was an asylum very d i f f e r e n t from the c h a o t i c i n s t i t u t i o n he described so vehemently i n the I n q u i r y . Conolly's i n s p i r a t i o n f o r the reforms which he enacted at Hanwell came from the experiments of Robert Gardiner H i l l at L i n c o l n Asylum. In 1835, H i l l had assumed the p o s i t i o n of house p h y s i c i a n to the L i n c o l n Asylum under 20 the superintendency of Dr. Charlesworth. During the next three years, he dispensed slowly w i t h the use of a l l the conventional forms of p h y s i c a l r e s t r a i n t , that i s , s t r a i t - j a c k e t s , c h a i r s , manacles, e t c . . H i l l l e c t u r e d on the success of h i s experiment to a Mechanics' I n s t i t u t e i n 1837, and the 21 paper was published i n 1838. Conolly was s u f f i c i e n t l y impressed by H i l l ' s 22 achievement to v i s i t L i n c o l n . There he observed a plan of asylum o r g a n i z a -t i o n that e n t i r e l y abjured p h y s i c a l r e s t r a i n t and the f e a r of punishment which he b e l i e v e d was i t s necessary accompaniment. I t was a system devoid of overt c o e r c i o n . R e s t r a i n t was achieved through i n t e r n a l means; the p a t i e n t s were induced to exert t h e i r powers of s e l f - c o n t r o l to moderate t h e i r behaviour i n accordance w i t h the examples of "healthy" behaviour w i t h which they were surrounded. No other asylum had yet been managed without the 23 t h r e a t of or a c t u a l recourse to p h y s i c a l r e s t r a i n t . L i n c o l n provided Conolly w i t h a model of asylum management that he was able to implement when 24 he assumed the post of superintendent at Hanwell i n June of 1839-Conolly went to Hanwell armed w i t h the v i s i o n of L i n c o l n , and, accord-i n g to S c u l l , g r e a t l y r e l i e v e d at f i n a l l y having achieved what appeared to 25 be secure and adequately remunerative employment. He immediately set about 73 implementing H i l l ' s system w i t h the r e s u l t that by October of 1839, the magistrates were s i n g i n g the p r a i s e s of n o n - r e s t r a i n t , and had a l s o voted enough e x t r a money to a l l o w f o r the s e r v i c e s of nine more attendants and an 2 tS enlarged d i e t f o r the p a t i e n t s . The comfortable r e l a t i o n s h i p between Conolly and the governors was s h o r t - l i v e d . Excerpts from h i s annual r e p o r t s r e v e a l a s t e a d i l y i n c r e a s i n g volume of complaint on Conolly's part concerning the growing s i z e of the i n s t i t u t i o n , the inadequate funding, and the r e s i s t a n c e to improving c e r t a i n 27 aspects of treatment, such as i n c l u d i n g education. In a d d i t i o n , Conolly was i l l i n 1841, a recurrence of a "rheumatic f e v e r " he had s u f f e r e d from i n 28 1830, and a f o r e t a s t e of h i s l a t e r i l l n e s s e s and d e c l i n e . Despite the f a i l u r e of t h e i r f i r s t attempt at p l a c i n g the s u p e r v i s i o n of the asylum i n the hands of a l a y a d m i n i s t r a t o r , the Middlesex magistrates decided to imple-ment j u s t such a system again. They b e l i e v e d that nonmedical a d m i n i s t r a t i o n would reduce c o s t s . This type of d i v i d e d a u t h o r i t y was completely opposed to a l l Conolly's p r i n c i p l e s , so he resigned, but the magistrates were eager to r e t a i n t h e i r advantageous connection w i t h Conolly, so they persuaded him to accept the p o s i t i o n of a v i s i t i n g and c o n s u l t i n g p h y s i c i a n at a s l i g h t l y reduced s a l a r y . A r e t i r e d army o f f i c e r , John Godwin, was appointed to be Governor of Hanwell i n the s p r i n g of 1844, w i t h two medical o f f i c e r s under h i s d i r e c t i o n . However, Godwin resigned i n August of that year (probably because of incompetence), and by e a r l y 1845, the magistrates declared them-29 s e l v e s s a t i s f i e d w i t h the medical management of Hanwell. Conolly continued 30 i n t h i s reduced c a p a c i t y u n t i l 1852, when he r e t i r e d to p r i v a t e p r a c t i c e . He continued to a g i t a t e f o r v a r i o u s kinds of improvement i n the asylum's management, and he wrote e x t e n s i v e l y , p u b l i s h i n g a s e r i e s of l e c t u r e s i n the 74 Lancet i n 1845 and 1846, The Cons t r u c t i o n of Government of Lunatic Asylums i n 1847., and On Some of the Forms of I n s a n i t y i n 1849 (the Croonian Lectures 31 of the previous y e a r ) . We w i l l t u rn to them now. The Con s t r u c t i o n and Government of Lu n a t i c Asylums i s a d i s t i l l a t i o n of a l l h i s most important conclusions regarding the s u c c e s s f u l o r g a n i z a t i o n and maintenance of a system of moral management centered around t o t a l n o n - r e s t r a i n t . I t s exhaustive d i s c u s s i o n o f the d e t a i l s of asylum o r g a n i z a t i o n i s proof of Conolly's commitment to lunacy reform. He began by g i v i n g c r e d i t to the county magistracy f o r i t s d e s i r e to comply w i t h the 1845 Act which compelled the p r o v i s i o n of care f o r pauper l u n a t i c s , and made the e r e c t i o n of rate-supported county asylums pr e f e r e n -32 t i a l . However, he had not i c e d that a number of the magistrates, f o r reasons of economy, p r e f e r r e d to house the pauper insane i n i n f i r m a r i e s attached to workhouses or to continue to provide f o r them i n p r i v a t e asylums. Conolly f e l t that an asylum was a much b e t t e r a l t e r n a t i v e to both these systems; although l e s s economical, i t was i n design and e f f e c t t h e r a p e u t i c , something n e i t h e r p r i v a t e houses nor workhouses could c l a i m . Conolly drew on m o r t a l i t y s t a t i s t i c s and cure r a t e s to argue that p r i v a t e asylums were more dangerous to the p a t i e n t and that workhouses o f f e r e d l i t t l e hope o f amend-33 ment. Conolly's switch to asylum advocacy might have been, i n pa r t , a r e a c t i o n to the over-economizing of the magistracy, of whose str i n g e n c y he was to complain through the remainder of h i s l i f e . According to Conolly, few p r i v a t e asylums were yet p r a c t i s i n g the n o n - r e s t r a i n t system, even i n a modified form, which he f e l t was e s s e n t i a l to the th e r a p e u t i c environment. The workhouse was not intended as a h o s p i t a l and thus i t was a l s o n e g l i g e n t , but negligence 75 could be expected there. Only i n properly c o n s t i t u t e d asylums could the insane poor r e c e i v e t r u l y remedial a t t e n t i o n . The key f a c t o r was the "properly c o n s t i t u t e d " asylum. C e r t a i n f a c t o r s i n design and a d m i n i s t r a t i o n were necessary. The subjects o u t l i n e d i n the f i r s t seven chapters of C o n s t r u c t i o n and Government comprise these e s s e n t i a l 34 elements of Conolly's system. These in c l u d e a r c h i t e c t u r a l design, p a t i e n t c l a s s i f i c a t i o n , d i e t and dress, v e n t i l a t i o n , employment and amusement, the a c t i v i t i e s o f the attendants, and the r o l e of the p h y s i c i a n . The c o n s t i t u -t i v e p r i n c i p l e was " n o n - r e s t r a i n t " — t h e r e f u s a l of a l l forms of p h y s i c a l c o e r c i o n . A l l the other f a c t o r s were an outgrowth of that determinate prac-t i c e . Together they c o n s t i t u t e d a system of management that acted a l s o as a 35 t h e r a p e u t i c regimen f o r the "comfort and cure" of the insane. This was to be the only standard by which h o s p i t a l arrangements were to be evaluated; every d e t a i l which c o n t r i b u t e d to that goal was worthy of a t t e n t i o n from the superintending p h y s i c i a n . Ease of s u p e r v i s i o n was an e s s e n t i a l element f o r the maintenance of a l l these other aspects, because constant watchfulness was the only s u b s t i t u t e f o r r e s t r a i n t . This was not j u s t the s u r v e i l l a n c e of the insane, but a l s o unending monitoring of the a c t i v i t i e s of the attendants and of a l l the d e t a i l s of asylum r o u t i n e . As Robin Evans has suggested i n h i s f a s c i n a t i n g 36 book, V i c t o r i a n p r i s o n a r c h i t e c t u r e was not only intended to promote v i r -tuous behaviour, but i t was designed to compensate f o r the unavoidable shortcomings of the men who d i r e c t e d and s t a f f e d " p r o g r e s s i v e " i n s t i t u t i o n s . C o nolly c l e a r l y had i n mind a scheme of design that found i t s support i n a n o t i o n that even d e f i c i e n t empathy could be at l e a s t p a r t i a l l y counter-acted by a s t r u c t u r e that kept a l l m a n i f e s t a t i o n s of p a t i e n t care out i n 76 the open, or i f p r i v a t e , secured the p a t i e n t from a l l a t t e n t i o n , even that of the s t a f f . 3 7 P a t i e n t c l a s s i f i c a t i o n was another e s s e n t i a l element of moral management. Conolly advocated a sep a r a t i o n of p a t i e n t s based, not on the obscure grada-t i o n s of a n o s o l o g i c a l t a b l e , but r a t h e r upon gender and behaviour. The unde r l y i n g p r i n c i p l e seems to have been o r d e r l i n e s s and calm: behaviour t h a t was d i s r u p t i v e was to be i s o l a t e d from behaviour that conformed to the standard of s o c i a b i l i t y that was considered appropriate to each group and which would c o n t r i b u t e to (or at l e a s t i . n o t * d e t r a c t from) the general " t r a n -q u i l " and " c h e e r f u l " tone of the whole establishment. The th e r a p e u t i c d i s t r i b u t i o n or p a t i e n t s must avoid a l l penal aspects of m i l i t a r y appear:—- -ances. The b u i l d i n g had to be so planned as to a l l o w f o r a c a r e f u l l y con-38 t r o l l e d " f l o w " — o n e that was regulated but not repressed. Much has been made of the moral managers' f a s c i n a t i o n w i t h the asylum 39 which could pay f o r i t s e l f . Conolly's view o f the r o l e of p a t i e n t employ-ment as an area of moral management p r a c t i c e d i f f e r e d from t h a t of other asylum p h y s i c i a n s . He was angered by those who made p u b l i c asylums i n t o l i t t l e more than workhouses f o r the mad; i t was axiomatic to him that the u t i l i t y of any p a t i e n t employment was to be subordinated to the th e r a p e u t i c 40 p r i n c i p l e . Employment was to serve as a d i s t r a c t i o n from the mental d i s -order or as an a c t i v i t y to s t i m u l a t e favourable mental f u n c t i o n s . In a d d i t i o n , i t was a method of reducing p h y s i c a l and mental i r r i t a t i o n . Whatever b e n e f i t s that accrued to the i n s t i t u t i o n were e n t i r e l y g r a t u i t o u s . For Conolly, work was e s s e n t i a l to the foundation o f ch a r a c t e r , and occupa-t i o n was n a t u r a l and necessary to normal human f u n c t i o n i n g . Lethargy and id l e n e s s were no b e t t e r than overwork. A p a t i e n t w i l l i n g to work was viewed 77 by Conolly as e x h i b i t i n g signs of recovery, and a neglect of assigned tasks or a r e f u s a l of labour was a s i g n of pathology. Conolly was opposed to the p r a c t i c e of a l l o w i n g convalescents to serve as attendants on the more severe wards, b e l i e v i n g that t h i s put too great a s t r a i n on the not yet healthy mental f a c u l t i e s of the rec o v e r i n g p a t i e n t s . Hence the p h y s i c a l tasks which c o n t r i b u t e d to the management of the asylum were f i t occupations f o r the l u n a t i c s , but not the broader p s y c h o l o g i c a l and emotional burdens. Occupation was part of the th e r a p e u t i c program, and thus was i n t e g r a t e d i n t o a c a r e f u l l y designed d a i l y schedule. The schedule was organized so as to i n c l u d e both work and e x e r c i s e , r e s t periods, r e g u l a r meals, and p o s s i b l e evening entertainments. The schedule was expected to re g u l a t e the behaviour 41 of the attendants as much as that of the p a t i e n t s . Work periods and ex e r c i s e periods were placed so as to n e c e s s i t a t e prompt f u l f i l l m e n t of housekeeping and sup e r v i s o r y d u t i e s . Moral management i n the n o n - r e s t r a i n t system r e q u i r e d constant watchfulness, and the day was d i v i d e d so th a t the warders had to spend v i r t u a l l y every minute with t h e i r charges. The p h y s i -c i a n s made rounds i n the e a r l y part of the day, and were expected, to r e t u r n l a t e r as w e l l i n order to keep c o n t r o l of the management problems. Very l a r g e demands were made upon the attendants, and p o l i c i e s f o r t h e i r easy management formed a l a r g e part of Conolly's recommendations. They should be s e l e c t e d w i t h an eye to t h e i r characters because kindness, sympathy and patience were necessary q u a l i t i e s f o r the e f f e c t i v e discharge of t h e i r d u t i e s . Conolly p r e f e r r e d younger people, e s p e c i a l l y women, because they were l e s s l i k e l y to have been i n f l u e n c e d by the r e s t r a i n t system. The attendants were re q u i r e d to accompany, a s s i s t , and supervise the p a t i e n t s 78 at a l l t h e i r a c t i v i t i e s throughout the day. There were p r o v i s i o n s f o r a n i g h t - s h i f t to watch i n the s u i c i d a l or other r e f r a c t o r y areas. At no time was an attendant permitted to d i s c i p l i n e , punish, or even r a i s e h i s voice to a p a t i e n t . A l l forms of p h y s i c a l coercion were taboo, and any breach of t h i s r u l e was to be handled w i t h the utmost s e v e r i t y . With regard to the p a t i e n t s ' d i s t u r b e d mental f u n c t i o n s , the r e s p o n s i -b i l i t i e s of the attendants are r a t h e r l e s s c l e a r . They might be summarized as the promoting of t r a n q u i l l i t y and t r u s t at a l l times. Therefore, they were enjoined to avoid disputes w i t h the p a t i e n t s , to a r b i t r a t e a l l disagree-ments, to quench d i s r u p t i v e behaviour by " f i r m yet g e n t l e " persuasion. In a d d i t i o n , the attendants were to c o l l e c t i n f o r m a t i o n f o r the p h y s i c i a n about the p a t i e n t ' s s t a t e of f u n c t i o n i n g . The major impact of the attendants was to be i n d i r e c t or environmental; they were to maintain the atmosphere of 42 ordered calm that Conolly f e l t was e s s e n t i a l to moral treatment. The f i n a l i n d i s p e n s a b l e element of the n o n - r e s t r a i n t system was the physician-superintendent. As described i n the C o n s t r u c t i o n , he defined the object of the care, set goals, coordinated the myriad of d e t a i l s o f adminis-t r a t i o n and p a t i e n t management, and a c t i v e l y sought to f a m i l i a r i z e h i m s e l f w i t h the p a t i e n t ' s symptoms i n order to b e t t e r adapt the treatment to the s p e c i f i c s of the case. He must v i s i t a l l areas of the asylum each day so as to make hi m s e l f a c c e s s i b l e to the p a t i e n t s and to e x e r c i s e due s u p e r v i s i o n over the r o u t i n e to ensure that the proper tone was maintained. He must be a v a i l a b l e to the l u n a t i c s f o r questions and appeals, and to the attendants f o r d i r e c t i o n w i t h regard to the use of s e c l u s i o n and dealings w i t h the r e c a l c i t r a n t . As a medical doctor, he must attend to the p h y s i c a l ailments which accompanied h i s p a t i e n t s ' mental d i s o r d e r s . He should have the 79 c a p a c i t y to do a l l the h i r i n g and f i r i n g of s t a f f who had d i r e c t a s s o c i a t i o n w i t h the p a t i e n t s . His d e c i s i o n s were to be the g u i d i n g p r i n c i p l e s of the asylum management, and, i n r e t u r n f o r t h i s , he was to assume t o t a l r e s p o n s i -b i l i t y . To be equipped f o r such an immense task, the physician-superintendent must be a man of c u l t u r e and l i b e r a l education, with a modern medical back-ground and a f a m i l i a r i t y , p r e f e r a b l y gained i n an i n s t i t u t i o n u t i l i z i n g a n o n - r e s t r a i n t system, w i t h the d e t a i l s of moral management. He must a l s o be a man of p r i n c i p l e , of kindness, empathy and u t t e r d e d i c a t i o n to h i s work, content to l i v e among h i s charges, immersed i n the t o t a l i t y of d e t a i l that 43 p e r f e c t c o n t r o l of the asylum would e n t a i l . Conolly had been c r i t i c a l of t r a d i t i o n a l medical treatment s i n c e he f i r s t considered the subject i n Insania et M e l a n c h o l i a . Such an a t t i t u d e conformed with the a n t i - m e d i c a l e t h i c then prevalent among p h y s i c i a n s who espoused moral management. However, i t would be an exaggeration to assume that Conolly had r e j e c t e d most current medical t h e r a p e u t i c s . According to h i s t e x t s , he made consi d e r a b l e use of most of the standard t h e r a p i e s a v a i l -able f o r the treatment of mental i l l n e s s i n which an accompanying p h y s i c a l d i s o r d e r could be a s c e r t a i n e d . Moreover, he argued s u c c i n c t l y against those 44 p r a c t i t i o n e r s who would dispense with a l l medical forms of treatment. His r a t i o n a l e was not a t y p i c a l of l u n a t i c p h y s i c i a n s of the p e r i o d : mental i l l n e s s was p r e d i c a t e d upon b r a i n disease, although i t appeared that sometimes the f u n c t i o n a l d i s o r d e r had preceded or indeed had never occasioned, a cor-responding p h y s i c a l l e s i o n . Despite the formidable metaphysical problems which were i m p l i e d by questions about the r e l a t i o n of b r a i n and mind, Conolly was as c e r t a i n as most of h i s colleagues t h a t i n s a n i t y was b r a i n disease and that i t could be a f f e c t e d by p h y s i c a l t h e r a p i e s . As we s h a l l 80 see, Conolly's moral management t h e o r i e s were r e s o l u t e l y p h y s i c a l i s t ; he l i k e d to account f o r the e f f e c t s of measures, such as quie t c o n v e r s a t i o n , k i n d handling, and warm c l o t h i n g , by suggesting that they c o n t r i b u t e d to a decrease i n c e r e b r a l excitement that was e s s e n t i a l l y p h y s i o l o g i c a l i n 45 o r i g i n and a c t i o n . Conolly argued that medical therapy d i r e c t e d to i d e n t i f i a b l e p h y s i c a l disease was e s s e n t i a l to complete care of the insane. He was conservative when i t came to the apparent absence of such m a n i f e s t a t i o n s , b e l i e v i n g i n these cases that i t was best to r e s t r i c t treatment to the i n d i r e c t e f f e c t s of the n o n - r e s t r a i n t system. His r e p e r t o i r e of p h y s i c a l treatments was conven-46 t i o n a l , composed of v a r i a t i o n s of o l d e r , w e l l - e s t a b l i s h e d t h e r a p i e s . Again, the r e s t o r a t i o n of e q u i l i b r i u m and order seems to have been the under-l y i n g p r i n c i p l e of Conolly's medical p r a c t i c e s . Some disturbance i n the production or consumption of nervous energy was the probable b a s i s of much mental d i s o r d e r , and t h i s could be r e c t i f i e d by c a r e f u l measures designed to di m i n i s h excitement or increase p h y s i c a l s t r e n g t h , to r e l i e v e congestion, or to encourage a c t i v i t y . Thus, v i o l e n t or o v e r l y - i n v a s i v e procedures were to be avoided s i n c e they would simply increase any imbalances present. A l l but one of the t o p i c s considered i n the Co n s t r u c t i o n and Government of L u n a t i c Asylums were conventional elements of moral management as i t had 47 developed i n the l a t e eighteenth and e a r l y nineteenth c e n t u r i e s . The exception was t o t a l n o n - r e s t r a i n t , and i t i s important to recognize that the heart and so u l o f Conolly's program was the a b o l i t i o n of a l l forms of p h y s i c a l coercion and the disuse of any attempts to exert mental co e r c i o n through f e a r . This meant the absence of p o s s i b l e recourse to even such "mild' 1 methods of c o n t r o l as the s t r a i t w a i s t c o a t or muffs f o r hands, as w e l l 81 as the complete p r o h i b i t i o n of t h r e a t s , expressions of anger, or even i r r i t a -t i o n or the u t i l i z a t i o n of petty punishments f o r bad behaviour. The complete-ness of the r e n u n c i a t i o n was the key to i t s e f f i c a c y . Only when mechanical r e s t r a i n t and moral forc e were e n t i r e l y o u t s ide the scope of the asylum's t h e r a p e u t i c atmosphere would i t be p o s s i b l e to t r a i n attendants to work e f f i c i e n t l y w i t h i n a "cure and comfort" framework and to i n s t r u c t medical students i n the a c t u a l m a n i f e s t a t i o n s of mental disease, uncomplicated by the i n t e r f e r e n c e s occasioned by the a p p l i c a t i o n of r e s t r a i n t s . Conolly's i n s i s t e n c e on the fundamental importance of t o t a l non-r e s t r a i n t was f u l l y developed i n h i s l a s t major work, The Treatment of the Insane Without Mechanical R e s t r a i n t s , w r i t t e n i n 1856, but a l s o defended i n 48 s e v e r a l a r t i c l e s published during the l a t e r part o f h i s l i f e . He maintained that the n o n - r e s t r a i n t system worked to c o n t r o l behaviour through two methods. The p r i n c i p a l form that i t took was embodied i n the emphasis on order and calm that was to be the c o n s t i t u t i v e q u a l i t y of asylum l i f e . The p r o h i b i t i o n of e x c i t e d speech and loud or r a p i d a c t i v i t y of any s o r t , the c a r e f u l a t t e n -t i o n to r o u t i n e , the concern w i t h minimizing noise, e s p e c i a l l y a t n i g h t , and the frequent references to the t r a n q u i l i z i n g e f f e c t of v a r i o u s measures were 49 a l l evidence of Conolly's t h e r a p e u t i c i n t e n t . Any v i o l e n c e , whether p h y s i c a l or emotional, must be avoided because i t would create excitement i n the minds of the t r a n q u i l . A second l i n e of defence was medical. He contended that the order and comfort and calm of a n o n - r e s t r a i n t asylum was e s p e c i a l l y powerful i n reduc-i n g the b r a i n excitement and calming the f u n c t i o n a l disturbance which had 50 occasioned the v i o l e n t o u t b u r s t s . E q u i l i b r i u m could be r e s t o r e d i n such an atmosphere; a balance between v a r i o u s mental f a c u l t i e s might be achieved, 82 or, at l e a s t , the f l u c t u a t i o n s i n nervous energy which caused the symptoms might be c o n t r o l l e d by the t r a n q u i l i z i n g aspects of n o n - r e s t r a i n t care. I t should be emphasized that t h i s t r a n q u i l l i t y was b e l i e v e d to be p h y s i c a l ; excitement and i r r i t a b i l i t y were thought to be expressions of a c t u a l d i s -turbances i n the neurophysiology which were, i n t u r n , the r e s u l t e i t h e r of l e s i o n s i n the b r a i n or other b o d i l y t i s s u e s , or of d i s r u p t i o n s i n the f u n c t i o n i n g of the f a c u l t i e s of the mind. These disturbances could be i n f e r r e d to have had a concurrent i n f l u e n c e on the b r a i n , producing observable symptoms of mental d i s o r d e r . N o n - r e s t r a i n t was m e d i c a l l y u s e f u l i n another sense. Conolly i s famous f o r having introduced, f o r medical students, a s e r i e s of c l i n i c a l l e c t u r e s i n mental disease at Hanwell i n 1842, the f i r s t such i n s t r u c t i o n to be given s i n c e W i l l i a m B a t t i e ' s e f f o r t s i n the 1760's. In these l e c t u r e s , and i n h i s Croonian Lectures, he argued that the i m p o s i t i o n of r e s t r a i n t s a c t u a l l y obscured the r e a l symptoms of mental i l l n e s s , and that i n order to g i v e cor-r e c t treatment, a p a t i e n t who had been so handled must be allowed to go without such r e s t r i c t i o n s and be observed c l o s e l y f o r a few days f o l l o w i n g 51 admission. The i m p l i c a t i o n seems to be that i n t r a c t a b l e v i o l e n c e was not a necessary q u a l i t y of most forms of i n s a n i t y ; o c c a s i o n a l outbreaks might have been provoked by some outside i r r i t a n t ; and a tendency to become a g i -t a t e d by c e r t a i n forms of s t i m u l a t i o n might be q u i t e t y p i c a l , but few l u n a t i c s were c o n s t i t u t i o n a l l y v i o l e n t . U n c o n t r o l l e d behaviour, was more l i k e l y to be a r e a c t i o n to some e x t e r i o r i n f l u e n c e than a response to an i n t e r i o r event. The emphasis on confinement i n an i n s t i t u t i o n or on main-t a i n i n g an environment of order and t r a n q u i l l i t y minimized or e r a d i c a t e d the usual i r r i t a n t s that had been observed to occasion v i o l e n c e . However, i t s 83 c u r a t i v e e f f e c t was s u f f i c i e n t l y extended so that f o r a few e a r l y days of h o s p i t a l i z a t i o n , the p a t i e n t e x h i b i t e d unadorned l u n a t i c symptoms which i f he were curable, would soon fade i n the remedial s i t u a t i o n , aided by whatever medical means might be thought a p p r o p r i a t e . Nevertheless, some p r o v i s i o n had to/be made f o r the' d i f f i c u l t - t o -manage p a t i e n t , and he was to be r e s t r a i n e d as a l a s t r e s o r t by s e c l u s i o n . Conolly designed s e c l u s i o n rooms that were to be as comfortable as p o s s i b l e , w i t h a t t r a c t i v e f u r n i t u r e so that any p u n i t i v e a s s o c i a t i o n s the p a t i e n t might make could be minimized. He devised c a r e f u l g u i d e l i n e s to r e g u l a t e the use of s e c l u s i o n , suggested non-physical methods o f p l a c i n g the p a t i e n t i n the room, and o u t l i n e d the extent of the s u r v e i l l a n c e that would be necessary while the p a t i e n t was confined. A l l of these g u i d e l i n e s were meant to r e i n -f o r c e the idea that s e c l u s i o n was a th e r a p e u t i c t o o l , to be employed when necessary, but w i t h e s p e c i a l care and only i n r e l a t i o n to some overt 52 p a t h o l o g i c a l m a n i f e s t a t i o n . Conolly a l s o advocated s e c l u s i o n because of i t s p h y s i o l o g i c a l b e n e f i t s . A p l a i n but comfortable room, an absence of any i r r i t a t i n g s i g h t s or sounds, were intended to permit the b r a i n excitement to d i s s i p a t e q u i c k l y . As h i s a g i t a t i o n lessened, the l u n a t i c would be rendered capable of r e a s s e r t i n g h i s powers of s e l f - c o n t r o l , and u s u a l l y s i g n a l l e d a r e t u r n to calm by req u e s t i n g r e l e a s e . C o n t r o l of the p a t i e n t ' s behaviour was thus obtained through enhancing methods or techniques which r e i n f o r c e d h i s own most admirable q u a l i t i e s without having recourse to any demeaning fea t u r e s of h i s or anyone 53 e l s e ' s conduct. The analogy to the f a m i l y that had begun with Tuke was perpetuated by Conolly. His v i s i o n of the a d m i n i s t r a t i v e order and comfort o f the asylum 84 resembled the a t t r i b u t e s of a c l o s e l y - k n i t and w e l l - r u n f a m i l y e s t a b l i s h m e n t — a h e a l t h f u l regimen, c l e a n l i n e s s , occupation, regulated hours, pleasant entertainment, a l l conducted i n a k i n d l y , c h e e r f u l but c o n t r o l l e d atmosphere, permeated by the a t t i t u d e s of the ph y s i c i a n s who d i r e c t e d treatment as a parent might d i r e c t a l l f a m i l y a c t i v i t i e s . In t h i s way, the asylum became an i n s t i t u t i o n , not run on e x t r a o r d i n a r y p r i n c i p l e s l i k e a p r i s o n , but a "normalized" establishment. The Treatment of the Insane Without Mechanical R e s t r a i n t s i n c l u d e d a d i s c u s s i o n o f two f u r t h e r refinements of the n o n - r e s t r a i n t system. The f i r s t was the " i n d i v i d u a l i z e d " approach. Conolly remarked t h a t : None but those d a i l y f a m i l i a r to the events o f asylums can duly appreciate the great e f f e c t s of such treatment i n s p e c i a l cases. A f t e r the f i r s t improvement i n p a t i e n t s r e c e i v e d i n t o the best asylum some w i l l remain s t a t i o n a r y f o r a l e n g t h of time without the s p e c i a l a t t e n t i o n o f a watchful attendant ,_. b4 whose d u t i e s are almost e x c l u s i v e l y confined to such cases. This i n t e r v e n t i o n appears to have been conceived e m p i r i c a l l y ; i t had been observed t h a t c e r t a i n p a t i e n t s recovered when given c l o s e contact w i t h a sympathetic attendant. The i n d i v i d u a l i z e d approach was e s s e n t i a l l y an i n t e n -s i f i c a t i o n o f a warden-inmate f r i e n d s h i p , not a new psychotherapeutic r e l a t i o n created by the doctor, and acquiesced i n by the p a t i e n t , as was e s t a b l i s h e d by Freud. In that sense, i t was s t i l l meant to be part of the general environment, d i r e c t e d by the p h y s i c i a n , from who i t s q u a l i t i e s d e r i v e d , but who had to f u n c t i o n as a general symbol throughout the asylum, and who there-f o r e could not be i n t i m a t e l y i n v o l v e d w i t h c e r t a i n s p e c i f i c p a t i e n t s . The other new aspect of Conolly's endeavours which appeared i n The  Treatment of the Insane was a d e s c r i p t i o n o f the n o n - r e s t r a i n t system as i t was being p r a c t i s e d i n the p r i v a t e asylums of Lawn House (also h i s r e s i d e n c e ) , 85 55 Wood End, and Hayes Park, a l l of which he was h e l p i n g to manage a f t e r 1850. Conolly had been openly c r i t i c a l o f the conduct of most p r i v a t e e s t a b l i s h -ments throughout h i s career, but he had not e n t i r e l y denounced a l l p r i v a t e care, e s p e c i a l l y when i t was d i r e c t e d by a p h y s i c i a n versed i n the tenets of n o n - r e s t r a i n t . But the a p p l i c a t i o n of h i s o r i g i n a l program had to be a l t e r e d i n a s e t t i n g that would c a t e r p r i m a r i l y to f i n a n c i a l l y secure, educated, and more c u l t i v a t e d p a t i e n t s . There was no question i n Conolly's mind t h a t , i n the area of treatment f o r mental i l l n e s s , paupers had heretofore enjoyed a r e a l advantage, because even moral management, l e t alone the non-restraint; 56 system, had been very slow i n f i n d i n g the way into, the p r i v a t e asylum. As w i t h the pauper insane, the most important therapy was "the separation of the p a t i e n t from a l l the circumstances which surrounded him when he became 57 insane, and p l a c i n g him i n the centre of new and s a l u t a r y i n f l u e n c e s . " The o b j e c t i v e was the same: "To t r a n q u i l l i z e and to cure, and not merely to s u b d u e n o t h i n g i n the treatment i s at variance w i t h the great system o f 58 n o n - r e s t r a i n t . . . . " A major problem was encountered i n the s u p e r i o r educa-t i o n and c u l t i v a t i o n of the mind common to p a t i e n t s of higher economic s t a t u s , but the removal to an asylum was oft e n s u f f i c i e n t to induce a more coopera-t i v e a t t i t u d e i n the p a t i e n t . An i l l - r e g u l a t e d moral education productive of s e l f - i n d u l g e n t h a b i t s was another'source of d i f f i c u l t i e s p e c u l i a r to the s i t u a t i o n of the well-to - d o insane. The r o u t i n e of the asylum was o f t e n a help i n c o u n t e r a c t i n g the e f f e c t s of a l a x upbringing. Upper-class women were more l i k e l y to have adopted extreme or e n t h u s i a s t i c r e l i g i o u s opinions as a r e s u l t of t h e i r i n s u f f i c i e n t l y - c o n t r o l l e d education, and, again, the c a r e f u l l y balanced regimen of the asylum could a i d i n reducing t h e i r b r a i n 59 excitement and encouraging more temperate h a b i t s of thought and b e l i e f . 86 For treatment, a good asylum was p r e f e r a b l e to an i s o l a t e d residence or the p a t i e n t ' s home, which were the a l t e r n a t i v e s f o r p a t i e n t s of the higher c l a s s e s , because i t "promotes the h e a l t h of the body, and to maintain a peaceful mental s t a t e ; so that as the b o d i l y c o n s t i t u t i o n becomes composed and healthy, nothing counteracts i t s favourable a c t i o n or the f e e l i n g s and the u n d e r s t a n d i n g . " ^ A p r i v a t e asylum, l i k e a p u b l i c one, had to be managed on the p r i n c i p l e of the primacy of the p a t i e n t . Most of a l l , the s e l e c t i o n of attendants became of paramount importance. They had to be i n d i v i d u a l s f i t t e d to accompany the p a t i e n t , and yet able to maintain a r o u t i n e of r e g u l a r a c t i v i t i e s . The power of the p h y s i c i a n i n e n f o r c i n g a regimen was e s p e c i a l l y important i n a s i t u a t i o n i n which the p a t i e n t s were l e s s l i k e l y t o 61 accept the d i r e c t i o n of an i n d i v i d u a l from an i n f e r i o r s o c i a l position.. For t h i s reason, i t was to the p a t i e n t ' s advantage t h a t the p h y s i c i a n r e s i d e i n the p r i v a t e asylum he managed. I t w i l l be c l e a r by now that the c o n s t i t u e n t s of the n o n - r e s t r a i n t sys-tem d i f f e r e d i n only one aspect from those of moral management. Conolly maintained that h i s d i f f e r e n c e was i n ki n d r a t h e r than degree: that the i m p o s i t i o n of n o n - r e s t r a i n t p o l i c i e s r e s u l t e d i n a r a d i c a l change i n the atmosphere of even w e l l - r u n "moral" asylums. The n o n - r e s t r a i n t asylum f u l -f i l l e d the promise of the moral managers that a t o t a l environment could be created w i t h i n the i n s t i t u t i o n , and took t h i s v i s i o n one step f u r t h e r by arguing that the c u r a t i v e regime could be sustained by recourse only to the charac t e r s o f the attendants and the p h y s i c i a n . Nothing must be now omitted that can have the e f f e c t of g a i n i n g the p a t i e n t ' s e n t i r e confidence.... Among the obs t a c l e s to the a c q u i s i t i o n of t h i s confidence, none i s found prac-t i c a l l y to be so great as any previous m a n i f e s t a t i o n of anger.... L u n a t i c s , however audacious, i n aspect, are 87 g e n e r a l l y the prey of f e a r s and s u s p i c i o n s T h e y are only assured and rendered attached by a c o n t i n u a l course of k i n d and encouraging conduct....The r e l i a n c e of the p a t i e n t must be e n t i r e i n order to be s a l u t a r y . ^ The p a t i e n t - s t a f f r e l a t i o n s h i p was c l e a r l y intended to be c o n t r a c t u a l i n nature. The s t a f f agreed to dispense w i t h overt means of c o e r c i o n , and the l u n a t i c surrendered h i s confidence, adopting the comparatively d o c i l e behaviour which was necessary to the smooth f u n c t i o n i n g of the i n s t i t u t i o n . This was the great advantage of the n o n - r e s t r a i n t system: i t compelled both p a r t i e s to engage i n an agreement r e s p e c t i n g both t h e i r spheres, whereas the use of r e s t r a i n t s made such an arrangement superfluous. As C a s t e l demon-s t r a t e s , a n o t i o n of c o n t r a c t u a l agreement pred i c a t e d upon i n d i v i d u a l r e s p o n s i b i l i t y was a major fea t u r e of nineteenth-century bourgeois concepts of s o c i a l r e l a t i o n s . ^ The problem w i t h the insane was that s o c i a l f e e l i n g breaks down, and i t was to f a c i l i t a t e the reinstatement of s o c i a l cohesion that the non-r e s t r a i n t system was developed. The basic i n g r e d i e n t s f o r appropriate s o c i a l behaviour were not n e c e s s a r i l y e r a d i c a t e d by mental disease, and moral t r e a t -ment sought to r e v i t a l i z e them. "Generally speaking, human nature i s seen a t a disadvantage i n mental d i s o r d e r s ; the s o c i a l f e e l i n g i s l o s t , and sympathy 64 w i t h others seems e x t i n c t . " But the insane were not depraved; t h e i r k i nd f e e l i n g s and v i r t u e s were buried but not l o s t . "To those f e e l i n g s we apply i t , " and s i n c e the l u n a t i c was very g r a t e f u l f o r kindness, i t created i n them a sense of o b l i g a t i o n which they were quick to acknowledge when able to do so. 88 I I I I n g e n e r a l , observers of Conolly's career have had a tendency to focus upon the reform he enacted at Hanwell w h i l e g i v i n g l i t t l e a t t e n t i o n to h i s w r i t i n g s on moral management or h i s t h e o r i e s of mental f u n c t i o n i n g . As was i n d i c a t e d e a r l i e r , from the beginning of h i s tenure at Hanwell, h i s innova-t i o n s were regarded w i t h s u s p i c i o n by a w i d e l y - a s s o r t e d group of p h y s i c i a n s and governing bodies; the range of c r i t i c s i n c l u d e d those who b e l i e v e d methods of p h y s i c a l r e s t r a i n t were e s s e n t i a l to a t h e r a p e u t i c regime, as w e l l as those whose major complaint l a y w i t h the expenses i n c u r r e d i n main-t a i n i n g the o v e r l y - l u x u r i o u s f a c i l i t i e s which Conolly b e l i e v e d were essen-t i a l to a t r u l y c u r a t i v e establishment. 66 However, commentators, such as S i r James Cl a r k and D a n i e l Hack Tuke, were laudatory i n t h e i r e v a l u a t i o n s of Conolly's achievements. C l a r k and Tuke saw Conolly i n terms of a grand t r a d i t i o n o f asylum reform and s o c i a l meliorism which was admirable i n i t s own terms without reference to progress i n understanding the a c t i v i t i e s of the mind. Another important nineteenth-century e v a l u a t i o n of Conolly was provided by Henry Maudsley, Conolly's son-in-law, a young ambitious asylum p r a c t i t i o n e r . Maudsley's memoir was s t r i k i n g i n i t s ambivalence; he p r a i s e d Conolly f o r h i s success i n extending the "humane sc i e n c e " of moral management, but he undermined h i s a p p r e c i a t i o n of the achievement by c a l l i n g a t t e n t i o n to Conolly's l i m i t a t i o n s as a t h e o r i s t , h i s undirected e a r l y career, and even the q u a l i t i e s of h i s character 67 which marked him, i n Maudsley's view, as feminine and t h e r e f o r e weak. Twentieth-century commentators have approached Conolly's career along l i n e s s i m i l a r to t h e i r nineteenth-century counterparts. In 1964, Denis Leigh published a small volume, e n t i t l e d The H i s t o r i c a l Development of 89 B r i t i s h P s y c h i a t r y , which was composed of b i o g r a p h i c a l sketches of the p r i n -c i p a l advocates of asylum r e f o r m . ^ His piece on Conolly d e r i v e s from Maudsley: Conolly was an i n e f f e c t u a l p h y s i c i a n and an o v e r l y emotional reformer with a broad humanitarian outlook who l u c k i l y r e s u r r e c t e d h i s career when he recei v e d the appointment at Hanwell. Richard Hunter and Ida MacAlpine were i n t e r e s t e d i n i d e n t i f y i n g the antecedents of twentieth-century p r a c t i c e s and t h e o r i e s i n nineteenth-century 69 reforms, and they found Conolly a sympathetic s u b j e c t . The reformed asylum of the V i c t o r i a n period was, to Hunter and MacAlpine, the foundation o f modern p s y c h i a t r i c treatment; hence Conolly's a d m i n i s t r a t i v e accomplishments could be pra i s e d unreservedly. Hunter, a n e u r o l o g i s t by p r o f e s s i o n , was not as concerned w i t h connections between the t h e o r i e s o f mental f u n c t i o n i n g which p r e v a i l e d among nineteenth-century moral managers and the techniques of moral treatment. His b e l i e f that good p s y c h i a t r i c treatment was based on sound n e u r o l o g i c a l understanding l e d him to emphasize i n v e s t i g a t i o n s i n t o physiology and neuroanatomy which began i n the V i c t o r i a n p e r i o d . Thus, f o r Hunter, Conolly's achievement was not marred by an inadequate t h e o r e t i c a l base. Hunter and MacAlpine researched Conolly's l i f e e x t e n s i v e l y ; they were at pains to disprove Maudsley's o p i n i o n of Conolly's pre-Hanwell i n s u f f i -c i e n c i e s . They t r i e d to e s t a b l i s h that Conolly was a competent p r o f e s s i o n a l before 1839, and the q u a l i t y of h i s accomplishments as a moral manager, r a t h e r than p u b l i c r e a c t i o n to the reforms, was r e s p o n s i b l e f o r h i s well-deserved 70 p o s i t i o n i n the h i s t o r y of nineteenth-century p s y c h i a t r y . S c u l l followed Maudsley and Leigh i n d e s c r i b i n g Conolly's e a r l y career 71 as i n e f f e c t u a l and h i s behaviour as f e c k l e s s . However, S c u l l was impressed by the I n q u i r y , which he depicted as a comprehensive at t a c k on 90 the asylum system as a method of t r e a t i n g l u n a t i c s . He was th e r e f o r e per-turbed by Conolly's appointment at Hanwell because i t appeared to S c u l l to be an act of b e t r a y a l , occasioned by a middle-aged desperation provoked by f i n a n c i a l i n s e c u r i t y and the prospect of p r o f e s s i o n a l o b l i v i o n . S c u l l a l l e g e d that Conolly began h i s career i n the g r i p of a r a d i c a l d i s t r u s t of the asylum as a centre of treatment, and that he a l t e r e d h i s o p i n i o n o f i t s t h e r a p e u t i c p o t e n t i a l when s e l f - i n t e r e s t d i c t a t e d a need to conform to the p r e v a i l i n g p s y c h i a t r i c ideology of the p e r i o d , which p o s i t e d the n e c e s s i t y of asylum care. S c u l l went on to i n t e r p r e t the second part o f Conolly's l i f e as a perpetual e f f o r t to s u s t a i n a high l e v e l of p u b l i c r e c o g n i t i o n and econmic s t a b i l i t y , which r e q u i r e d that he g r a d u a l l y r e l i n q u i s h any t h e r a p e u t i c p r i n c i p l e s he might have held to i n h i s e a r l y career. Conolly's d e c i s i o n to accept the post a t Hanwell was based, as I have argued, on h i s a p p r e c i a t i o n of Gardiner H i l l ' s achievement a t L i n c o l n Asylum. Doubtless, self-advancement was a powerful inducement f o r Conolly. However, a d e s i r e f o r personal advancement could have c o e x i s t e d w i t h a w e l l -constructed plan of a d m i n i s t r a t i v e reform which was informed by the accepted nineteenth-century understanding o f mental f u n c t i o n i n g . Moreover, Conolly's commitment to the n o n - r e s t r a i n t system as the most p e r f e c t r e a l i z a t i o n of the p r i n c i p l e s of moral management was not p r o f e s s i o n a l l y popular, but he promoted and defended n o n - r e s t r a i n t u n t i l the end of h i s l i f e . His consistency on t h i s p o i n t made him vul n e r a b l e to the c r i t i c i s m s t hat he was u n r e a l i s t i c and that h i s charac t e r was feminized. I t i s important to emphasize that the p r i n c i p l e s o f moral management which Conolly enacted at Hanwell had been developed and implemented i n a wide v a r i e t y of asylums f o r a h a l f - c e n t u r y a t l e a s t . Even n o n - r e s t r a i n t was 91 not an i n n o v a t i o n . In a d d i t i o n , a set of ideas about the r e l a t i o n between the mind and the body was i n v o l v e d i n the p r a c t i c e s of moral management, which had an e q u a l l y e s t a b l i s h e d pedigree. Conolly's personal motives and the socio-economic fo r c e s by which they were shaped have been described 72 thoroughly by S c u l l i n h i s a r t i c l e and h i s previous works. Thus, the major question which presents i t s e l f i n r e l a t i o n to Conolly's career i s "Why n o n - r e s t r a i n t ? " Why d i d he stake h i s r e p u t a t i o n and a con-v e n t i o n a l program of asylum management on an idea that was regarded as v i s i o n a r y when f i r s t advanced, and which, w i t h i n twenty years of i t s appear-ance, was being q u i e t l y ignored by a l a r g e number of asylum doctors? The answer i s p a r t l y s e l f - i n t e r e s t . He was the r e c i p i e n t of much p u b l i c recog-n i t i o n f o r h i s reforms, and he must have f e l t t hat i t was imperative to continue to defend the a c t i o n s which had given him such prominence. F u r t h e r -more, Conolly's program expressed an understanding that the emphasis upon the r o l e of the p h y s i c i a n i n the n o n - r e s t r a i n t system, h i s primacy, and the way i n which the i n s t i t u t i o n must c e n t r a l i z e a l l i t s operations i n h i s person, was the best defence f o r the medical p o s i t i o n i n the treatment of i n s a n i t y . S c u l l has argued most p e r s u a s i v e l y that the need f o r p r o f e s s i o n a l s t a t u r e and r e c o g n i t i o n was a major impetus to the asylum doctors' t h e o r i z i n g about the c u r a t i v e asylum, the n e c e s s i t y f o r confinement and medical attendance, which, i n t u r n , r e i n f o r c e d the n o t i o n that madness was indeed 73 mental i l l n e s s . Conolly's reforms at Hanwell can be seen as an example of the extension of medical e x p e r t i s e . More i m p o r t a n t l y , n o n - r e s t r a i n t possessed a s o c i a l meaning which r e f l e c t e d two s t r a i n s i n nineteenth-century s o c i a l d e f i n i t i o n . F i r s t , i t e x e m p l i f i e d the c o n t r a c t u a l aspect of the moral manager's t h e r a p e u t i c . The 92 l u n a t i c and the p h y s i c i a n - a d m i n i s t r a t o r entered i n t o an agreement r e s p e c t i n g mutual complementary standards of a p p r o p r i a t e behaviour. This was not, of course, a c o n t r a c t between equals, but i n exchange f o r a decrease i n v i o l e n t behaviour and the promise of conformity to the r u l e s of the i n s t i t u t i o n , the l u n a t i c received assurances that h i s p h y s i c a l w e l l - b e i n g would be protected and h i s d i s o r d e r would be considered as a disease and not as an act of s o c i a l r e b e l l i o n r e q u i r i n g punishment. N o n - r e s t r a i n t operated at the highest l e v e l of agreement because i t i m p l i e d that both p a r t i e s could be t r u s t e d t o con-t r o l t h e i r behaviour and responses so as to dispense w i t h the need f o r p h y s i c a l c o e r c i o n . The sense of personal r e s p o n s i b i l i t y which l a y behind the n o n - r e s t r a i n t pact was evidence of i t s second l e v e l of s o c i a l meaning. Moral management r e l i e d upon the moral a c c e s s i b i l i t y of the l u n a t i c f o r i t s e f f e c t i v e n e s s . P h y s i c a l r e s t r a i n t s suggested the p o t e n t i a l l y u n c o n t r o l l a b l e , the unreach-ab l e . N o n - r e s t r a i n t worked on the p r i n c i p l e t h a t the insane could be contacted by language, by gesture, by the i m p l i c a t i o n s which were conveyed by a s t r u c t u r e of behaviours. Moral treatment was a s t r a t e g y of i n t e g r a -t i o n ; i t presupposed that the mentally disordered could be included i n the web of s o c i a l i n t e r a c t i o n s . Lunacy was thus organized; i t was l o c a t e d and d e f i n e d . By e l i m i n a t i n g the use of p h y s i c a l r e s t r a i n t s , t h i s organized d i s o r d e r expressed a p a r t i a l s o c i a l i n t e g r a t i o n of the l u n a t i c . 93 CHAPTER IV MORAL MANAGEMENT IN HISTORICAL PERSPECTIVE By a combination of a l l the means now enumerated,... p r i v a t e and p u b l i c asylums f o r the insane have become... places of r e a l r e f uge;...Society i s thus at f i r s t and at once protected from the consequences that might r e s u l t from the dangerous i r r e g u -l a r i t i e s of human beings whose g u i d i n g reason i s impaired; and then the frame of mind and body i s c a r e f u l l y inspected, w i t h a view to r e s t o r i n g i n each case,...the a c t i v e and r e g u l a r e x e r c i s e of the i n t e l l e c t , and the h e a l t h f u l flow of the a f f e c t i o n s , and the consequent r e s t r a i n t of the pro-p e n s i t i e s w i t h i n safe and reasonable bounds c o n s i s t e n t w i t h the r e s t o r a t i o n of l i b e r t y . T , „ ,, 1 John Conolly To t h i s p o i n t , I have discussed the p r i n c i p l e s which c o n s t i t u t e d moral management and the t h e o r i e s of disease and mental f u n c t i o n i n g which were espoused by asylum p h y s i c i a n s . John Conolly was r e p r e s e n t a t i v e of the major currents of nineteenth-century p s y c h i a t r i c medicine. Whatever reasons drew him to n o n - r e s t r a i n t are part of what made p o s s i b l e the change from e i g h t -eenth century modes of response to insane behaviour to nineteenth-century modes as they were expressed i n the development of the p r a c t i c e of moral management. Conolly's medical psychology was supported by three u n d e r l y i n g concepts which provided i n t e l l e c t u a l and s o c i a l r a t i o n a l e s f o r the theory and p r a c t i c e of moral management. They d i d not possess an explanatory power great enough to r e s o l v e enduring metaphysical problems or remove i n t e l l e c t u a l u n c e r t a i n -t i e s . Nevertheless, they were advantageous to asylum doctors because, i n t h e i r incompleteness and ambiguity, l a y a realm of freedom f o r productive s p e c u l a t i o n that permitted t o l e r a t i o n o f i n c o n s i s t e n c y and incoherence. These concepts were the schema of s t i m u l a t e d motion, the d o c t r i n e of p r e d i s p o s i t i o n , and the idea of h i e r a r c h y . The schema of s t i m u l a t e d motion 9A provided a medium f o r mind and body to connect, us i n g p h y s i o l o g i c a l p r i n c i p l e s that had been developed i n the seventeenth century but which could s t i l l be made to f i t the e x i s t i n g s t a t e of n e u r o l o g i c a l knowledge i n the nineteenth century. P r e d i s p o s i t i o n allowed the expression of the ambigu i t i e s inherent i n the r e l a t i o n of moral and p h y s i c a l causes which permitted the asylum p h y s i c i a n to t r e a t the mad without n e c e s s a r i l y having e i t h e r to condone moral lapses or to s t i g m a t i z e innocent but unacceptable behaviour as v i c i o u s . The n o t i o n o f h i e r a r c h y i n s o c i e t y explained and j u s t i f i e d the h i e r a r c h i c a l s t r u c t u r e of the a s y l u m — t h e s o c i a l environment was ranked and ordered, and the asylum that was so organized was t h e r a p e u t i c because i t promoted con-f o r m i t y to s o c i a l r e a l i t i e s . In s h o r t , these concepts allowed the asylum p h y s i c i a n s to organize madness and mad behaviour i n t o a form t h a t was both m e d i c a l l y and s o c i a l l y a p p r o p r i a t e . The f i r s t of these three concepts, or d o c t r i n e s , the schema of stimu-l a t e d motion, postulated a theory about the f u n c t i o n s of the b r a i n which supposed a p h y s i o l o g i c a l process whereby mental and p h y s i c a l events could 2 a f f e c t each other. One of the f i r s t proponents of t h i s theory was Robert Whytt, who i d e n t i f i e d three p r i n c i p l e s which regulated thought and animation i n the human frame. The o l d dualism had recognized only two kinds of a c t i o n i n the world: voluntary a c t i o n governed by reason, and p h y s i c a l a c t i o n , governed by mechanism. Whytt now argued f o r the existence of a t h i r d , fundamentally d i s t i n c t , type of a c t i o n represented by 'motion from a s t i m u l u s ' . In the r a t i o n a l and the mechanical determinants of a c t i o n there was now added a t h i r d set of determinants derived from the s e l f - r e g u l a t i o n of the l i v i n g body.^ The important i d e a which was developed from t h i s n o t i o n of "sti m u l a t e d motion" was that the i n i t i a t i n g events d i d not have to be i d e n t i f i a b l e as p a r t i c u l a r p h y s i c a l or mental occurrences. 95 Both p h y s i c a l and mental events could operate i n the same way to produce i d e n t i c a l e f f e c t s because t h e i r a c t i o n was medi-ated by the same 'sen t i e n t ' p r i n c i p l e inherent i n the ,nature of the l i v i n g organism. A mental event could t h e r e f o r e be regarded as a s t i m u l u s , not i n a metaphorical, but i n a r e a l sense. The stimulus concept now begins to take on a purely f u n c t i o n a l meaning. What de f i n e s a stimulus as such i s n e i t h e r a p a r t i c u l a r conscious experience nor a p h y s i c a l i n f l u e n c e but a c e r t a i n p a t t e r n of e f f e c t s . ^ W i l l i a m C u l l e n was Whytt's successor at Edinburgh, where he continued to u t i l i z e the n o t i o n of stimulus by " r e f e r r i n g to anything which has the 5 power of e x c i t i n g animate motion as a s t i m u l u s . " He a l s o took up Whytt's " s e n t i e n t s o u l " as an un d e r l y i n g p r i n c i p l e , but a l t e r e d i t s substance to th a t of "energy". The b r a i n was seen as possessing a c e r t a i n q u a n t i t y of power which i t a p p l i e d to d i f f e r e n t p a r ts of the body. As has been quoted above, w e l l i n t o the nineteenth century, mental and p h y s i c a l a c t i v i t y were a t t r i b u t e d to l e v e l s of e x c i t a t i o n which concentrated i n the b r a i n , the f l u c t u a t i o n s of which were b e l i e v e d to be r e s p o n s i b l e f o r i n s a n i t y . The most i n t e r e s t i n g aspect of the s u r v i v a l of Whytt's ideas i s that of the f u n c t i o n a l d i s t urbance, the cause of which might be indeterminate,'though~ expressed through the absence of the s t i m u l u s , • but whose "pattern of e f f e c t s " can be named and t r e a t e d . Nineteenth-century asylum p h y s i c i a n s absorbed the ideas of st i m u l u s , the r e g u l a t o r y p r i n c i p l e , and the f u n c t i o n a l disturbance, a l l of which were of use i n e s t a b l i s h i n g the i n t e l l e c t u a l foundations of asylum medicine. That a stimulus could be n o n - p h y s i o l o g i c a l i n o r i g i n , i . e . mental, and yet be mediated through a s e n t i e n t p r i n c i p l e , which had some s o r t of organic s t a t u s , l i n k e d the mind and body i n an indeterminate r e l a t i o n s h i p which was very u s e f u l to doctors wishing to account f o r the moral c a u s a t i o n of mental disturbance. The r e g u l a t o r y p r i n c i p l e had a s i m i l a r l y p h y s i o l o g i c a l aura 96 that corresponded w e l l to the l o n g - e s t a b l i s h e d t h e r a p e u t i c s of a " t o n i c " or " l o w e r i n g " regimen. The idea of the f u n c t i o n a l disturbance was a boon i, because i t meant that symptoms could be addressed without e s p e c i a l concern f o r the source of the i l l n e s s . A l l of these notions allowed moral management t h e o r i s t s to s i d e - s t e p the i m p l i c a t i o n s of the mind-body dualism which was s t i l l a p h i l o s o p h i c a l dogma i n the e a r l y nineteenth century. However, Cu l l e n ' s legacy was not without i t s ambiguities to p h y s i c i a n s concerned w i t h mental and nervous disease: What defined a stimulus as such were i t s e f f e c t s , not i t s o n t o l o g i c a l s t a t u s as belonging to the mental or the p h y s i c a l realm. But t h i s p o s i t i o n could e a s i l y become subversive of t r a d i t i o n a l d u a l i s m . . . i t a c t i v e l y undermined dualism by i t s always present tendency to b l u r the sharp d i s t i n c t i o n between voluntary and i n v o l u n t a r y a c t i o n . ^ So l o n g as the p r e v a i l i n g e n v i r o n m e n t a l i s t outlook of l a t e eighteenth-century medicine p r i v i l e g e d the nervous system i n the realm of internal.;.regulation, 7 the threat to dualism was muted. However, by the 1830's, "the metaphysical s t a t u s of mind" was g e n e r a l l y considered e s s e n t i a l to the proper f u n c t i o n i n g of the moral and s o c i a l realms. The controversy between M a r s h a l l H a l l and W i l l i a m A l i s o n about the concept of r e f l e x f u n c t i o n was but one of s e v e r a l disagreements which f l o u r i s h e d throughout the nineteenth century and. .whose fundamental components had to do w i t h questions of n e c e s s i t y and voluntarism. Although the concept of stimulus as f u n c t i o n a l was o c c a s i o n a l l y per-ceived as p o t e n t i a l l y d i s r u p t i v e of the metaphysical d o c t r i n e s which were inherent i n much nineteenth-century s o c i a l and p o l i t i c a l thought, i t appears that i t continued to be widely employed by e a r l y p s y c h i a t r i c t h e o r i s t s . Moreover, asylum p h y s i c i a n s were not able to avoid other questions regarding free w i l l and r e s p o n s i b i l i t y ; indeed, t h e i r own d o c t r i n e s , derived i n part from what they f e l t was a s t r i c t empiricism, l e d i n t o the very murky waters 97 which surrounded such formulations as p a r t i a l or moral i n s a n i t y . Many of the p r i n c i p l e s upon which medical psychology was based possessed an equal or even g r e a t e r p r o p o r t i o n of ambiguity. The d o c t r i n e of p r e d i s p o s i t i o n was one of these. I t encompassed both h e r e d i t a r y f a c t o r s and c o n g e n i t a l weaknesses, although i t could not be con-f i n e d to any s t r i c t correspondence o f behavioural disturbance and p h y s i c a l l e s i o n . I t could be caused by an inadequate development of the mental f a c u l t i e s . F a u l t y education might provoke p r e d i s p o s i t i o n ; f u n c t i o n a l disease could be the r e s u l t . The idea of p r e d i s p o s i t i o n was, of course, to be found i n standard medical ex p l a n a t i o n , and i t derived some of i t s c r e d i b i l i t y from a long t r a d i t i o n , based on obse r v a t i o n , which asserted that i n s a n i t y was c l e a r l y i n h e r i t e d . In such cases, the acquired defect could be s i t u a t e d e i t h e r i n the t i s s u e s or the f a c u l t i e s . This arose from the observation of s p e c i f i c p h y s i c a l c h a r a c t e r i s t i c s which were passed on i n f a m i l i e s , such as head shape or the tendency toward c r e t i n i s m , which were o f t e n accompanied by disturbances i n i n t e l l e c t u a l f u n c t i o n . The p r e d i s p o s i t i o n toward i n t e l l e c t u a l or moral i n s a n i t y could a l s o be passed on, and i f whole f a m i l i e s d i s p l a y e d " v i c i o u s " behaviour, i t was o f t e n assumed that some inherent weakness of the mental a t t r i b u t e s must be r e s p o n s i b l e , although poor education, i n the form of i n c o n s i s t e n t or d e l i b e r a t e l y immoral p a r e n t a l a c t i o n s , might be inc l u d e d as an adjunct e x p l a n a t i o n . But p r e d i s p o s i t i o n d i d not need to be i n h e r i t e d . I t could simply be acquired, perhaps p r e n a t a l l y or l a t e r d u r i ng childhood i n response t o the same inadequate moral education that could t r i g g e r l u n a t i c behaviour i n i n h e r i t e d i n s a n i t y . A p r e d i s p o s i t i o n could a l s o be induced by indulgence i n d e b i l i t a t i n g a c t i v i t i e s , such as sexual excess, drunkenness, or la c k o f 98 u s e f u l employment. I t might a l s o f o l l o w a period of general p h y s i c a l i l l -h e a l t h or excessive mental s t r e s s caused by g r i e f , worry, or even over-studiousness. The existence of p r e d i s p o s i t i o n i n mental i l l n e s s was i n f e r r e d " e m p i r i -c a l l y " from observations of f a m i l i a l patterns of i n s t a b i l i t y . I t was a l s o u s e f u l i n accounting f o r v a r i a t i o n s i n s e n s i t i v i t y to noxious p h y s i c a l and mental experiences. This was e s p e c i a l l y important when observers were attempting to e x p l a i n the apparent r i s e i n the incidence of pauper lunacy by p o s t u l a t i n g the i n f l u e n c e of the i n c r e a s i n g complexity of " c i v i l i z e d " s o c i e t y . Such accounts were s a t i s f y i n g , p a r t l y because they gave scope to the nineteenth-century concern w i t h the i n f l u e n c e of the environment, while emphasizing the sense of s o c i a l r e s p o n s i b i l i t y which could be derived from negative conclusions about the e f f e c t s of i n d u s t r i a l i s m and poverty on the minds of the lower orders. Many eighteenth-century observers of types of i n s a n i t y would have argued that v a r i e t i e s of disturbance were r e l a t e d to s o c i a l c l a s s . By the l a t e r part of the eighteenth century, however, more observers were s t a t i n g t h a t mental i l l n e s s cut across s o c i a l boundaries. The a s s o c i a t i o n s between c l a s s and forms of i l l n e s s never e n t i r e l y disappeared, and, by the m i d - V i c t o r i a n p e r i o d , Conolly was t e l l i n g medical students that lunacy could occur i n any s o c i a l group, and that i t s g r e a t e r prevalence among the poor was not so much 10 the r e s u l t of " v i c i o u s " behaviour as i t was the e f f e c t of d e p r i v a t i o n . He was concerned t h a t a p h i l a n t h r o p i c a t t i t u d e toward the pauper insane should not be diminished by a perception that i n s a n i t y was the outcome o f loose l i v i n g , and was t h e r e f o r e l a r g e l y w i t h i n the bounds of personal r e s p o n s i b i l i t y . The problem of r e s p o n s i b i l i t y i s of great importance when the meaning of the d o c t r i n e of p r e d i s p o s i t i o n i s considered. To say th a t a c e r t a i n 99 l u n a t i c had been predisposed to develop an i l l n e s s n e i t h e r excused h i s i l l -ness as s o c i a l l y caused, nor condemned i t as i n d i v i d u a l l y induced. Both p o s s i b i l i t i e s e x i s t e d , and from an a d m i n i s t r a t i v e point of view, n e i t h e r was important. The p r i n c i p l e s of moral management were expected to r e i n f o r c e the power of s e l f - r e s t r a i n t i n a l l cases of madness, and thus a d e f e c t i v e or damaged f a c u l t y of mind could be improved by exposure to the asylum atmos-phere. P r e d i s p o s i t i o n possessed impeccable medical connotations which allowed nineteenth-century p h y s i c i a n s to regard i t as a p r i m a r i l y s c i e n t i f i c d o c t r i n e , w i t h only secondary moral i m p l i c a t i o n s . However, there was no denying the impact that s e l f - i n d u l g e n c e of a moral or p h y s i c a l k i n d was b e l i e v e d to be i n v o l v e d i n many cases of i n s a n i t y . In speaking of a medical p r e d i s p o s i t i o n , p h y s i c i a n s could i n c l u d e personal r e s p o n s i b i l i t y i n the genesis of d i s e a s e , while c o n t i n u i n g to support the p h i l a n t h r o p i c and p a t e r n a l i s t i c explanations that were more e a s i l y forthcoming when the advent of disease was considered to be a c c i d e n t a l . The i s s u e of personal r e s p o n s i b i l i t y d i d not l o g i c a l l y r e l i e v e s o c i e t y of the need to provide f o r the insane, but i t i s evidence of a c o n t i n u i n g t e n s i o n w i t h i n the t h e o r e t i c a l and moral c o n s t r u c t s of the t h e r a p e u t i c imperative. The s h i f t towards an i n c r e a s i n g l y d e t e r m i n i s t i c theory of the causes of i n s a n i t y , which focused upon degeneration and i n h e r i t a n c e , and which was 12 most power f u l l y argued by Henry Maudsley, was, i n p a r t , prepared f o r by the acceptance i n the e a r l i e r part of the nineteenth century of the impor-tance of p r e d i s p o s i t i o n . A predisposed l u n a t i c could be v i c t i m of an unavoidable accident of b i r t h , or h i s own i n d i s c r e t i o n s . The determined and the v o l u n t a r y c o - e x i s t e d , and as long as that uneasy combination could 100 be t o l e r a t e d , moral management could p e r s i s t i n i t s claims that causation was not of paramount importance, and th a t a c t i v e treatment should be uniform. By the time of Maudsley's ascendancy, the balance had a l t e r e d i n favour o f determinism, and treatment was perceived as p a l l i a t i v e at best and, to some extent, i r r e l e v a n t . Another c e n t r a l preoccupation f o r doctors l i k e Conolly was revealed i n t h e i r e f f o r t s to l o c a t e the insane w i t h i n the s o c i a l environment. I t was a question of order, of f i n d i n g a place f o r the diseased mind w i t h i n the various h i e r a r c h i e s of which the s o c i a l world was composed. These included an order of precedence w i t h i n the mind, between the mind and the body, and w i t h i n v a r i o u s groups of i n d i v i d u a l s . These c a t e g o r i e s may be s a i d to have the power of b a s i c premises i n nineteenth-century t h i n k i n g . Thus, when the eighteenth-century f o r m u l a t i o n of the l u n a t i c as beast-man, the man without reason, gave way to the concept of the l u n a t i c as a man with a v i t i a t e d i n t e l l e c t , or weak c o n t r o l over emotions, or an incomplete w i l l , i t was necessary to i d e n t i f y the p o s i t i o n of the mentally i l l w i t h i n the general s t r u c t u r e s of s o c i e t y . The t h e o r i e s of mental f u n c t i o n i n g and the development of the p r i n c i p l e s of moral management were constructed around a general mind housed i n an u n s p e c i f i e d body. But i t was understood that gender and s o c i a l p o s i t i o n would s i g n i f i c a n t l y a l t e r c e r t a i n aspects of mental and p h y s i c a l behaviour, e s p e c i a l l y as they a f f e c t e d the extent of " s e n s i b i l i t y " . An i l l - d e f i n e d but of t e n mentioned q u a l i t y , s e n s i b i l i t y seemed to denote both r e c e p t i v i t y to a l l forms of e x t e r n a l s t i m u l a t i o n and a l s o a c e r t a i n l e v e l of d e l i c a c y i n the c o n s t i t u t i o n which rose and f e l l i n r e l a t i o n to gender and the degree to which the i n d i v i d u a l had been exposed to i n f l u e n c e s of s o c i a l improvement. 101 Such v a r i a t i o n s i n mental e n t i t i e s possessed an e m p i r i c a l r e a l i t y f o r nine-teenth-century p h y s i c i a n s . Thus the references to disease types and asylum management had to take account of t h i s data. Doctors l i k e Conolly d i d not analyze the r e l a t i o n between what they i d e n t i f i e d as d i f f e r e n t c a t e g o r i e s o f mind and s o c i a l s t r u c t u r e s c o n s c i o u s l y or d i r e c t l y . Rather, t h e i r a s s o c i a t i o n s or unacknowledged b e l i e f s about the fundamental nature of s o c i a l h i e r a r c h y provided a basis upon which they could begin to construct h i e r a r c h i e s of mental types. The mind had i t s own h i e r -archy; the i n t e l l e c t u a l f a c u l t i e s , such as a t t e n t i o n , memory, and comparison, were b e l i e v e d to be of gr e a t e r importance than the emotions or even the w i l l . The s t r e n g t h of the reasoning a b i l i t i e s permitted proper e x e r c i s e of the w i l l and r e s t r a i n t on the emotions, which were otherwise l i k e l y to become unman-ageable. The i n t e l l e c t u a l f a c u l t i e s were concerned i n an i n d i v i d u a l ' s s o c i a l p a r t i c i p a t i o n . I t had long been assumed that educated persons could be expected to e x e r c i s e more s e l f - c o n t r o l , and to behave i n a more s o c i a l l y r e s p o n s i b l e manner than the i l l i t e r a t e . However, the l e s s i n t e l l e c t u a l man could be taught to reason along l i n e s a p propriate to h i s s o c i a l s t a t i o n by exposure to p r i n c i p l e s such as deference, l o y a l t y , and perseverance. The i n t e l l e c t u a l f a c u l t i e s could be i n f l u e n c e d , not only by d i r e c t a p p l i c a t i o n of t e x t s , but a l s o by example and precept; indeed, the mind unaccustomed to i n t e l l e c t u a l e x e r c i s e and i n s u f f i c i e n t l y acquainted with proper moral guidance or l a c k i n g a p r a c t i c a l o u t l e t f o r acquired i n f o r m a t i o n could be damaged "by a rig o r o u s or unbalanced educative endeavour. I t i s i n such a view that Conolly endorsed the type of l e a r n i n g to be 1 3 found i n Mechanics' I n s t i t u t e s . He d e c r i e d the view that any e d u c a t i o n a l improvement f o r the lower orders would be s o c i a l l y d i s r u p t i v e . He argued 102 that g i v i n g them i n f o r m a t i o n about the r e a l i t i e s o f economic l i f e and f a c t s about the n a t u r a l world would i n f a c t permit them to see and accept t h e i r place as subordinate economic agents and decrease s o c i a l s t r i f e . S t r a i g h t -forward e m p i r i c a l knowledge a p p l i e d to a c t u a l s i t u a t i o n s could do no harm, and, indeed, would strengthen t h e i r commitment to present r e a l i t i e s , under-mining both n o s t a l g i c sentiments and s o c i a l d i s c o n t e n t s . In t h i s way, c o n t r o l over the p e r s o n a l i t y would proceed from the "highest" mental centres whether they had been developed by exposure to formal e d u c a t i o n a l m a t e r i a l s or by a blend of moral example and i r r e d u c i b l e e m p i r i c a l data. The h i e r a r c h y of mental f u n c t i o n s was continuous with a dominance of the mental over the p h y s i c a l . I t could be s a i d that the "lower" elements of the mind, such as the passions, owed t h e i r s u b o r d i n a t i o n , i n p a r t , to t h e i r obvious l i n k s w i t h p h y s i c a l processes. The i n t e l l e c t u a l f a c u l t i e s , e s p e c i a l l y any a s s o c i a t e d w i t h the reason, on the other hand, had long ago acquired great value because of t h e i r presumed p r o x i m i t y to the s o u l . The mental operations thus took precedence over p h y s i c a l m a n i f e s t a t i o n s i n s o f a r as the s o u l ranked above the body. E s t a b l i s h i n g a necessary a s s o c i a t i o n between b r a i n and mind d i d not d i m i n i s h the higher s t a t u s that was enjoyed by the i n t e l l e c t u a l f a c u l -t i e s , and the p e r s i s t e n c e of t h i s ranking was of p a r t i c u l a r importance t o the development of moral management. Although s e v e r a l of the f e a t u r e s of moral management were a p p l i e d to the body, e s p e c i a l l y the p r o v i s i o n s f o r housing, food and employment, the t h e r a p e u t i c r a t i o n a l e was intended to modify the mind, both through the c r e a t i o n of an emotionally balanced environment, and i n d i r e c t l y through the p h y s i c a l m i n i s t r a t i o n s . In the degree to which moral therapy was d i r e c t e d towards mind, i t b e n e f i t t e d from the s t a t u s which a l l aspects of "mind" enjoyed i n r e l a t i o n to the l e s s e r value of the body. 103 This h i e r a r c h y of mind and body helps to e x p l a i n the a t t r a c t i o n of t o t a l n o n - r e s t r a i n t f o r some of the moral managers. The highest good was r e s t r a i n t through e x e r c i s e of the i n t e l l e c t u a l f a c u l t i e s . Reason was to d i r e c t the w i l l and emotions i n the maintenance of s e l f - c o n t r o l . I f the object of moral treatment was to b o l s t e r or renew the powers of s e l f - c o n t r o l , then s u r e l y those methods of management were p r e f e r a b l e which appealed most completely to i n t e l l e c t u a l operations and which r e l i e d l e a s t upon p h y s i c a l c o n s t r a i n t s . The body must be made comfortable and secure, but the forc e of the therapy should apply to the mental s t a t u s , and, i n s o f a r as s e l f - r e s t r a i n t was the k e r n e l of moral management, so the s p e c i f i c aspects of c o n t r o l should be most nearly non-physical. The other aspects of h i e r a r c h y which were of importance to the c o n s t i t u -t i o n of nineteenth-century p s y c h i a t r i c theory and p r a c t i c e manifested them-selv e s i n s o c i a l r e l a t i o n s h i p s . The ranking o f s o c i a l c l a s s e s upon which V i c t o r i a n s o c i e t y was s t r u c t u r e d informed the major elements of moral manage-ment. The t h e o r e t i c a l premises of moral treatment were developed i n a v a r i e t y of s i t u a t i o n s ' i n which the c l a s s a f f i l i a t i o n s of the p h y s i c i a n -managers and t h e i r p a t i e n t s were very d i f f e r e n t ; but the most renown was obtained by the e f f o r t s of the Tukes, who e s t a b l i s h e d a system of care which accepted as a primary value the r e l a t i v e e q u a l i t y of a l l souls before God. This e g a l i t a r i a n i s m was tempered by a p r a c t i c a l p a ternalism t h a t was c l e a r l y 14 enunciated i n the Tuke's equating of l u n a t i c s w i t h c h i l d r e n . This analogy was not new i n the p u b l i c understanding o f madness, and was, indeed, the expression of a deep b e l i e f i n the ranking of the managers and the mad which was both s o c i o l o g i c a l and p s y c h o l o g i c a l . The s o c i o - p o l i t i c a l orders which comprised the nineteenth-century B r i t i s h p u b l i c found t h e i r counterparts i n a h i e r a r c h y of psychologies. The 104 interdependence of the disease ranking and the s o c i a l h i e r a r c h y i s v i s i b l e i n t h e i r shared assumptions about the importance of breeding and education i n the formation of d i s t i n c t p h y s i o l o g i c a l and i n t e l l e c t u a l groups. The g e n t l y -born and academically-educated male was at the top of the pyramid, followed by h i s e q u a l l y well-born and appropriately-educated w i f e . Lowest i n the s c a l e were a l l those reared i n a combination of moral and p h y s i c a l squalor, who had i n h e r i t e d d e f i c i e n t i n t e l l e c t u a l f a c u l t i e s and who were engaged i n immoral a c t i v i t i e s . ^ The importance of these p a r a l l e l h i e r a r c h i e s d i d not r e s t e n t i r e l y i n . i the realm of d i a g n o s i s . They a l s o a f f e c t e d the question of therapy. The management of attendants was a great worry i n the annals of moral treatment, f o r i t was widely acknowledged that the p s y c h o l o g i c a l demands e n t a i l e d i n c a r i n g f o r the insane were so great, e s p e c i a l l y i n a morally t h e r a p e u t i c i n s t i t u t i o n , t hat i t was u n r e a l i s t i c to expect a high standard of performance from the c l a s s of person who could be induced to perform the task. This e x p l a i n s why the asylum p h y s i c i a n expanded h i s r o l e i n the adminis-t r a t i o n . The force of h i s p e r s o n a l i t y was intended to dominate the whole establishment to the extent that the attendants, who lacked h i s a t t r i b u t e s of education, breeding, and almost d i v i n e c h a r a c t e r , could be i n s p i r e d to behave toward the p a t i e n t s along the l i n e s l a i d down f o r s u c c e s s f u l moral treatment. A s p i r i t of s e l f - s a c r i f i c e equal to that r e q u i r e d of the p h y s i c i a n -d i r e c t o r seemed to be a p o s i t i v e n e c e s s i t y f o r the ord i n a r y ward attendant, 16 without any of the advantages which accompanied the doctor's commitment. The problem grew even more complicated i n the s i t u a t i o n of the upper and middle c l a s s l u n a t i c s . I t was d i f f i c u l t enough to f i n d attendants w i t h the necessary personal q u a l i t i e s to deal w i t h the pauper insane. A l a r g e r 105 question, one i n v o l v i n g the c o n s t i t u t i o n of the emotional environment, e x i s t e d i n r e l a t i o n to the higher orders. Should not t h e i r moral treatment i n v o l v e a t t e n t i o n from i n d i v i d u a l s who possessed an i n t i m a t e knowledge of the p h y s i c a l and p s y c h o l o g i c a l needs of the upper and middle c l a s s e s ? The higher ranks were thought to possess more h i g h l y developed s e n s i b i l i t i e s which re q u i r e d a more r i c h l y endowed atmosphere f o r t h e i r most e f f e c t i v e expression. I t was not merely the need f o r a m e n i t i e s — p r i v a t e l i v i n g q u a r t e r s , b e t t e r food, more s o p h i s t i c a t e d entertainment, as w e l l as s o c i a l l y a p p r o p r i a t e avenues f o r occupation. I t was a l s o the fundamental requirement of deferen-t i a l and w e l l - t r a i n e d s e r v i c e . "Good" servants could be had f o r the mentally w e l l and w e l l - t o - d o , but were they to be e a s i l y come by i n an asylum s e t t i n g ? In some of the most e x c l u s i v e i n s t i t u t i o n s , such as T i c e h u r s t , i t seems that 17 such w e r e . a v a i l a b l e . But i n the l e s s l a v i s h p r i v a t e establishment, i t was very u n l i k e l y that the hardworking, soft-spoken, i n t e l l i g e n t i d e a l of a menial was procurable. Even i f the s e r v i c e s of such a g i f t e d domestic could be obtained, was he the most appropriate companion f o r the upper c l a s s l u n a t i c ? There were two problems. In order to r e g a i n h i s former s a n i t y , the mentally d i s t u r b e d i n d i v i d u a l needed to have some contact w i t h a mind capable of i n f l u e n c i n g him. In the p u b l i c asylum, d a i l y exposure to healthy minds came from; contact w i t h the attendants whose mental equipment was considered e q u i v a l e n t i n breadth and c a p a c i t y to that of the p a t i e n t s . This i n d i v i d u a l experience of s a n i t y was not the task of the p h y s i c i a n to provide, except i n s o f a r as h i s person-a l i t y , i n f l u e n c i n g a l l aspects of i n s t i t u t i o n a l l i f e , had b e n e f i c i a l e f f e c t s on the characters of those d i r e c t l y i n v o l v e d i n the care of the mad. In the case of the h i g h e r - s t a t u s madman confined i n a p r i v a t e asylum, h i s d a i l y exposure would not be to an equal mind, but to an i n f e r i o r one, 106 i n the event that h i s attendant was a servant. His s o c i a l and mental peer was the p h y s i c i a n . Thus, there e x i s t e d a th e r a p e u t i c r a t i o n a l e f o r the i n t i m a t e q u a l i t y of the s o c i a l i z i n g which obtained among the e l i t e insane 18 i n t i n y asylums such as the one Conolly ran i n h i s l a t e r yearsJ Not only d i d teas and dinner p a r t i e s reproduce the s o c i a l occasions which made up a s u b s t a n t i a l amount of the p u b l i c l i v e s o f the we l l - t o - d o , but such s i t u a t i o n s allowed the p a t i e n t s to b e n e f i t from the remedial i n f l u e n c e o f the medico-p s y c h o l o g i s t ' s c h a r a c t e r . However, the problem of the impact of the s e r -vants' l e s s - r e f i n e d s e n s i b i l i t i e s upon the weakened f a c u l t i e s of the upper c l a s s l u n a t i c remained, s i n c e i n a l l but the sma l l e s t p r i v a t e establishments, most of the care was i n the hands of badly-educated domestics employed by the management or h i r e d by the p a t i e n t ' s f a m i l y . The other problem i n c u r r e d i n the treatment of upper c l a s s l u n a t i c s was r e l a t e d to the i s s u e of subo r d i n a t i o n . I t was axiomatic that e f f e c t i v e moral therapy r e i n f o r c e d or renewed powers of s e l f - c o n t r o l , o p e r a t i n g through the c a r e f u l l y planned d a i l y r o u t i n e which was a major f e a t u r e of p u b l i c asylum l i f e . E s s e n t i a l to the e f f i c a c y of t h i s r o u t i n e was the c a p a c i t y to accept d i r e c t i o n , to subordinate personal d e s i r e and i n d i v i d u a l w i l l to the w i l l s of the attendants, as they were d i r e c t e d by the p h y s i c i a n . Such a chain of command' r e f l e c t e d a c c u r a t e l y the h i e r a r c h y of c o n t r o l which obtained between the s o c i a l c l a s s e s , and thus was n a t u r a l to the environment of the p u b l i c asylum. I t was not so J-natural i n the p r i v a t e i n s t i t u t i o n - i n which attendants were servants and the p h y s i c i a n , i n e f f e c t , a h i r e d p r o f e s s i o n a l . The com-pany o f the doctor could be t o l e r a t e d as he was a r e l a t i v e s o c i a l .equal, but an attendant was there to obey orders, not to give them, and could never be considered as a th e r a p e u t i c companion because of the s u f f i c i e n c i e s r e s u l t i n g from h i s l a c k of breeding and education. 107 But an upper-class insane person must be l e d , l i k e a pauper l u n a t i c , to see that h i s powers of s e l f - r e s t r a i n t were h i s c h i e f a i d to recovery. An aspect of such r e s t r a i n t was found i n submission to the management by the mentally healthy, i n c l u d i n g persons who ranked as s o c i a l i n f e r i o r s . This predicament was rendered even more acute i n the p r o p o r t i o n of cases i n which the mentally d i s t u r b e d were behaving g r a n d i o s e l y , e i t h e r imagining themselves to be e x a l t e d personages, or g i v i n g orders i n an a u t o c r a t i c and s e l f - i n d u l g e n t manner, or a combination of the two. In such s i t u a t i o n s , i t could be deemed the r a p e u t i c to d e l i b e r a t e l y d e f l a t e the pretensions of the p a t i e n t , not through p h y s i c a l v i o l e n c e , but through l a c k of compliance with h i s d i r e c t i v e s . I t might even be necessary to remove from h i s c o n t r o l a l l but the most essen-t i a l servant and to g i v e him the r i g h t to enforce d i s c i p l i n e on the d e t a i l s 19 of the p a t i e n t ' s l i f e . However, to place a wel l - b r e d l u n a t i c under the management of poorly educated, a l b e i t warm-hearted servants offended against s o c i a l p r o p r i e t y f o r a l l ranks and undermined the s u c c e s s f u l recovery of the p a t i e n t , who was expected to r e t u r n to a s t r u c t u r e of l i f e which r e q u i r e d an unquestioning h a b i t of a u t h o r i t y among the higher c l a s s . I t may be seen that the p r i n c i p l e s of h i e r a r c h y w h i le p r o v i d i n g impor-tant s t r u c t u r a l support to c e r t a i n elements of moral management, a l s o increased i t s a m b i g u i t i e s . The d i f f i c u l t i e s encountered i n p l a c i n g the upper c l a s s l u n a t i c w i t h i n the t h e r a p e u t i c framework stemmed from'the problem of s o c i a l i d e n t i f i c a t i o n . Conolly was among the prominent medico-psychologists 20 who were drawn to the nascent study of ethnology. Questions about the human s t a t u s and the i n t e l l e c t u a l , p h y s i c a l , and emotional a t t r i b u t e s of the "savages" who were being brought to England f o r d i s p l a y from A f r i c a and the Americas were s i m i l a r i n i n t e n t to the unsolved disputes of the eighteenth century concerning the o n t o l o g i c a l s t a t u s of the man w i t h v i t i a t e d reason. 108 A l l w r i t e r s on p s y c h i a t r i c t o p i c s who were concerned about the i n f l u -ence o f c i v i l i z a t i o n of the genesis of lunacy began w i t h c e r t a i n r e c e i v e d notions about the incidence of disturbance among the p r i m i t i v e , which l e d to questions about the c o n s t i t u t i o n of the savage mind and i t s r e l a t i o n to 21 minds of a more so c i a l l y - a d v a n c e d type as w e l l as minds of d i f f e r e n t races. The existence of d i f f e r e n t types of minds, and the c o n d i t i o n s which had had co n t r i b u t e d to t h e i r d i f f e r e n t i a t i o n , were ideas which were present i n the background o f many d i s c u s s i o n s of the causes and treatments o f i n s a n i t y throughout the e a r l y and middle decades of the nineteenth century. Just as Conolly f e l t o b l i g e d to e s t a b l i s h the e s s e n t i a l humanity o f the retarded c h i l d r e n from C e n t r a l America, about whom he wrote a paper i n 1853 22 f o r the E t h n o l o g i c a l S o c i e t y , so i t was necessary to determine the boun-d a r i e s of the human w i t h i n the ranks of the mentally i l l , e s p e c i a l l y i n a period i n which i t might be contended that a more s t r i c t l y r a t i o n a l i s t theory of human nature v i e d w i t h the o l d e r t h e o l o g i c a l understanding, although both r e l i e d i n c r e a s i n g l y upon the f a c u l t y of reason as a bas i c d e f i n i n g c h a r a c t e r -i s t i c f o r the possession of a p e r s o n a l i t y . The exp l a n a t i o n could be, and was, invoked to excuse and render comprehensible the conduct of the l u n a t i c ; but that c a t e g o r i z a t i o n was not s u f f i c i e n t to account f o r the madman's p o s i t i o n among the other s o r t s of men who demonstrated what the E u r o c e n t r i c nineteenth-century p h y s i c i a n designated as i n t e l l e c t u a l d e f i c i e n c i e s . In the end, despi t e the c o n f l i c t s i t engendered w i t h the e x i s t i n g system of s o c i a l h i e r a r c h y , the l u n a t i c was c l a s s e d w i t h the pauper, the c h i l d , and the c r i m i n a l (and i f the c o l o n i a l e t h i c i s considered, the savage) as those who had to be managed f o r t h e i r own good and i n order to ensure s o c i a l harmony. This was a category defined i n terms of what might be described as 109 s o c i a l competence, since i t included such f a c t o r s as a c a p a c i t y f o r sustained human i n t e r a c t i o n s and a sense of s o c i a l belonging i d e n t i f i e d by adherence to s o c i a l and l e g a l conventions, as w e l l as a c a p a c i t y f o r economic s e l f -s u f f i c i e n c y . These requirements are elements which describe what C a s t e l has c h a r a c t e r i z e d as " c o n t r a c t u a l s o c i e t y " — o n e i n which "the subject p a r t i c i -pates i n f r e e and r a t i o n a l exchanges, or, because of [an i n a b i l i t y to do so] 23 i s placed under a r e l a t i o n de t u t e l l e . " Such an o r d e r i n g must be described as managerial and "pedagogic", r a t h e r than s p e c i f i c a l l y medical or even g e n e r a l l y s c i e n t i f i c . Moreover, t h i s c l a s s i f i c a t i o n was not a s o l u t i o n to the enduring o n t o l o g i c a l problem of l o c a t i n g the l u n a t i c type of man among other men. The above-mentioned h i e r a r c h i e s , the p s y c h o l o g i c a l , the socio-economic, and the e t h n o l o g i c a l were part of the great p r o j e c t of nineteenth-century p h y s i c a l and s o c i a l i n q u i r y which was to make a place f o r man i n the n a t u r a l world. In the end, the medico-psychologists were not able to account f o r i n s a n i t y ' as a n a t u r a l phenomenon, even when the concept of the n a t u r a l included both the most p r i m i t i v e passions of the savage and the e x q u i s i t e a r t i f a c t s o f the haute monde. Broadly speaking, f o r many nineteenth-century p h y s i c i a n s , the insane man was caught between nature and s o c i e t y , h i s mind-soul preventing him from r e s i d i n g w i t h i n the former, while h i s l a c k of s e l f - c o n t r o l made him u n f i t f o r the l a t t e r . At the same time, the ideas of nature and s o c i e t y d i d meet i n the n o t i o n of the s o c i a l environment which included a l l the i n f l u e n c e s of the p h y s i c a l world and s o c i a l o r g a n i z a t i o n t h a t could be s a i d to have medi-, . ... 24 c a i s i g n i f i c a n c e . But the d e s i r e to complete the p i c t u r e , to make coherent the growing confusion of the s o c i a l , the medical, the economic, and the i n t e l l e c t u a l , 110 which confronted p h y s i c i a n s l i k e C o n o lly, i s expressed by what K a r l F i g l i o has i d e n t i f i e d as the metaphor of o r g a n i z a t i o n . F i g l i o develops hisi'theoryy about the importance of an un d e r l y i n g concept f o r the understanding o f the nineteenth-century biomedical sciences by l o o k i n g at various d i s p u t e s that took place during the eighteenth .through to the middle of the nineteenth century, and which can be shown on a n a l y s i s to possess a fundamental coher-ence, des p i t e t h e i r surface p o l a r i t i e s . F i g l i o takes pains to d i s t i n g u i s h .. h i s idea of the u t i l i t y of such a metaphor from Foucault's much broader scheme of the episteme: o r g a n i z a t i o n as a u n i f y i n g concept operated a t a l e v e l intermediate to what he terms " H i s t o r y " ("the spoken, but h i g h l y regulated s t r a t a of discourse") and the "unspoken", t o t a l l y i n c l u s i v e e p i s -25 teme. The importance of the metaphorical nature of the concept of o r g a n i z a t i o n l i e s i n i t s c a p a c i t y to a l l o w f o r the expression of both s c i -e n t i f i c discourse and i t s context. I t conveys the n o t i o n which was c e n t r a l to e a r l y nineteenth-century p h y s i o l o g y — t h a t of the depth, the "inwardness" of the l i v i n g s u b j e c t . In order to describe t h i s i n t e r i o r r e a l i t y , the t o o l s of the anatomist were e s p e c i a l l y p r i z e d , and t h i s , i n t u r n , was connected with the older i n t e r e s t i n comparative anatomy, which enabled the p h y s i o l o -g i s t s to e s t a b l i s h the l o c a t i o n of t h e i r subject i n r e l a t i o n to other forms of l i f e . This inwardness might leave signs on the su r f a c e , and was thus s u s c e p t i b l e to the physiognomist, but i t was u l t i m a t e l y "beyond the reach 26 of v i s i b i l i t y or t o t a l comprehension." The i n t e r i o r was not e x c l u s i v e l y p h y s i c a l , however; i t was a l s o moral, and thus o r g a n i z a t i o n came i n t o use i n areas concerned w i t h human behaviour. This might take the form of medical psychology, or p o l i t i c s , or economics. The e s s e n t i a l idea was that the presence of o r g a n i z a t i o n i n the body, i n the 111 mind, and i n s o c i e t y , pointed to the e x i s t e n c e of God and h i s c o n t r o l l i n g design. F i g l i o ' s a l l u s i o n s to John B a r c l a y , the S c o t t i s h philosopher, are a p p o s i t e . For B a r c l a y , " . . . o r g a n i z a t i o n i s s i m i l a r to behaviour, to man's moral f a c u l t i e s and to s o c i e t y ; a l l are l i v i n g , cohesive, purposeful pro-27 cesses." His argument was i d e n t i c a l to those used by members of the Scot-^ . t i s h School, such as Dugald Stewart or Thomas Reid. I t was a " p o s i t i o n which emphasized man's moral f a c u l t i e s , i n c l u d i n g h i s c a p a c i t y to perceive immedi-a t e l y the design i n every aspect of c r e a t i o n and the appropriateness of h i s 28 a c t i o n s , but which s t r e s s e s e q u a l l y h i s b o d i l y frame." What i s important i s that there was a c l e a r connection between the emphasis upon human p h y s i c a l and moral o r g a n i z a t i o n and nineteenth-century t h e o r i e s of the s t a t e as an organism. In the S c o t t i s h t r a d i t i o n , o r g a n i z a t i o n r e f e r r e d to the a c t i v e i n t e r r e l a t i n g of c o n s t i t u e n t parts according to a wise plan....At each l e v e l (medicine, e t h i c s and p o l i t i c a l economy) human knowledge depends upon grasping the o r g a n i z a t i o n expressed by n a t u r e . ^ We may now d e c l a r e more c o n f i d e n t l y that p r a c t i t i o n e r s of moral manage-ment and n o n - r e s t r a i n t employed three p r i n c i p a l s t r a t e g i e s of e x p l a n a t i o n i n 30 order to g i v e a c e r t a i n coherence to t h e i r theory and t h e r a p e u t i c s . The f i r s t s t r a t e g y , the stimulus concept, was n e u r o - p h y s i o l o g i c a l i n d e r i v a t i o n and was intended to provide a b a s i s f o r understanding questions of that nature w i t h regard to mental f u n c t i o n i n g . - Secondly, the n o t i o n of p r e d i s -p o s i t i o n was drawn from contemporary medical p r a c t i c e i n r e l a t i o n to i t s sources and according to i t s a p p l i c a b i l i t y . F i n a l l y , h i e r a r c h y was used as a medical f a c t as w e l l as to account f o r the c o m p l i c a t i o n s a r i s i n g from w i t h i n the s o c i o - p o l i t i c a l s t r u c t u r e s of s o c i e t y . In each case, there was no defined boundary between what might be designated as the. " s c i e n t i f i c " and the 112 " s o c i a l " . F i g l i o speaks of the "metaphorical flow" which i s permitted by the concept of o r g a n i z a t i o n ; the ambiguity contained i n i t s s e v e r a l meanings, such as "mere complexity, but a l s o organic body, organized being, or the 31 process of o r g a n i z i n g . " I t was p r e c i s e l y the e l a s t i c i t y o f meaning which was conveyed i n the three techniques o u t l i n e d above which gave them the explanatory power they had. The e s s e n t i a l l y " l i n g u i s t i c " nature of nineteenth-century medico-p s y c h o l o g i c a l d i s c u s s i o n has a l s o been noted by Roger Smith: Medical discourses i n t e g r a t e d a s c i e n t i f i c i d e a l and a moral-i s t i c p r a c t i c e . While the discourse contained many e s o t e r i c elements, i t a l s o formulated everyday concerns. I t s s t r e n g t h l a y i n i t s c a p a c i t y to r a t i o n a l i z e so much w i t h i n i t s frame of reference. I t was at i t s weakest when forced to confront spe-c i f i c problems... ...neurophysiology was the language not the occupation of a l i e n i s t s . I t would seem that neurophysiology was one among s e v e r a l languages d i s c e r n -i b l e i n the discourse of the nineteenth-century medico-psychologists. The management p r o v i s i o n s i n the t r e a t i s e s on moral therapy comprise another aspect, along w i t h the more s p e c i f i c a l l y medical j u s t i f i c a t i o n f o r c e r t a i n o r g a n i z a t i o n a l d e c i s i o n s . I t could be s a i d t h a t moral management was a "metaphorical p r a c t i c e " . Although, i n a c t u a l i t y , the b u i l d i n g s and t h e i r behavioural codes were designed to modify or, at l e a s t , c o n t a i n i n s a n i t y , t h i s was i n another sense the enactment of s a n i t y . I f the e x e r c i s e of s e l f -c o n t r o l was the hallmark of the sane, and the m u l t i f a r i o u s d e t a i l s o f the morally-managed asylum were intended to cure the mentally i l l (or, i n other words, produce s e l f - r e s t r a i n t ) , then i t could be s a i d that the a r t i f a c t s of containment were themselves a metaphor because, they were things which stand f o r something e l s e , which i s an o l d d e f i n i t i o n of metaphor. The.language of s e l f - c o n t r o l was represented by the enactment of o r g a n i z a t i o n . 113 I f moral management was, then, the language of the nineteenth-century p s y c h i a t r i s t s , t h e i r occupation was s u r e l y a d m i n i s t r a t i v e . The s t r u c t u r e of treatment w i t h i n the asylum r e f l e c t s an attempt on the part of the p h y s i c i a n managers to in c o r p o r a t e recognized medical e x p e r t i s e w i t h novel forms of o r g a n i z a t i o n . Or, as one c r i t i c says i n h i s review of C a s t e l : What can be seen i s not the adoption o f p o l i c i e s based on the apprehension of s c i e n t i f i c t r u t h , but a mutual adjustment o c c u r r i n g among c o n f l i c t i n g sources of power d e a l i n g w i t h s o c i a l and economic problems. The experts i n i n s a n i t y had a l l the advantages of l i n k i n g medical and a d m i n i s t r a t i v e p r a c t i c e s i n t h e i r work. What i s important, C a s t e l reminds us, i s not so much what mental medicine was supposed to be doing at the l e v e l of p r a c t i c e as what i t was a c t u a l l y doing when masking or covering up the c o n t r a d i c t i o n s between i t s t h e r a p e u t i c and i t s s o c i a l and c u s t o d i a l o b j e c t i v e s . ^ Part of the r e s o l u t i o n of those " c o n t r a d i c t i o n s " could be obtained from the n o t i o n of l o c a t i n g , i n the person of the p h y s i c i a n - a d m i n i s t r a t o r , a con-fluence of the t h e r a p e u t i c and s o c i a l . M i l l e r d e s c r ibes C a s t e l as saying o f moral treatment that i t "represented the paradigm of an a u t h o r i t a r i a n peda-gogy, the p o s s i b i l i t y f o r a g e n e r a l i z e d s t r a t e g y of moral r e g u l a t i o n based 34 on a t e c h n i c a l medical r e f e r e n c e . " I n s o f a r as the character of the moral manager was to in c o r p o r a t e both the personal q u a l i t i e s d e s i r a b l e i n both p a t i e n t s and attendants, and h i s person was to stand f o r the s o c i a l h i e r -a r c h y — t h e J'order" of s o c i e t y to which the "disordered" man must be r e c o n c i l e d — h e e x i s t e d as the very f i g u r e of "an a u t h o r i t a r i a n pedagogy," a l b e i t one tempered by i t s r o o t s i n a broader p a t e r n a l i s t i c philanthropy.. The metaphorical nature of moral treatment i s again underlined i n the f i g u r e of the p h y s i c i a n who i s a l s o an a d m i n i s t r a t o r , and who i s a r e p r e s e n t a t i o n of the s o c i a l meaning of s a n i t y . His p o s i t i o n became a locus f o r the s t r a i n s — m e d i c a l , t e c h n i c a l , s o c i a l , and managerial—which were brought together i n the reformed asylum. 114 The e f f e c t i v i t y of moral treatment i s l i k e w i s e evaluated not i n terms of i t s success i n p r o v i d i n g a 'cure' but through i t s 'symbolic e f f e c t i v i t y ' . Moral treatment, developed as i t was on the b a s i s of a pedagogic analogy, was to make the asylum a ' s p e c i a l ' form of e d u c a t i o n a l system. 3^ John Conolly's works on the theory and p r a c t i c e of asylum a d m i n i s t r a t i o n exemplify the p r i n c i p l e s and u n d e r l y i n g concepts of moral management. In the d e t a i l s of h i s plans f o r the n o n - r e s t r a i n t system can be found a l l the aspects of the metaphorical p r a c t i c e so f a r discussed. From h i s designs f o r window frames to h i s d e l i n e a t i o n of the character of the p h y s i c i a n -superintendent, there can be seen an enveloping concern w i t h the meaning of every f e a t u r e of asylum l i f e . Cure and comfort were h i s g o a l s , k i n d l i -ness and cheerfulness were to be the primary experiences to be conveyed by the minutiae of asylum design and the c a r e f u l : r e g u l a t i o n of the behaviour of the p a t i e n t , attendant, and medico-psychologist. N o n - r e s t r a i n t was the o r g a n i z i n g p r i n c i p l e around which the "symbolic e f f e c t i v i t y " of moral treatment was to be constructed. 115 CONCLUSION MORAL MANAGEMENT AS A SOCIAL MEDICINE The p h y s i c i a n , however harassed and impeded, now enjoys, i n t h i s department of physic, a pleasure long almost e x c l u s i v e l y a s s o c i a t e d w i t h the treatment of b o d i l y a i l m e n t s ; he sees the progress of improvement i n numerous cases from p l a i n and i n t e l l i g i b l e methods of r e l i e f and cure, and he f i n d s a f i e l d o f contemplation open to him,...the r i c h products of which w i l l be d i f f u s e d not only over the disordered and s u f f e r i n g i n mind, but mingle w i t h a l l the i n t e l l e c t u a l movements now d i r e c t e d to the comprehensive views of that s o c i a l science to which a l l u s e f u l knowledge i s s u b s i d i a r y , and which embraces not only the r e l i e f of s o c i a l t r o u b l e s and v i c e s , but t h e i r prevention. John Conolly The morally-managed asylum was a device f o r o r g a n i z i n g both i l l n e s s behaviour and t h e r a p e u t i c endeavour. I t i n s t i t u t i o n a l i z e d a b e l i e f i n the necessary connection between mind and body, si n c e i t was designed to make p o s s i b l e the d i r e c t i o n of i n t e r i o r patterns of thought by means of the manipulation of p h y s i c a l a c t i o n s i n order to produce s e l f - d i s c i p l i n e d behaviours. Moral management was an instrument of asylum a d m i n i s t r a t i o n which depended upon a deep-seated idea of h i e r a r c h y , extending from outward s o c i a l forms to inward mental s t r u c t u r e s . This h i e r a r c h y i n t u r n , served as a support to mechanisms of s e l f - c o n t r o l which were e s s e n t i a l to s a n i t y as w e l l as to the maintenance of the s o c i a l order. The success of moral management was der i v e d from'the)tenets of a physiology which argued t h a t e x t e r n a l p h y s i c a l m i n i s t r a t i o n s could determine i n t e r n a l mental events, and that these mental events were subject to an o r g a n i z i n g p r i n c i p l e which was a s c e r t a i n a b l e by means of p h y s i c a l o b s e r v a t i o n and i n t r o s p e c t i o n . The event of lunacy was i t s e l f i n part the product of an i n t e r n a l defect of 116 o r g a n i z a t i o n . I t was, i n t u r n , i n f l u e n c e d by the complexity o f the e x t e r n a l environment. The i n t e r n a l d i s o r d e r could be r e c t i f i e d by the i m p o s i t i o n of a system of c o n s t r a i n t and reward which would r e i n f o r c e the i n t e r n a l r e g u l a -t o r y mechanisms and r e s u l t i n inward conformity to e x t e r n a l l y sanctioned standards of behaviour. The n o n - r e s t r a i n t system that John Conolly envisaged would have com-pl e t e d the process o f o r g a n i z i n g the m a n i f e s t a t i o n s of madness which had been the o b j e c t i v e of the moral managers. In the n o n - r e s t r a i n t asylum, the mental and the p h y s i c a l were mingled so that a l l p r o v i s i o n s of regimen a f f e c t e d each i n equal p r o p o r t i o n , thus v a l i d a t i n g the p h y s i o l o g i c a l r a t i o n -a l e s which had been developed to support the ideas of moral treatment. The p r i n c i p l e of h i e r a r c h y was honoured i n the s u b o r d i n a t i o n of methods i n v o l v -i n g p h y s i c a l c o e r c i o n i n favour of a t h e r a p e u t i c based on moral suasion. In a d d i t i o n , n o n - r e s t r a i n t e s t a b l i s h e d an i n s t i t u t i o n a l imperative f o r the c e n t r a l i t y of the p h y s i c i a n - a d m i n i s t r a t o r that rendered him i n d i s p e n s a b l e . Thus, the medical domination of the asylum was assured. I t gave ammunition to the medico-psychologists i n t h e i r b a t t l e f o r i n t r a - p r o f e s s i o n a l r e c o g n i -t i o n . Two d i f f i c u l t i e s were always present. These were unresolvable w i t h i n the e p i s t e m o l o g i c a l framework i n which the moral managers had to work. The f i r s t had to do w i t h the o n t o l o g i c a l problem o f d e f i n i n g mental i l l n e s s i n an age when mind and s o u l were s t i l l considered to be interchangeable con-cepts. Did a d i s r u p t i o n of mental f u n c t i o n i n g imply a d i s o r d e r of the so u l which i m p e r i l l e d the v i c t i m ' s s a l v a t i o n ? The i s s u e was one of r e s p o n s i b i l i t y . Since i l l n e s s was s a i d to a r i s e from the over-indulgence of passions and a p p e t i t e s , or from surrender to i n s t i n c t s and d e s i r e s r e s i s t e d by more 117 mor a l l y developed i n d i v i d u a l s , d i d a l o s s of reason imply a s t a t e of s i n which the s u f f e r e r had brought on him s e l f ? Such a c o n d i t i o n might i n d i c a t e the need f o r l e s s "comfortable" methods of treatment; i t c e r t a i n l y m i l i t a t e d a g a i n s t an indulgent humanitarianism which proposed l a v i s h treatment f o r people who were, i n e f f e c t , morally " v i c i o u s " . However, the d o c t r i n e o f p r e d i s p o s i t i o n , w i t h i t s c o n f l a t i o n of exogenous and i n t e r n a l f a c t o r s , softened the problem of s i n and r e s p o n s i b i l i t y . The n o n - r e s t r a i n t system, i n i t s r e p u d i a t i o n of p h y s i c a l c o e r c i o n , sought to e l i m i n a t e the p u n i t i v e connotations of asylum treatment which had d e r i v e d , i n p a r t , from those unresolved d i s p u t e s about the s o u l of the l u n a t i c . In a d d i t i o n , the t h e o r e t i c a l aspects of moral management were plagued by a complex p h i l o s o p h i c a l problem: that of the r e l a t i o n between the mind and the body. As we have seen, the fundamental dogma p o s i t e d an immaterial mind which i n t e r a c t e d w i t h a co r p o r e a l body. The d i f f i c u l t i e s inherent i n t h i s metaphysic were r e f l e c t e d i n the o c c a s i o n a l incoherence of the ideas w i t h which the moral managers approached t h e i r p r a c t i c e s . The p h y s i c i a n s reasoned that a connection e x i s t e d between mental and p h y s i c a l , and t h e i r t h e r a p e u t i c s echoed that n o t i o n ; but t h e i r language revealed a deep-seated b e l i e f i n the se p a r a t i o n of mind and body which was r e i n f o r c e d by t h e i r use of terms l i k e "moral" and " p h y s i c a l " i n r e l a t i o n to causes and treatments. The complexity of the connection between the mind and body i n the specula-t i o n s of the asylum doctors mirrored the interdependence and i n t e r -p e n e t r a t i o n of p r a c t i c e and theory in'the asylum i t s e l f . The moral managers took t h e i r concepts of the s t r u c t u r e and"function of the mind from eighteenth-century f o r m u l a t i o n s , and continued to ela b o r a t e d e f i n i t i o n s and c a t e g o r i e s of mental disturbance which had been i n exi s t e n c e 118 from the e a r l i e s t periods of p s y c h o l o g i c a l a n a l y s i s . S c u l l has held them n e g l i g e n t f o r having f a i l e d to make much use of the increased knowledge about n e u r o l o g i c a l f u n c t i o n which was sl o w l y amassing from. 1820 to 1850. Robert C a s t e l has, however, suggested another e x p l a n a t i o n . The antiquated theo-r e t i c a l s t r u c t u r e was, he argues, necessary to moral management, because the process of asylum reform was not p r i m a r i l y a medical and s c i e n t i f i c p r o j e c t but a pedagogical and s o c i a l e n t e r p r i s e : I t i s i n f a c t , [ C a s t e l ] suggests, the weakness of the 'theo-r e t i c a l ' system of the a l i e n i s t s which c o n s t i t u t e d i t s p r a c t i c a l s t r e n g t h s i n c e i t was p r e c i s e l y through i t s f a i l -ure to autonomise a p r o p e r l y ' s c i e n t i f i c ' dimension that p s y c h i a t r y was able to e s t a b l i s h ' i t s e l f through i t s p r a c t i c a l o b j e c t i v e s . The nosographies of the f i r s t a l i e n i s t s merely r e i t e r a t e d the supremacy of order and ensured that through the form of treatment employed the p o l i t i c a l s t r a t e g i e s o f the dominant power were imposed. 2 P s y c h i a t r y developed as a " s o c i a l medicine", according to C a s t e l , and thus i t s c o n c e n t r a t i o n upon behaviour and c o n t r o l was a response to i t s s o c i o -p o l i t i c a l mandate. The t h e o r e t i c a l and p r a c t i c a l aspects of moral management d i d not e x i s t i n a vacuum, but were the products of s p e c i f i c socio-economic and p o l i t i c a l e x i g e n c i e s of the l a t e eighteenth and e a r l y nineteenth cen-t u r i e s and r e f l e c t e d as w e l l a number of broad conceptual c a t e g o r i e s which informed nineteenth-century B r i t i s h s o c i e t y . The s o c i o - p o l i t i c a l context of moral management p r a c t i c e s has been thoroughly explored by Andrew S c u l l . The importance of the i n f l u e n c e of s o c i a l , p o l i t i c a l , and economic for c e s upon the t h e o r i e s and p r a c t i c e s of asylum p h y s i c i a n s cannot be ignored. However, the i n t e l l e c t u a l content of those t h e o r i e s , and t h e i r i n t e r a c t i o n w i t h the techniques of moral t r e a t -ment i s e q u a l l y an element i n the study of moral management. The l i m i t a -t i o n s of S c u l l ' s approach are apparent i n h i s work on Conolly. I t i s not 119 enough to i n t e r p r e t the va r i o u s aspects of Conolly's career and h i s a t t i -tude towards asylum a d m i n i s t r a t i o n i n terms of h i s personal and p r o f e s s i o n a l inadequacies, and h i s need to achieve some long-awaited r e c o g n i t i o n and f i n a n c i a l s e c u r i t y . Rather, as t h i s paper has attempted to show, h i s a c t i v i t i e s as a moral manager should be examined i n r e l a t i o n to the e p i s -t e m o l o g i c a l framework—the " d i s c o u r s e " i n connection with the " s o c i a l " — w i t h i n which i t had meaning and through which i t was c o n s t i t u t e d . 120 FOOTNOTES INTRODUCTION John Conolly, The Treatment of the Insane Without Mechanical R e s t r a i n t s (London: Smith, E l d e r & Co., 1856; r e p r i n t ed., London: Dawsons of P a l l M a l l , 1973), p. 29-2 In the h i s t o r y of B r i t i s h p s y c h i a t r y , the t r a d i t i o n a l school i s dominated by the work of Richard Hunter and Ida MacAlpine, whose Three  Hundred Years of P s y c h i a t r y : 1550-1860 (London: Oxford U n i v e r s i t y Press, 1963), i s the f i r s t reference f o r s e r i o u s study of the p r i n c i p a l c o n t r i -butors on p s y c h i a t r i c t o p i c s i n the eighteenth and e a r l y nineteenth century. The book i s a c o l l e c t i o n of excerpts on t o p i c s s e l e c t e d by the authors, who attempted to represent e v e r y t h i n g from-.theories of mental f u n c t i o n i n g to r e s t r a i n t devices. However, they c l e a r l y s t a t e t h e i r d e s i r e to i l l u s t r a t e the progressive accumulation of true s c i e n t i f i c knowledge about the mind, the b r a i n , and the treatment of mental i l l n e s s which they b e l i e v e d had taken place throughout the period covered by the book. Hunter and MacAlpine a l s o embraced the humanitarian t h e s i s , as i s evident In.their a t t i t u d e toward John Conolly. They wrote a s e r i e s of b i o g r a p h i c a l i n t r o d u c t i o n s to the r e p r i n t s of h i s major t e x t s , and d i d some new research i n t o h i s career because they were impressed by the improvement i n the care of the insane which they b e l i e v e d Conolly had achieved i n h i s n o n - r e s t r a i n t system. Kathleen Jones's A H i s t o r y of the Mental Health S e r v i c e s (London: Routledge and Kegan P a u l , 1972) i s a s t r a i g h t - f o r w a r d account of the growth of humani-t a r i a n a t t i t u d e s and the concomitant development of l e g i s l a t i v e s t r a t e g i e s f o r d e a l i n g w i t h i n s a n i t y . Denis Leigh's The H i s t o r i c a l Development of  B r i t i s h P s y c h i a t r y v o l . I (Oxford: Pergamon Press, 1961) i s a s e r i e s of b i o g r a p h i c a l s t u d i e s of the major f i g u r e s of nineteenth-century p s y c h i a t r y , with some a n a l y s i s of t h e i r work. 3 The r e v i s i o n i s t school of the h i s t o r y of B r i t i s h p s y c h i a t r y owes much to the a t t e n t i o n of French h i s t o r i a n s . Michel Foucault, i n h i s Madness  and C i v i l i z a t i o n : A H i s t o r y of I n s a n i t y i n the Age of Reason, t r a n s , by Richard Howard (New York: Random House, 1965; r e p r i n t ed., New York: Vintage Books, 1973) concentrated upon p o l i t i c a l , s o c i a l , and medical s t r a t e g i e s f o r d e a l i n g w i t h the mad i n seventeenth and eighteenth century France and England. Robert C a s t e l ' s focus was e n t i r e l y d i r e c t e d towards eighteenth and nineteenth-century France i n h i s L'Ordre P s y c h i a t r i q u e : L'YAge d'Or de l ' A l i e n i s m e . ( P a r i s : Les E d i t i o n s de M i n u i t , 1976). Andrew S c u l l i s the major f i g u r e i n the r e v i s i o n i s t school who has d e a l t w i t h B r i t a i n . Museums of Madness: The  S o c i a l Organization of I n s a n i t y i n Nineteenth-Century England (London: A l l e n Lane, 1979; r e p r i n t ed., Harmondsworth: Penguin Books L t d . , 1981) concen-t r a t e d on the s o c i o - p o l i t i c a l aspects of the m e d i c a l i z a t i o n of i n s a n i t y . Another u s e f u l work i s Klaus Doerner's Madmen and the Bourgeoisie: A S o c i a l  H i s t o r y of I n s a n i t y and P s y c h i a t r y , t r a n s , by Joachim Neugroschel and Jean St e i n b e r g (Oxford: B. B l a c k w e l l , 1981) which t r e a t e d s o c i a l , p o l i t i c a l and medical events i n the care of the insane f o r eighteenth and nineteenth-century F rance,England, and Germany. 121 The a n t i - p s y c h i a t r y movement began i n the 1960's with the work of f i g u r e s such as R.D. Laing and Thomas Szasz. In books such as The Myth of Mental I l l n e s s : Foundations of a Theory of Personal Conduct (New York: Hoeber-Harper, 1961); and idem, The Manufacture of Madness: A Comparative  Study of the I n q u i s i t i o n and the Mental Health Movement (New York: Harper & Row, 1970), Szasz c r i t i c i z e d both the m e d i c a l i z a t i o n of i n s a n i t y and the p r a c t i c e o f p s y c h i a t r y , which he saw as i n t r u s i v e and c o e r c i v e . Laing was a l s o c r i t i c a l of the concept of mental i l l n e s s and the range of psychothera-p e u t i c techniques i n h i s The Divided S e l f : A Study of S a n i t y and Madness (London: Tavistock P u b l i c a t i o n s , 1960) and idem, The P o l i t i c s of Experience (Harmondswprth:"Penguin"Books, 1967). Other a n t i - p s y c h i a t r y f i g u r e s i n c l u d e David Rothman i n The Discovery of the Asylum: S o c i a l Order and Disorder i n t t h e New Republic (Boston: L i t t l e , Brown, 1971); and E r v i n g Goffman, Asylums: Essays on the S o c i a l S i t u a t i o n of  Mental P a t i e n t s and Other Inmates (Garden C i t y , N.Y.: Anchor Books, 1961) who saw the mental h o s p i t a l as a t o t a l i n s t i t u t i o n t h a t , i n e f f e c t , produced aberrant behaviour i n i t s inmates. For more recent books of the a n t i - p s y c h i a t r y s c h o o l , see David Ingleby, ed., C r i t i c a l P s y c h i a t r y : The P o l i t i c s of Mental Health (New York: Pantheon Books, 1980); and Peter Sedgwick, Psycho P o l i t i c s : Laing, Foucault,  Goffman, Szasz, and the Future of Mass P s y c h i a t r y (New York: Harper & Row, 1982) . The phrase about the l i b e r a l e n t e r p r i s e o f the l a s t two hundred years i s drawn from a review a r t i c l e by Lawrence Stone, "Madness," The New York  Review of Books, 29 (December 16, 1982):~28-36. 5 Michel Foucault, Madness and C i v i l i z a t i o n . W i l l i a m Tuke was a Quaker who e s t a b l i s h e d an asylum f o r Quaker l u n a t i c s c a l l e d the Retreat i n 1793. He was convinced that the mad could be t r e a t e d by l e s s severe measures than those that f l o u r i s h e d i n most asylums at the time. P h i l i p p e P i n e l was a French p h y s i c i a n who reorganized the care of the insane i n two l a r g e P a r i s i a n p u b l i c h o s p i t a l s . He a l s o advocated l e s s p u n i t i v e approaches. More d e t a i l s about these men can be found i n Chapters I and I I of t h i s t h e s i s . For a general c r i t i q u e of Foucault's approach, see A l l a n M e g i l l , "Foucault, S t r u c t u r a l i s m , and the Ends of H i s t o r y , " Journal of Modern H i s t o r y , 51 (1979 ): ;451-503 ; f o r h i s t o r i c a l c r i t i c i s m see E r i k M i d e l f o r t , "Madness and C i v i l i z a t i o n i n E a r l y Modern Europe: A Reappraisal o f Michel Foucault," i n A f t e r the Reformation: Essays i n Honour of J.H. Hexter, ed. by B. Malament ( P h i l a d e l p h i a : U n i v e r s i t y of Pennsylvania Press, 1980), pp. 247-266; f o r a c r i t i q u e from a member of the a n t i - p s y c h i a t r y movement, see Peter Sedgwick, Psycho P o l i t i c s , pp. 125-148; f o r the t r a d i t i o n a l i s t p e r s p e c t i v e on Foucault, see Stone, "Madness". A general examination of both the t r a d i t i o n a l and the r e v i s i o n i s t schools, see Thomas E. Brown, "Foucault plus twenty: On w r i t i n g the h i s t o r y of Canadian p s y c h i a t r y i n the 1980's," Canadian B u l l e t i n of  Medical H i s t o r y , 2 (Summer 1985): 23-50. ^Michel Foucault, D i s c i p l i n e and Punish: The B i r t h of the P r i s o n , t r a n s , by Alan Sheridan (New York: Pantheon Books, 1978; r e p r i n t ed., New York: Vintage Books, 1979)• 122 7 Andrew S c u l l , Museums of Madness. In t h i s t h e s i s , I have drawn most h e a v i l y upon Museums of Madness, as w e l l as, idem, " C y c l i c a l Trends i n P s y c h i a t r i c P r a c t i c e : The Case of Bettelheim and Tuke," S o c i a l Science and  Medicine, 9 (1975): 633^-640; idem, "Moral Treatment Reconsidered: Some Socio-l o g i c a l Comments on an Episode i n the H i s t o r y of B r i t i s h P s y c h i a t r y , " i n Madhouses, Maddoctors, and Madmen: The S o c i a l H i s t o r y of P s y c h i a t r y i n the  V i c t o r i a n Era ( P h i l a d e l p h i a : U n i v e r s i t y of Pennsylvania Press, 1981), pp. 105-120; idem, "The Domestication of Madness," Medical H i s t o r y , 27 ( J u l y 1983)::233-248; idem, "A B r i l l i a n t Career? John Conolly and V i c t o r i a n P s y c h i a t r y , " V i c t o r i a n S t u d i e s , 27 (1984): 203-235; and an e a r l i e r , unpub-l i s h e d v e r s i o n of the l a t t e r given to me by the author. For an extended b i b l i o g r a p h y o f S c u l l ' s w r i t i n g s , see the b i b l i o g r a p h y of t h i s t h e s i s , g S c u l l , Museums of Madness, p. 15. 9 * I b i d . 10 For Foucault's recent work on power, see idem, Power/Knowledge:  Selected I n t e r v i e w s - a n d Other W r i t i n g s 1972-1977, ed. by C o l i n Gordon, t r a n s , by C o l i n Gordon, Leo M a r s h a l l , John Mepham, Kate Soper (New York: Pantheon Books, 1980). 11 Robert C a s t e l , L'Ordre P s y c h i a t r i q u e . I am indebted f o r my under-standing of t h i s author to the review a r t i c l e s by Peter M i l l e r , "The T e r r i t o r y of the P s y c h i a t r i s t , " Ideology and Consciousness, no. 7 (Autumn 1980:63-105; and Harvey M i t c h e l l , " P o l i t i c s , Power and P s y c h i a t r y : A Review of L'Ordre P s y c h i a t r i q u e : L'fige d'Or de l ' A l i e n i s m e by Robert C a s t e l , " I n t e r n a t i o n a l Review of Law and P s y c h i a t r y , 2 (1979)?249-262. 12 M i l l e r , " T e r r i t o r y " , p. 72. 1 3 I b i d . , p. 78. 1 4 I b i d . , p. 98. 1 5 I b i d . 1 6 I b i d . , p. 69. 1 7 I b i d . , p. 99. 18 Roger Smith, T r i a l by Medicine: I n s a n i t y and R e s p o n s i b i l i t y i n V i c - t o r i a n T r i a l s (Edinburgh: Edinburgh U n i v e r s i t y Press, 1981), p. 8. 19 * I b i d . , p. 10. 123 CHAPTER I John Conolly, On Some of the Forms of I n s a n i t y (The Croonian Lec-t u r e s , 1848) ( S o u t h a l l : S t. Bernard's H o s p i t a l , 1960), p. 16. 2 P a t r i c i a A l l d e r e d g e , " H o s p i t a l , Madhouses and Asylums: Cycles i n the Care of the Insane," B r i t i s h J o u r n a l of P s y c h i a t r y 134 ( 1 9 7 9 ) : 328-329. '• 3 Wi l l i a m Parry-Jones, The Trade i n Lunacy: A Study of P r i v a t e Mad- houses i n England i n the Eighteenth and Nineteenth Centuries_(London: Routledge and Kegan P a u l , 1972). 4 Richard Hunter and Ida MacAlpine, ed., Three Hundred Years of  P s y c h i a t r y : 1535-1860 (London: Oxford U n i v e r s i t y Press, 1963), pp. 451-456, which describes the c o n t r o v e r s i e s surrounding the l e g i s l a t i o n of the e i g h t -eenth century, as w e l l as Parry-Jones, The Trade i n Lunacy, pp. 7-10. 5 Hunter and MacAlpine, Three Hundred Years, pp. 277-599; Roy P o r t e r , "A Rage of Pa r t y : A G l o r i o u s R e v o l u t i o n i n E n g l i s h P s y c h i a t r y , " Medical  H i s t o r y 27 (1983): 35-50; Klaus Doerner, Madmen and the Bourg e o i s i e : A S o c i a l H i s t o r y o f I n s a n i t y and P s y c h i a t r y , t r a n s . Joachim Neugroschel and Jean Steinberg "(Oxford: , B. B l a c k w e l l , 1981), pp. 20-95. Hunter and MacAlpine, Three Hundred Years, pp. 543-546. 7 W i l l i a m Bynum, "Rationales f o r Therapy i n B r i t i s h P s y c h i a t r y : 1780-1835," Medical H i s t o r y 18 (1974): 317-334. Q Hunter and MacAlpine, Three Hundred Years, pp. 930-937; Kathleen Jones, A H i s t o r y of the Mental Health S e r v i c e s (London: Routledge and Kegan Pa u l , 1972) , pp. 144-145. 9 For the p e r s i s t e n c e of the myth of P i n e l ' s i n i t i a l a c t of reform, see Walter Bromberg, MD, From Shaman to Psychotherapist: A H i s t o r y o f the Treat- ment of Mental I l l n e s s (Chicago: Henry Regnery Company, 1975), pp. 94-97; Jan Ehrenwald, The H i s t o r y of Psychotherapy: From Healing Magic to Encounter (New York: Jason Aaronson, Inc., 1976), p. 211. P i n e l gave c r e d i t t o the example set by h i s l a y a d m i n i s t r a t o r , see P h i l i p p e P i n e l , A T r e a t i s e on  I n s a n i t y , t r a n s . D.D. Davis, MD (London: C a d e l l and Davies, 1806; r e p r i n t ed., New York: Haffner P u b l i s h i n g Company, 1962), pp. 9-10, 53-54. 10 Hunter and MacAlpine, Three Hundred Years, pp. 543-546. 1 1 P i n e l , T r e a t i s e , pp. 43-47, 48-110, 134-136, 174-177. 12 R. Hunter and I . MacAlpine, I n t r o d u c t i o n to D e s c r i p t i o n of the  Retre a t , An I n s t i t u t i o n near York, f o r Insane Persons of the S o c i e t y o f  Fr i e n d s , by Samuel Tuke (York: Alexander, 1813; r e p r i n t ed., London: Dawsons of P a l l M a l l , 1964), p. 22. 124 13 Hunter and MacAlpine, Three Hundred Years, p. 685; K. Jones, A_ H i s t o r y of the Mental Health S e r v i c e s , p. 53; D.H. Tuke, Chapters,' i n the H i s t o r y of the Insane i n the B r i t i s h I s l e s (London: Kegan P a u l , Trench & Co., 1882) , pp. 128-129, 131-142. 14 S. Tuke, D e s c r i p t i o n of the Retr e a t , p. 19. 15 Great B r i t a i n , Parliament, Parliamentary Papers,(Commons), Health,  Mental 1807-15, v o l . 1 (Reports from S e l e c t Committes on C r i m i n a l and Pauper L u n a t i c s and on the B e t t e r Regulation of Madhouses i n England w i t h Minutes of Evidence and Appendices, v o l . I V ) , Cmnd. 296, "Second Report", pp. 134-135. 16 Andrew S c u l l , Museums of Madness: The S o c i a l O r g a n i z a t i o n o f I n s a n i t y  i n Nineteenth-Century England (London: A l l e n Lane, 1979, rep. Hammondsworth: Penguin Books,Ltd., 1982), pp. 59-62, 90-95. 17 S c u l l , Museums of Madness, p. 113; Hunter and MacAlpine, Three  Hundred Years, p. 955; K. Jones, A H i s t o r y o f the Mental Health S e r v i c e s , pp. 145-149. 18 Hunter and MacAlpine, Three Hundred Years, pp. 299-301, 452-456. 1 9 I b i d . , pp. 452-456. 2 0 I b i d . , pp. 696-704. 21 Great B r i t a i n , Parliament, Parliamentary Papers (Commons), Health,  Mental: 1807-1815, v o l . I (Reports from the S e l e c t Committees on C r i m i n a l and Pauper L u n a t i c s . . . ) , Cmnd. 398, "Th i r d Report", pp. 3-6. 22 S c u l l , Museums of Madness, p. 88. 23 George Mann Burrows, Commentaries upon the Causes, Forms, Symptoms,  and Treatment, Moral and Medical o f I n s a n i t y (London: Underwood, 1828; , r e p r i n t ed., New York: Arno Press, 1976). 24 J.G. M i l l i n g e n , Aphorisms on the Treatment and Management of the Insane (London: C h u r c h i l l , 1840), p. 106. 25 Robert Gardiner H i l l , T o t a l A b o l i t i o n o f Personal R e s t r a i n t i n the  Treatment of the Insane (London: Simpkin and M a r s h a l l , 1838). 26 D.H. Tuke, Chapters i n the H i s t o r y of the Insane, pp. 192-193. 27 S c u l l , Museums of Madness, pp. 105-106. 2 8 G a r d i n e r H i l l , T o t a l A b o l i t i o n , pp. 21-23, 37-38; John Conolly, The  Treatment of the Insane Without Mechanical R e s t r a i n t (London: Smith, Elder & Co., 1856; r e p r i n t ed., London: Dawsons of P a l l M a l l , 1973), pp. 35-36'.. 29 Hunter and MacAlpine, Three Hundred Years, p. 886. 125 30 R. Hunter and I . MacAlpine, I n t r o d u c t i o n to The C o n s t r u c t i o n and  Government of L u n a t i c Asylums, by John Conolly (London: John C h u r c h i l l , 1847; r e p r i n t ed., London: Dawsons of P a l l Mall,'. .1968) , p. 24. 31 For E n g l i s h o p p o s i t i o n , see Andrew S c u l l , "A B r i l l i a n t Career? John Con o l l y and V i c t o r i a n P s y c h i a t r y " , V i c t o r i a n Studies 27 (1984): 219; J.R. B u c k n i l l and D.H. Tuke, A Manual of P s y c h o l o g i c a l Medicine (London: John C h u r c h i l l , 1858; r e p r i n t ed., New York: Haffner P u b l i s h i n g Company, 1968), p. 502. For French o p p o s i t i o n , see John Conolly, "Notices on the L u n a t i c Asylums of P a r i s , " B r i t i s h Foreign and Medical Review 19 (1845): 281-288, 574-613. The r e s i s t a n c e to the n o n - r e s t r a i n t system c o n s t i t u t e d i t s e l f around two s t r a t e g i e s of argument: one a d m i n i s t r a t i v e , the other t h e r a p e u t i c . The f i r s t was d i c t a t e d by p r a c t i c a l d i f f i c u l t i e s i n p r o c u r i n g s u f f i c i e n t s t a f f to provide adequate s u p e r v i s i o n i n order to prevent what M i l l i n g e n c a l l e d "much danger to personal s e c u r i t y , and a useless waste and d i l a p i d a t i o n of property." (J.G. M i l l i n g e n , Aphorisms, p. 106.) I t was couched i n the language of a n t i - s e c l u s i o n or i n the tone of concern at t h i s self-imposed r e s t r i c t i o n of the p h y s i c i a n ' s armature of remedies. The second i s e p i -tomized i n t h i s statement by Dr. Samuel Haldwin, who had once been the house surgeon at L i n c o l n : " R e s t r a i n t forms the very b a s i s and p r i n c i p l e on which the sound treatment of l u n a t i c s i s founded. The j u d i c i o u s and a p p r o p r i -ate adaptation of the v a r i o u s m o d i f i c a t i o n s of t h i s powerful means to the p e c u l i a r i t i e s of each case of i n s a n i t y , comprises a l a r g e p o r t i o n of the c u r a t i v e regimen of the s c i e n t i f i c and r a t i o n a l p r a c t i t i o n e r ; i n h i s hands i s a remedial agent of the f i r s t importance, and i t appears to me that i t i s about as \ l i k e l y to be dispensed w i t h , i n the cure of mental diseases, as that the various a r t i c l e s of the materia medica w i l l a l t o g e t h e r be dispensed w i t h i n the cure of the b o d i l y . " (The Times, January 25, 1841, p. 6, quoted i n Andrew S c u l l , unpublished e a r l i e r d r a f t of S c u l l , "A B r i l l i a n t Career," p. 31.) S c u l l p o i n t s out t h a t the t h e r a p e u t i c e f f i c a c y of both mechanical r e s t r a i n t and moral c o e r c i o n was w e l l e s t a b l i s h e d i n the l i t e r a t u r e on i n s a n i t y treatment; two i n f l u e n -t i a l exponents were W i l l i a m C u l l e n and John Haslam. For references, see Hunter and MacAlpine, Three Hundred Years, pp. 475, 635. 32 John Conolly, Treatment of the Insane, pp. 41-47. 33 Hunter and MacAlpine, Three Hundred Years, pp. 957-958. 34 John C o n o l l y , " R e c o l l e c t i o n s of the V a r i e t i e s of I n s a n i t y , " Medical Times and Gazette (v.'1, 1860): 118; S i r James C l a r k , _A Memoir of John Conolly,  MD, D.C.L., Comprising a Sketch of the Treatment of the Insane i n Europe  and America (London: John Murray, 1869), pp. 95-107-3 5 B u c k n i l l and Tuke, A Manual, p. 502; C l a r k , A Memoir, p. 159-3 6 S c u l l , Museums of Madness, pp. 213-219-126 I b i d . , p. 205./ 3 8 I b i d . , p. 77. 39 Isaac Ray. Mental Hygiene ( r e p r i n t ed., New York: Haffner P u b l i s h i n g Company, 1968); Henry Maudsley, The Pathology of Mind (London: MacMillan and Co., 1879). 40 These ideas are c o n s t a n t l y present i n the l i t e r a t u r e on madness throughout the nineteenth century. They w i l l be developed at length i n a l a t e r s e c t i o n of t h i s paper. CHAPTER I I John Conolly, An I n q u i r y Concerning the I n d i c a t i o n s of I n s a n i t y (London: John T a y l o r , 1830; r e p r i n t ed., London: Dawsons of P a l l M a l l , 1964), p. 294. 2 Richard Hunter and Ida MacAlpine, Three Hundred Years of P s y c h i a t r y :  1550-1860 (London: Oxford U n i v e r s i t y Press, 1963), pp. v i i - x . "This book then i s not a systematic t r e a t i s e but an endeavour to present o r i g i n a l sources and through them t r a c e c l i n i c a l and p a t h o l o g i c a l o b s e r v a t i o n s , no s o l o g i e s , t h e o r i e s and t h e r a p i e s , and the care of the insane as w e l l as s o c i a l and l e g a l a t t i t u d e s to mental i l l n e s s . . . . I t i s intended to serve the dual purpose of a sourcebook of p s y c h i a t r i c h i s t o r y . . . and a c o n t r i b u t i o n to c l i n i c a l p s y c h i a t r y by p r o v i d i n g a record of i t s problems and growth." (pp. i x - x ) • 3 Andrew S c u l l , Museums of Madness: The S o c i a l O r g a n i z a t i o n of  I n s a n i t y i n Nineteenth-Century England (London: A l l e n Lane, 1979; r e p r i n t ed., Harmondsworth: Penguin Books, 1981), pp. 15, 129-163. 4 There i s a s t e a d i l y growing l i t e r a t u r e concerned with the development of t h e o r i e s of mind and mental operations i n l a t e eighteenth and nineteenth-century B r i t a i n . The works l i s t e d were of p a r t i c u l a r help t o me i n my research. W i l l i a m Bynum, "Rationales f o r Therapy i n B r i t i s h P s y c h i a t r y : 1780-1835," Medical H i s t o r y 18 (1974): 317-334; Michael J . C l a r k , "'A p l a s t i c power m i n i s t e r i n g to o r g a n i s a t i o n ' : i n t e r p r e t a t i o n s of the mind-body r e l a t i o n i n l a t e nineteenth-century B r i t i s h p s y c h i a t r y , " P s y c h o l o g i c a l Medicine 13 (1983): 487-497; L.S. Jacyna, "Somatic t h e o r i e s of mind and the i n t e r e s t s of medicine i n B r i t a i n , 1850-1899," Medical H i s t o r y 26 ( J u l y 1982): 233-258; idem, "The Physiology of Mind, The Unity of Nature, and The Moral Order i n V i c t o r i a n Thought," B r i t i s h J o u r n a l f o r the H i s t o r y of Science 14 (1981): 109-132; R. Smith, "The Background of P h y s i o l o g i c a l Psychology i n N a t u r a l 127 Philosophy," H i s t o r y o f Science 11 (1973): 75-123; Andrew S c u l l , ed., Mad- houses, Maddoctors and Madmen: The S o c i a l H i s t o r y of P s y c h i a t r y i n the  V i c t o r i a n Era ( P h i l a d e l p h i a : U n i v e r s i t y of Pennsylvania Press, 1981). (See e s p e c i a l l y the a r t i c l e s by A. S c u l l , "Moral Treatment Reconsidered: Some S o c i o l o g i c a l Comments on an Episode i n the H i s t o r y of B r i t i s h P s y c h i a t r y , " pp. 105-120; Michael J . C l a r k , "The R e j e c t i o n of P s y c h o l o g i c a l Approaches •to Mental Disorder i n Late Nineteenth-Century B r i t i s h P s y c h i a t r y , " pp. 271-312; Roger Smith, "The Boundary Between I n s a n i t y and C r i m i n a l Responsi-b i l i t y i n Nineteenth-Century England," pp. 363-377; Roger Smith, T r i a l By  Medicine: I n s a n i t y and R e s p o n s i b i l i t y i n V i c t o r i a n T r i a l s (Edinburgh: Edinburgh U n i v e r s i t y Press, 1981), pp. 12-66, 161-175. 5 Hunter and MacAlpine, Three Hundred Years, pp. 473-475. C u l l e n (1710-1790) was s u c c e s s i v e l y p r ofessor o f medicine at Glasgow U n i v e r s i t y (1751-1755) and then professor o f chemistry, o f the i n s t i t u t e s of medicine, and the p r a c t i s e of physic at Edinburgh U n i v e r s i t y (1755-1790) ( I b i d . , p. 473) . John Thomson, MD, ed., The Works of W i l l i a m C u l l e n (Edinburgh: W i l l i a m Blackwood, and London: T. and G. Underwood, 1827), pp. 17-21. 7 I b i d . , pp. 102-132. 8 I b i d . , pp. 513-517. g George Mann Burrows, Commentaries upon the Causes, Forms, Symptoms,  and Treatment, Moral and Medical of I n s a n i t y (London: Underwood, 1828; r e p r i n t ed., New York: Arno Press, 1976). Burrows (1771-1846) began h i s medical career as a surgeon and general p r a c t i t i o n e r . He was chairman of the A s s o c i a t i o n of Apothecaries and Surgeon-Apothecaries. A f t e r 1815, he devoted h i m s e l f to the treatment o f insanityL-and was the owner of two p r i v a t e asylums. (Hunter and MacAlpine, Three Hundred Years, pp. 777-780.) 10 Burrows, Commentaries, p. 8. 1 1 I b i d . , p. 9. 12 I b i d . , p. 7. 13 James Cowles P r i c h a r d , A T r e a t i s e on I n s a n i t y (London: Sherwood et a l , 1835; r e p r i n t ed., New York: Arno Press, 1973). P r i c h a r d (1786-1848) was appointed to be p h y s i c i a n to St. Peter's H o s p i t a l i n 1810 and to the B r i s t o l I n f i r m a r y i n 1816. He was the f i r s t p r a c t i s i n g i n s a n i t y s p e c i a l i s t to be made a Commissioner i n Lunacy, which p o s i t i o n he held from 1844-1848. He was a l s o a respected e t h n o l o g i s t . (Hunter and MacAlpine, Three Hundred  Years, p. 836.) 14 P r i c h a r d , T r e a t i s e on I n s a n i t y , pp. 76-77-1 5 I b i d . , p. 185. 128 16 M a r s h a l l H a l l , Lectures on the Nervous System and i t s Diseases (London: Sherwood, G i l b e r t and' P i p e r , 1836). M a r s h a l l H a l l (1790-1857) was the n e u r o p h y s i o l o g i s t c r e d i t e d w i t h the d i s c o v e r y o f s p i n a l r e f l e x a c t i o n . (Hunter and MacAlpine, Three Hundred Years, p. 903.) 17 H a l l , Lectures, p. 11. l 8 I b i d . , pp.. 19, 86-87. 19 * I b i d . , p. 87. 20 M a r s h a l l H a l l , On the Diseases and Derangements of the Nervous Sys- tem (London: H. B a i l l i e r e , 1841), pp. 265-266. 21 John B u c k n i l l and Danie l Hack Tuke, A Manual of P s y c h o l o g i c a l  Medicine ( P h i l a d e l p h i a : Blanchard and Lea, 1858; r e p r i n t ed., New York: Haffner P u b l i s h i n g Company, 1968)-. This work was designed by i t s authors to replace the outdated P r i c h a r d . S i r John Charles B u c k n i l l (1817-1897) was the f i r s t e d i t o r of the Asylum Journa l of Mental Science and medical superintendent of the Devon County L u n a t i c Asylum. He was a Lord Chancel-l o r ' s V i s i t o r i n Lunacy from1862 to 1876 and a co-founder and c o - e d i t o r of B r a i n : A Jo u r n a l of Neurology. The Manual of P s y c h o l o g i c a l Medicine he pub-l i s h e d w i t h D.H. Tuke was "the standard work f o r almost a quarter o f a century". (Hunter and MacAlpine, Three Hundred Years, p. 1063.) D a n i e l Hack Tuke (1827-1895) was the son of Samuel Tuke and a son-in-law of John Co n o l l y ' s . He published e x t e n s i v e l y on p s y c h i a t r i c s u bjects and was the v i s i t i n g p h y s i c i a n to the York Retreat. ( I b i d . , p. 1069.) 22 B u c k n i l l and Tuke, A Manual, p. 342. 2 3 I b i d . , p. 354. . "A small u l c e r i n the mucous membrane of the stomach, some-times deranges a l l the f u n c t i o n s of the v i s c u s ; a blow to the head causes vomiting; i n e i t h e r i nstance we know not how; but we r e f e r the f a c t to others of a s i m i l a r nature, tab u l a t e d under the terms of sympathy or i r r i t a t i o n ; t hat i s , we p r o v i s i o n a l l y formulate our knowledge. In doing so, we act i n accordance w i t h unexceptionable methods o f p h i l o s o p h i z i n g . . . " 2 4 I b i d . , pp. 345-348, 364-367. 25 John Conolly, An I n q u i r y Concerning the I n d i c a t i o n s of I n s a n i t y (London: T a y l o r , 1830; r e p r i n t ed., London: Dawsons of P a l l M a l l , 1964); idem, " C l i n i c a l Lectures on Some of the P r i n c i p a l Forms of I n s a n i t y , " Lancet, v. 1 (1846): 12 Lectures; idem, On Some of the Forms o f I n s a n i t y (The Croonian Lectures of 1848) ( S o u t h a l l : S t . Bernard's H o s p i t a l , 1960); idem, "On the Characters of I n s a n i t y , " Notices of the Proceedings at the Meetings of the Members of the. Royal I n s t i t u t i o n (1854), pp. 375-381. 129 2 6 Conolly, I n q u i r y , p. 38. 2 7 I b i d . , pp. 40-41. 2 8 I b i d . , pp. 42-45. 2 9 I b i d . , pp. 52-53. 30 I b i d . , pp. 54-55• 31 I b i d . , p. 55. 3 2 I b i d . , p. 71. 3 3 I b i d . , p. 62. 3 Z ( I b i d . , p. 84. 35 Thomson, Works of W i l l i a m C u l l e n , p. 336. 3 6 I b i d . , pp. 214-219-3 7 I b i d . , pp. 530-535. 38 P h i l i p p e P i n e l , A T r e a t i s e on I n s a n i t y , t r a n s . D. Davies (London: S h e f f i e l d , 1806; r e p r i n t ed., New York: Haffner P u b l i s h i n g Company, 1962), p. 185. P h i l i p p e P i n e l (1745-1826) was p h y s i c i a n to the B i c e t r e (the P a r i s i a n h o s p i t a l f o r male l u n a t i c s ) from1793 to 1795, then becoming p h y s i c i a n to the S a l p e t r i e r e (the P a r i s i a n h o s p i t a l f o r female l u n a t i c s ) , at which post he remained u n t i l h i s death. He was a l s o p r o f e s s o r of hygiene and l a t e r of pathology at the Ecole de Medecine i n P a r i s and a c o n s u l t i n g p h y s i c i a n to Napoleon. (Hunter and MacAlpine, Three Hundred Years, p. 602.) 39 P i n e l , T r e a t i s e on I n s a n i t y , p. 41. Z*°Ibid., pp. 39-40. 41 I b i d . , p. 41. 42 Burrows, Commentaries, pp. 18-19. "But many of the causes in d u c i n g i n t e l l e c t u a l derangement, and which are c a l l e d moral, have t h e i r o r i g i n not i n i n d i v i d u a l passions or f e e l i n g s , but i n the s t a t e of s o c i e t y at l a r g e ; and the more a r t i f i c i a l , i . e . , c i v i l i z e d , s o c i e t y i s , the more do these causes m u l t i p l y and exten-s i v e l y operate. The v i c e s of c i v i l i z a t i o n , of course, must conduce to t h e i r i n c r e a s e ; but even the moral v i r -tues, r e l i g i o n , p o l i t i c s , nay philosophy i t s e l f , and a l l the best f e e l i n g s o f our nature, i f too e n t h u s i a s t i c a l l y i n c i t e d , c l a s s among the causes producing mental i n t e l -l e c t u a l d i s o r d e r s . " (p. 19) 130 I b i d . , pp. 58-59. 44 I b i d . , pp. 60-74. 45 J I b i d . , P- 93. I b i d . , P- 97-Z t 7 I b i d . , pp. 100-104. I b i d . , pp. 111-113. " S t i l l , a d i s o r d e r of the nerves may be, and f r e q u e n t l y i s , the immediate cause of i n s a n i t y ; f o r a v i o l e n t moral impression being made on any of the senses, i s f i r s t c a r r i e d to the b r a i n , which immediately a c t s syncronously w i t h the heart, and r e - a c t s on the b r a i n . . . a l l the passions and emotions are s a i d to be m o d i f i c a t i o n s of the w i l l ; and whenever the w i l l s t i m u l a t e s the b r a i n to v i o l e n t e x e r t i o n , the a c t i o n s of the heart are always r e s p o n s i b l e . . . " (p. 112) 49 J.E.D. E s q u i r o l , Mental Maladies: A T r e a t i s e on I n s a n i t y , t r a n s , by E.K. Hunt ( P h i l a d e l p h i a : Lea & Blanchard, 1845; r e p r i n t ed., New York: Haffner P u b l i s h i n g Company, 1965). E s q u i r o l (1772-1840) was a p u p i l of P i n e l ' s , and worked at various times during h i s l i f e as p h y s i c i a n to the Salp§triere, c h i e f p h y s i c i a n to the Royal Asylum a t Charenton, and Inspector-General of the F a c u l t i e s of Medicine. (Hunter and MacAlpine, Three Hundred  Years, p. 73 1. ) 50 E s q u i r o l , Mental Maladies, p. 60. 5 1 I b i d . , p. 71. 5 2 I b i d . , pp. 54, 200-212, 228-230, 320-334, 398-401. 53 S i r Benjamin Brodie, Lectures I l l u s t r a t i v e of C e r t a i n Nervous A f f e c - t i o n s (London: Longman et a l , 1837), pp.','37-75. 54 P r i c h a r d , T r e a t i s e on I n s a n i t y , pp. 20-30. 55 I b i d . , pp. 30-79- P r i c h a r d ' s longer d e f i n i t i o n o f moral i n s a n i t y i s as f o l l o w s : " E c c e n t r i c i t y of conduct, s i n g u l a r and absurd h a b i t s , a propen-s i t y to perform the common a c t i o n s of l i f e i n a d i f f e r e n t way from that u s u a l l y p r a c t i s e d , i s a fe a t u r e i n many cases of moral i n s a n i t y , but can hardly be s a i d to c o n s t i t u t e s u f f i c i e n t evidence of i t s e x i s t e n c e . When, however, such phenomena are observed i n connection w i t h a wayward and i n t r a c t a b l e temper, w i t h a decay of s o c i a l a f f e c t i o n s . . . i n s h o r t , w i t h a change in'the moral character of the i n d i v i d u a l , the case becomes t o l e r a b l y w e l l marked." ( I b i d . , p. 28.) 131 P r i c h a r d recognized the l e g a l problems i m p l i c i t i n the i d e n t i f i c a t i o n of a form of madness i n which no d e l u s i o n need operate, but i n which the w i l l or emotions were so diseased that the l u n a t i c could not c o n t r o l h i s beha-v i o u r . Moral i n s a n i t y became i n v o l v e d i n s i t u a t i o n s i n which " i r r e s i s t i b l e impulse" or "psychopathy" would be a p p l i e d today. The idea of moral i n s a n i t y o r i g i n a t e d w i t h P i n e l , who c a l l e d i t "manie  sans d e l i r e " (mania without d e l u s i o n ) . He concluded that i t was "marked by a b s t r a c t and sanguinary f u r y , w i t h a b l i n d propensity to act s of v i o l e n c e . " ( P i n e l , A T r e a t i s e , p. 156.) E s q u i r o l a l s o remarked upon a connection he had observed between insane v i o l e n c e and r a t i o n a l and moral awareness (see Smith, T r i a l by Medicine, p. 37). V i o l e n t behaviour was not e s s e n t i a l t o Pr i c h a r d ' s d e f i n i t i o n , however. 56 P r i c h a r d , T r e a t i s e on I n s a n i t y , pp. 240-241. 5 7 I b i d . , p. 252. 58 B u c k n i l l and Tuke, Manual, p. 267. 5 9 I b i d . , p. 226. 6 0 I b i d . , p. 87. 61 T , . , I b i d . 62 T,., I b i d . , p. 191 • 6 3 I b i d . , p. 193. I b i d . 65 Conolly, " C l i n i c a l L e c t u r e s , " pp. 203, 293. 6 6 I b i d . , p. 204. I b i d . , p. 294; idem, "On the Characters of I n s a n i t y , " p. 376. 68 Idem, " C l i n i c a l L ectures," p. 309. 69 * I b i d . , p. 272. 70 Idem, I n q u i r y , pp. 62-87, 93-284; idem, On Some of the Forms, pp. 68-72. 71 Conolly, "On the Characters," p. 380. 72 Idem, On Some of the Forms, p. 27. 7 3 I b i d . , p. 59. 74 Idem, "On the Characters of I n s a n i t y , " p. 375. 132 75 See Bynum, "Rationales f o r Therapy," pp. 320-330; K a r l E i g l i o , "Theories of Per c e p t i o n and the Physiology o f Mind i n the Late Eighteenth Century," H i s t o r y of Science 13 (1975): 177-212; R. Hoeldkte, "The H i s t o r y of A s s o c i a t i o n i s m and B r i t i s h Medical Psychology," Medical H i s t o r y 11 (1967): 46-65. 7 6Thomson, Works of W i l l i a m C u l l e n , pp. 523-528. 7 7 I b i d . , pp. 530-535. 7 8 P i n e l , T r e a t i s e on I n s a n i t y , pp. 180, 216-217, 224, 228-234. 79 ' * I b i d . , p. 193. 8 ^ I b i d . , pp. 60-63. 8 1 I b i d . , pp. 2-5. 82 Burrows, Commentaries, p. 342. 8 3 I b i d . , pp. 572-581. 84 I b i d . , p. 667. 8 5 I b i d . 8 6 I b i d . , pp. 669-670. 87 E s q u i r o l , Mental Maladies, p. 76. 8 8 I b i d . , pp. 77-85. 8 9 I b i d . , pp. 200-212, 228-230, 320-334, 398-401. 90 P r i c h a r d , T r e a t i s e on I n s a n i t y , pp. 180-203. 91 y I b i d . , p. 214. 92 B u c k n i l l and Tuke, A Manual, p. 485. 9 3 I b i d . , p. 404. "...the removal of a p a t i e n t from home i s hygiene, inasmuch as i t removes him from the causes of d i s e a s e — a n d moral, insasmuch as i t produces novel mental impressions, which are o f t e n of much s e r v i c e i n the treatment. A b l i s t e r to the nape may be thought purely m e d i c i n a l ; but there can be no doubt that sometimes i t s moral e f f e c t i s not i n s i g -n i f i c a n t by a t t r a c t i n g the a t t e n t i o n of the p a t i e n t from a morbid idea to a new se n s a t i o n . " 133 94 I b i d . , pp. 486-488. B u c k n i l l and Tuke are r e f e r r i n g to Conolly, The  Treatment of the Insane Without Mechanical R e s t r a i n t s (London: Smith E l d e r , & Co., 1856; r e p r i n t ed., London: Dawsons of P a l l . M a l l , 1973), pp. 64-65. 95 B u c k n i l l and Tuke, • - Manual, p. 488. 96 y I b i d . , p. 489. 97 * ' i b i d . , p. 501. 98 * I b i d . , p. 502. 99 ^ I b i d . , p. 503. ''^Andrew S c u l l , Museums of Madness, pp. 164-204. 101 General p a r a l y s i s of the insane was f i r s t defined and described by A. Bayle, an i n t e r n at Charenton, i n 1822. He i d e n t i f i e d a connection between progressive mental d e c l i n e l e a d i n g to dementia and c e r t a i n p h y s i c a l s i g n s that l e d to p h y s i c a l p a r a l y s i s , and a t t r i b u t e d these symptoms to a chronic inflammation of the meninges and the outer grey l a y e r of the b r a i n . Burrows saw the importance of the concept s i n c e general p a r a l y s i s of the insane was the f i r s t example of a form of i n s a n i t y i n which a disturbance of mental f u n c t i o n s could be l i n k e d to p h y s i c a l d i s o r d e r s during l i f e and to changes i n morbid anatomy. He p u b l i c i z e d the work of Bayle i n h i s Commen- t a r i e s , pp. 77-82, 177-179- Conolly a l s o described p a t i e n t s w i t h general p a r a l y s i s i n On Some of the Forms of I n s a n i t y , pp. 29-58. The f i r s t mono-graph on general p a r a l y s i s was w r i t t e n by Thomas James A u s t i n , A P r a c t i c a l  Account of General P a r a l y s i s , I t s Mental and P h y s i c a l Symptoms, S t a t i s t i c s ,  Causes, Seat, and Treatment (London: C h u r c h i l l , 1859). The d i s o r d e r was not i d e n t i f i e d as t e r t i a r y s y p h i l i s u n t i l 1913 when the spirochete was seen i n the b r a i n . (See a l s o Hunter and MacAlpine, Three Hundred Years, pp. 777-780, 1052-1053; and Smith, T r i a l by Medicine, p. 35.) CHAPTER I I I John Conolly, "Notices on the L u n a t i c Asylums of P a r i s , " B r i t i s h  F oreign and Medical Review 19 (1845); 291. 2 Andrew S c u l l , "A B r i l l i a n t Career? John Conolly and V i c t o r i a n P s y c h i a t r y , " V i c t o r i a n Studies 27 (1984): 203-235; and an e a r l i e r , unpub-l i s h e d v e r s i o n of t h i s paper given to me by the author. For nineteenth-century sources on Conolly's l i f e , see S i r James C l a r k , A Memoir of John  Conolly, MP, D.C.L. (London: Murray, 1869); and Henry Maudsley, "Memoir of the Late John Co n o l l y , " Journal of Mental Science 12 (1866): 151-174. Maudsley married Conolly's daughter i n 1865, and h i s piece i s permeated with great condescencion towards Conolly's career and p e r s o n a l i t y . Denis Leigh, i n h i s chapter on Conolly, i n The H i s t o r i c a l Development of B r i t i s h 134 P s y c h i a t r y , v o l . , 1 (Oxford: Pergamon Press, 1961), pp."210-270, r e l i e s h e a v i l y upon Maudsley without mentioning the p o s s i b i l i t y o f b i a s . Richard Hunter and Ida MacAlpine researched Conolly r a t h e r more thoroughly, and thus make l e s s use of Maudsley. See R. Hunter and I . MacAlpine, I n t r o d u c t i o n to An Inquiry . Concerning the I n d i c a t i o n s of - I n s a n i t y .(.London: .JohnnTaylor,. 1830; r e p r i n t ed., London: Dawsons of P a l l M a l l , 1964), pp. 1-38; idem, I n t r o d u c t i o n to The Construction and Government of L u n a t i c Asylums (London: John C h u r c h i l l , 1847; r e p r i n t ed., London: Dawsons of P a l l M a l l , 1968), pp. 7-38; idem, I n t r o d u c t i o n to Treatment of the Insane Without Mechanical R e s t r a i n t (London: Smith, E l d e r & Co., 1856; r e p r i n t ed., London: Dawsons of P a l l M a l l , 1973) , pp. 7-44. 3 Dr. George Birkbeck began the Mechanics' I n s t i t u t e movement by e s t a b l i s h i n g i n Glasgow i n 1800, a cheap course of l e c t u r e s on science f o r working men. He graduated i n medicine at Edinburgh i n 1799, and p r a c t i s e d as a p h y s i c i a n i n London where he founded another Mechanics' I n s t i t u t e . He was a founder and c o u n c i l l o r of U n i v e r s i t y C o l lege, London. (The Concise  D i c t i o n a r y of N a t i o n a l Biography, Part I : From the Beginnings to 1900 (London: Oxford U n i v e r s i t y Press, 1953), pp. 105-106. 4 For i n f o r m a t i o n about the aims and membership of t h i s o r g a n i z a t i o n , see, Charles Knight, Passages of a Working L i f e , 3 v o l s . (London: Bradbury and Evans, 1864): v. 2, pp. 80-85, 99-118; Harold P e r k i n , The O r i g i n s of  Modern E n g l i s h S o c i e t y : 1780-1880 (London: Routledge and Kegan Pau l , 1969), pp. 306-320; Harold Smith, The S o c i e t y f o r the D i f f u s i o n of U s e f u l Knowledge:  1826-1846 ( H a l i f a x , N.S.: Dalhousie U n i v e r s i t y L i b r a r y Occasional Paper, no. 8, 1974); David Vincent, Bread, Knowledge and Freedom: A Study of Nineteenth- Century Working Class Autobiography (London: Europa, 1981), pp. 138-139; R.K. Webb, The B r i t i s h Working-Class Reader: 1790-1848 (London: A l l e n and Unwin, 1955), pp. 66-73. 5 Conolly was among the group of p r o f e s s o r s who expressed con s i d e r a b l e d i s c o n t e n t because of the arrogant, i n t e r f e r i n g behaviour of the U n i v e r s i t y ' s Warden, Leonard,Horner, who was employed to oversee the d a i l y a f f a i r s of the U n i v e r s i t y at a f a r g r e a t e r s a l a r y than the teaching s t a f f r e c e i v e d . The question o f s a l a r y became e s p e c i a l l y acute when the C o u n c i l made known i t s d e s i r e t o reduce the guaranteed wages and make the prof e s s o r s more dependent upon fees from l e c t u r e s . Conolly a l s o supported two col l e a g u e s , G r a n v i l l e Sharp P a t t i s o n and John Gordon Smith, i n t h e i r attempts to r e t a i n t h e i r p o s i t i o n s a f t e r numerous complaints of t h e i r i n s u f f i c i e n t p r o f e s s i o n a l e x p e r t i s e and t h e i r inept behaviour i n the classroom. This i n f o r m a t i o n i s drawn from S c u l l , "A B r i l l i a n t Career?", pp. 226-227; the unpublished e a r l i e r v e r s i o n , pp. 15-22. Hunter and MacAlpine a l s o deal w i t h the prob-lems at the U n i v e r s i t y i n the I n t r o d u c t i o n to I n q u i r y , pp. 22-31. Maudsley, "A Memoir of the Late John Co n o l l y , " p. 169. 7 Charles Reade, Hard Cash: A Matter-of-Fact Romance (London: Ward, Lock, 1864).. Conolly was i d e n t i f i a b l e as Dr. Wycherley, the owner and manager of the asylum i n which the hero was u n j u s t l y confined. Conolly had published A Study of Hamlet i n 1863 i n which he argued the Hamlet was 135 not f e i g n i n g madness. "The hero had only to say 'Hamlet was mad' to g a i n r e l e a s e from Wycherley's asylum." (Hunter and MacAlpine, I n t r o d u c t i o n to C o n s t r u c t i o n and Government, p. 11^) g S c u l l , "A B r i l l i a n t Career?", p. 221. Conolly's h e a l t h was poor throughout t h i s p e r i o d , complicated by problems i n e s t a b l i s h i n g h i s only son i n some form of occupation. His w i f e disappeared from view at an e a r l y date, but evidence from h i s w i l l i n d i c a t e s that she was s t i l l a l i v e when he died i n 1866. One of h i s daughters married a missionary and s e t t l e d i n China; the other two married Daniel Hack Tuke and Henry Maudsley r e s p e c t i v e l y , and thus the Conollys remained a s s o c i a t e d w i t h l a t e nineteenth-century p s y c h i a t r y . 9 S c u l l , "A B r i l l i a n t Career?", pp. 216-217. 10 For example, Conolly's v i s i t to Glasgow Royal Asylum in.1818, h i s v i s i t to Charenton i n France i n 1827-11 John Conolly, De Statu Mentis i n I n s a n i a et Melancholia (Edinburgh: J . Ba l l a n t y n e and Co., 1822): t i t l e page. My d i s c u s s i o n of Insanie et Melan- c h o l i a draws upon a rough t r a n s l a t i o n from the L a t i n which was most k i n d l y produced by a f r i e n d of mine, Mrs. Pat Anderson. She has a s c e r t a i n e d the general d i r e c t i o n o f the argument throughout, and was able t o provide me with a l i t e r a l reworking of c e r t a i n key segments of the document. No formal t r a n s l a t i o n e x i s t s , although Hunter and MacAlpine quote from Insania et  Melancholia i n t h e i r biography of Conolly. 12 I b i d . , p.2. 1 3 I b i d . , pp. 26-28. 1 Z * I b i d . , p. 28. 15 John Conolly, An In q u i r y Concerning the I n d i c a t i o n s of Insanity. (London: John Taylor, 1830; r e p r i n t ed., London: Dawsons of P a l l M a l l , 1968). 16 I b i d . , pp. 13-34. 1 7 I b i d . , p. 16. l 8 I b i d . , pp. 15 T 313-333. 19 I b i d . , pp. 478-482. This plan f o r care i s i n t e r e s t i n g because i n i t Conolly advocated a government-financed and administered system of treatment that was s u r p r i s i n g l y comprehensive. Three of h i s most important recommendations were: "That a l l persons of unsound mind should become the care of the s t a t e ; and should continue so u n t i l recovery. 136 Every Lunatic Asylum should be the property o f the S t a t e , and be c o n t r o l l e d by p u b l i c o f f i c e r s . . . A l l the o f f i c e r s and keepers of each asylum should be appointed by the Secretary.of S t a t e . " (Conolly, I n q u i r y , p. 481.) 20 R. Hunter and I . MacAlpine, Three Hundred Years of P s y c h i a t r y ;  1535-1860 (London: Oxford U n i v e r s i t y Press, 1963), p. 87. 21 Robert Gardiner H i l l , T o t a l A b o l i t i o n of Personal R e s t r a i n t i n the Treatment of the Insane (London: Simpkin, M a r s h a l l , 1839). 22 Hunter and MacAlpine, I n t r o d u c t i o n to Treatment of the Insane, p. 10. 23 Later i n h i s l i f e , C onolly was o f t e n c r e d i t e d w i t h having been the f i r s t to introduce n o n - r e s t r a i n t . He repeatedly acknowledged h i s debt to Gardiner H i l l i n p r i n t ; f o r example, see Hunter and MacAlpine, I n t r o d u c t i o n to Treatment of the Insane, p. IQ, and Conolly, Treatment of the Insane, pp. 176-178; and Conolly, " P r e s i d e n t ' s Address to the A s s o c i a t i o n o f Medical O f f i c e r s of Asylums and H o s p i t a l s f o r the Insane, 1858", Journal o f Mental  Science 5 (1859): 74. 24 The Pauper Asylum f o r Middlesex at Hanwell was opened i n 1831 . I t s f i r s t superintendent was Dr. W i l l i a m E l l i s , who had e s t a b l i s h e d a r e p u t a t i o n f o r moderate but e f f i c i e n t management i n a previous p o s i t i o n at Wakefield Asylum. Working w i t h him was an apothecary, while the matron's d u t i e s were undertaken by E l l i s ' s w i f e . The asylum had two hundred and n i n e t y - f i v e p a t i e n t s at the end of i t s f i r s t year, and i t s numbers were then increased u n t i l they t o t a l l e d some eigh t hundred by the time Conolly a r r i v e d i n 1839-During E l l i s ' s tenure, the regime at Hanwell was probably f a i r l y represen-t a t i v e o f the k i n d and l e v e l of care to be found i s most p u b l i c asylums. P h y s i c a l r e s t r a i n t of the order of s t r a i t w a i s t c o a t s , r e s t r a i n i n g c h a i r s , padded l e g and arm devices f o r attachment to f u r n i t u r e , would have been q u i t e acceptable. There i s a l s o evidence that some of the more extreme devices of moral management, such as the swinging c h a i r , baths of s u r p r i s e , or elaborate i l l u s o r y performances, were i n use at Hanwell. During E l l i s ' s tenure, the number of p a t i e n t s a t Hanwell had t r e b l e d . This l e d the magistrates to attempt an a d m i n i s t r a t i v e r e o r g a n i z a t i o n f o l l o w -i n g E l l i s ' s r e s i g n a t i o n . The combined p o s i t i o n of medical superintendent and steward (the f i n a n c i a l o f f i c e r ) was d i v i d e d , the medical post going to an ex-army surgeon, J.S. M i l l i n g e n , who had won the competition i n which Conolly had a l s o p a r t i c i p a t e d . The steward was a layman, Mr. Hunt; and a second medical a s s i s t a n t , Dr. John Begley, j o i n e d the establishment. How-ever, M i l l i n g e n l a s t e d only one year, l a r g e l y because he made the mistake of attempting "to introduce a system of m i l i t a r y d i s c i p l i n e among the o f f i c e r s of the asylum...the consequence t h e r e f o r e had been th a t a s p i r i t of insub-o r d i n a t i o n had arisen....He had a l s o introduced a harsher system of treatment as regarded the p a t i e n t s . " In a d d i t i o n , the arrangement d i v i d i n g a d m i n i s t r a -t i v e r e s p o n s i b i l i t y seemed t o have increased c o s t s . M i l l i n g e n was dismissed, and thanks to some en e r g e t i c l o b b y i n g by Mr. Sergeant Adams, then a member of the Committee of V i s i t i n g J u s t i c e s , and the r e s i g n a t i o n of the former chairman, Conolly was given the post of Resident P h y s i c i a n , which was a 137 r e t u r n to the o r i g i n a l system of a u t h o r i t y under which E l l i s had worked. (See Hunter and MacAlpine, I n t r o d u c t i o n to C o n s t r u c t i o n and Government, pp. 10-21.) 2 5 S c u l l , "A B r i l l i a n t Career?", pp. 216-217-2 6 Hunter and MacAlpine, I n t r o d u c t i o n to C o n s t r u c t i o n and Government, p. 28. Apparently, the Middlesex magistrates were s u f f i c i e n t l y e x c i t e d by the p u b l i c r e a c t i o n to the reforms at Hanwell to p u b l i s h i n a s i n g l e volume Conolly's f i r s t f our Annual Reports. Conolly l a t e r attached excerpts from these r e p o r t s to Treatment of the Insane, pp. 192-274. 2 7 C o n o l l y , Treatment of the Insane, pp. 97-99, 104, 251-252, 274-278; and Conolly, C o n s t r u c t i o n and Government, pp. 130-136. 28 Hunter and MacAlpine, I n t r o d u c t i o n to C o n s t r u c t i o n and Government, p. 28. 2 9 S e e Footnote 24; and S c u l l , "A B r i l l i a n t Career?", pp. 226-227; e a r l i e r v e r s i o n , pp. 15-22; a l s o Hunter and MacAlpine, I n t r o d u c t i o n to C o n s t r u c t i o n and Government, pp. 14-22. ^0 S c u l l , "A B r i l l i a n t Career?", p. 227. S c u l l claims that Conolly resigned "to the r e l i e f of the m a g i s t r a t e s , to whom h i s departure now meant l i t t l e more than saving the ratepayers some money." He o f f e r s no evidence f o r t h i s a s s e r t i o n . 31 John Conolly, " C l i n i c a l Lectures on Some of the P r i n c i p a l Forms of I n s a n i t y , " Lancet ( V o l . 2 1845; V o l . 1 1846), 18 Lectures; idem, On Some  of the Forms of I n s a n i t y (The Croonian Lectures).(SouthalT: S t . Bernard's H o s p i t a l , 1960); idem, C o n s t r u c t i o n and Government. 32 John Conolly, C o n s t r u c t i o n and Government, pp. 1-8. Conolly argued that the cure r a t e s reported by some p r i v a t e asylums, high i n comparison with the r e p o r t s of the p u b l i c i n s t i t u t i o n s , a c t u a l l y revealed t h e i r f a i l u r e to o f f e r t r u l y remedial care to most p a t i e n t s . The lower r a t e s of the p u b l i c asylums were a r e s u l t of t h e i r p o p u l a t i o n being formed, i n l a r g e p a r t , by pauper i n c u r a b l e s who were forced to spend the e a r l y , and t h e r e f o r e most c u r a b l e , period of t h e i r i l l n e s s e s i n p r i v a t e asylums or workhouses. 33 I b i d . , p. 68. 3 4 I b i d . , pp. 1-144. 3 5 I b i d . , pp. 102, 131, 138. Robin Evans, F a b r i c a t i o n of V i r t u e : E n g l i s h P r i s o n A r c h i t e c t u r e 1750-1840 (Cambridgeshire: Cambridge U n i v e r s i t y Press, 1982). 138 37 Conolly, C o n s t r u c t i o n and Government, pp. 15-17, 26. S e c l u s i o n rooms, the l o c a t i o n o f any p r i v a t e care i n a p u b l i c asylum, were to have s o l i d doors with an i n s p e c t i o n window covered by a p l a t e which could be manipulated n o i s e l e s s l y so as to minimize d i s t r a c t i o n to the p a t i e n t . 3 8 I b i d . , pp. 19-21, 52-53. 39 See Hunter and MacAlpine, I n t r o d u c t i o n to Co n s t r u c t i o n and Government, pp. 10-16. See a l s o Andrew S c u l l , Museums of Madness; The S o c i a l Organiza- t i o n o f I n s a n i t y i n Nineteenth-Century England (London: A l l e n Lane, 1979; r e p r i n t ed., Harmondsworth: Penguin Books, 1981), pp. 105-106. The i s s u e of productive employment f o r a l l p a t i e n t s had been of p a r t i c u l a r concern to Dr. E l l i s , Conolly's predecessor, who reported i n 1836 that he had suc-ceeded i n occupying: "...the i m b e c i l e , and even the mischevious p a t i e n t . I t i s tha t of p i c k i n g i n pieces the f i b r e s of the outer husk of the cocoa-nut....Six pounds ten s h i l l i n g s a ton i s recei v e d f o r the work; and the employment saves more than the sum paid f o r the labour i n keeping the p a t i e n t s from d e s t r o y i n g t h e i r c l o t h e s , and i t a l s o renders personal confinement l e s s necessary. (See Hunter and MacAlpine, I n t r o d u c t i o n to Const r u c t i o n and Government- p. 18.) 40 Conolly, C o n s t r u c t i o n and Government, pp. 79-82. H l I b i d . , pp. 84-87, 112-115. A 2 I b i d . , pp. 83-121. 4 3 I b i d . , pp. 38-44. 44 Conolly, On Some of the Forms o f I n s a n i t y , pp. 17—19-4 5 I b i d . , pp. 3-5, 24. 46 Con o l l y , Treatment of the Insane, pp. 66-80. Where " c e r e b r a l con-gestion'-' was . d i s t i n c t , l o c a l b l e e d i n g was advocated by Conolly, as w e l l as the use of c o u n t e r - i r r i t a n t s . Purging was approved of, i n small and w e l l -c o n t r o l l e d amounts, f o r much mental disturbance could be l a i d at the door of c o n s t i p a t i o n . He d i d use opium and some other drugs, but he frowned on an o v e r l y e m p i r i c a l approach to pharmacological means. He considered the warm bath and c o l d douche to be u s e f u l t h e r a p i e s , to be u t i l i z e d w i t h d i s c r e t i o n but nonetheless e f f i c a c i o u s i n the r i g h t hands. He b e l i e v e d that much i l l n e s s was occasioned by general d e b i l i t y , and thus argued against the " a n t i p h l o g i s t i c " measures favoured by some a l i e n i s t s , although he agreed that w i t h some p a t i e n t s , e s p e c i a l l y those accustomed to over-indulgent or l u x u r i o u s l i v i n g , a s i m p l i f i e d and r e s t r i c t e d d i e t was necessary. However, o v e r a l l , he p r e f e r r e d the use of t o n i c s to emetics and strong purges, and he u t t e r l y abhorred the use of devices l i k e the r o t a r y swing or the bath of s u r p r i s e . 139 I t i s perhaps worth nothing t h a t , i n 1835, J.C. P r i c h a r d was saying of the swinging c h a i r that i t seemed to have a t h e r a p e u t i c e f f e c t and should not be discarded as a medical t o o l . Some E n g l i s h p h y s i c i a n s were s t i l l u s i n g i t ; P r i c h a r d mentions Dr. Bompas, the successor to Dr. Cox, and Dr. Wake, p h y s i c i a n to the asylum at York. (J.C. P r i c h a r d , A T r e a t i s e on  I n s a n i t y (London: Sherwood et a l , 1835; r e p r i n t ed., New York: Arno Press, 1973), p. 135. 47 Three other aspects of Conolly's plan of treatment i n c l u d e d educa-t i o n , entertainment and r e l i g i o u s s e r v i c e s . Each of these areas was con-t e n t i o u s i n V i c t o r i a n p s y c h i a t r i c l i t e r a t u r e , and Conolly was g r i e v e d by the f a i l u r e of h i s attempts to expand these f e a t u r e s of asylum l i f e , f a i l u r e s r e s u l t i n g , i n most cases, from the parsimony of the Middlesex magistrates. Conolly couched h i s argument to i n c l u d e education i n the Hanwell program i n medical terms. Schooling would be t h e r a p e u t i c i n three ways. One was that i t encouraged the e x e r c i s e of mental f a c u l t i e s that were o f t e n under-developed, so that i t enhanced the balance of f u n c t i o n s i n the mind, and might help the higher q u a l i t i e s to r e g a i n c o n t r o l . I f t h i s was u n l i k e l y , the occupation was at l e a s t a d i s t r a c t i o n , and the need to d i v e r t a l u n a t i c ' s thoughts from t h e i r p a t h o l o g i c a l channels was an axiom of moral management. A t h i r d e f f e c t o f education was to increase self-esteem, which was necessary to the resumption, or at l e a s t the augmentation, of s e l f - c o n t r o l . And i f i t could achieve none of those three o b j e c t s , i t provided at l e a s t an a l t e r n a -t i v e source of comfort and amusement to the c h r o n i c a l l y i l l or the con-g e n i t a l l y i d i o t i c . But d e s p i t e t h i s argument, other s t a f f and the board at Hanwell e l i m i n a t e d a schoolroom and dismissed a teacher s e l e c t e d by Conolly. He recognized the r o l e of s o c i a l p r e j u d i c e i n the d e c i s i o n to a b o l i s h the s c h o o l . There was not only the problem of the dangers of educating the lower o r d e r s , but an added concern which stemmed from a " l e s s - e l i g i b i l i t y " p o i n t of view. The governors seemed o f t e n to f e e l threatened by the pros-pect of a t o o - i n v i t i n g system; they seem to have suspected m a l i n g e r i n g . A concern w i t h l e s s e l i g i b i l i t y may w e l l have been at the bottom of Conolly's long b a t t l e s over entertainment f o r the p a t i e n t s . Conolly wanted to i n s t i t u t e musical evenings, a l e n d i n g l i b r a r y , and an in-house press, but r e c e i v e d l i t t l e support from the board. Such entertainments were intended to act on the mind i n ways s i m i l a r to s c h o o l i n g — s t i m u l a t i n g dormant f u n c t i o n s , i n c r e a s i n g self-esteem, d i v e r t i n g the a t t e n t i o n to l e s s o b j e c t -t i o n a b l e s u b j e c t s , and g e n e r a l l y e l e v a t i n g the tone of d a i l y l i f e . Conolly d i d not approve of excesses of amusement, such as t h e a t r i c a l s , which had been t r i e d at other asylums, and which he f e l t would increase e x c i t a b i l i t y and undermine confidence i n e x t e r n a l r e a l i t y . The question of the s u i t a b i l i t y of r e l i g i o u s p r a c t i c e s i n the l u n a t i c asylum was a vexing one i n e a r l y V i c t o r i a n medical psychology. On the one hand, many l u n a t i c s ' i l l n e s s e s were complicated by, or indeed r e s u l t e d from, some s o r t of exaggerated r e l i g i o u s b e l i e f or p r a c t i c e . On t h i s b a s i s , i t had u s u a l l y been argued that any contact w i t h the c l e r g y , or a s e r v i c e or a piece of l i t e r a t u r e on the s u b j e c t , would be d e t r i m e n t a l . On the other hand, there was a strong s o c i a l pressure to expose everyone to r e l i g i o u s i n f l u e n c e , both f o r i t s moral e f f e c t and to stem the time of encroaching i n d i f f e r e n c e or o u t r i g h t apostasy. This movement was e s p e c i a l l y concerned 140 w i t h the lower orders, whose l a c k of regard f o r the Church was widely recog-n i z e d . A r e l a t e d problem was one of t o l e r a t i o n ; many pauper insane were a f f i l i a t e d w i t h non-conformist and other s e c t a r i a n groups, and the very f a c t of t h e i r d i s s e n t i n g d o c t r i n e s was held to have a p a t h o l o g i c a l e f f e c t on t h e i r minds. A cooperative and s e n s i t i v e m i n i s t e r could be a great adjunct to therapy, Conolly argued, because he was p r i v y to much of the inner f u n c t i o n -i n g of the p a t i e n t ' s mind, and co u l d , i f p r o p e r l y i n s t r u c t e d and possessed of s u f f i c i e n t d e l i c a c y , counsel the l u n a t i c out of some cherished, but erroneous, b e l i e f . But he must be prepared to see h i s m i n i s t r y was secondary to the medical program. I f t h i s p r o v i s o were accepted, then p a t i e n t s of v i r t u a l l y any r e l i g i o u s persuasion might r e c e i v e a t t e n t i o n , although Conolly drew the l i n e at what he considered o b v i o u s l y f r a u d u l e n t or p s y c h o l o g i c a l l y d i s r u p t i v e groups. 48 For i n s t a n c e , see John Conolly, "Notices on the Lunatic Asylums of P a r i s , " B r i t i s h and Foreign Medical Review 19 (1845): 594-613; idem, " C l i n i c a l Lectures on Some of the Forms of I n s a n i t y , " Lancet (v. 2, 1845; v. 1, 1846) 18 Lect u r e s ; idem, "The Physiognomy of I n s a n i t y , " Medical Times  and Gazette 17 (1858): 81-83 and 18 (1859): 183-186; idem, "On the Prognosis of Mental Disease," Transactions of the P r o v i n c i a l Medical and S u r g i c a l  A s s o c i a t i o n 18 (185'1): 195-218; idem, "Presid e n t ' s Address t o the As s o c i a -t i o n of Medical O f f i c e r s of Asylums and H o s p i t a l s f o r the Insane, 1858," Journal of Mental Science 5 (1859): 71-78; idem, " R e c o l l e c t i o n s of the V a r i -e t i e s of I n s a n i t y , Part I I , " Medical Times and Gazette (v. 1, 1860): 6-9; idem, "On the Prospects of P h y s i c i a n s Engaged i n P r a c t i c e i n Cases of I n s a n i t y , " J o u r n a l of Mental Science 7 (1861): 180-194; idem, "Licenses and C e r t i f i c a t e s , " Journal of Mental Science 7 (1861): 127-136. 49 Conolly, C o n s t r u c t i o n and Government, p. 28. 50 Conolly, Treatment of the Insane, pp. 43, 47-49, 54. 51 Conolly, "On Some of the Forms of I n s a n i t y , " p. 11. 52 Conolly, C o n s t r u c t i o n and Government, p. 28. 5 3 I b i d . , p. 29-54 Conolly, Treatment of the Insane, p. 72. 55 Hunter and MacAlpine, I n t r o d u c t i o n to Treatment o f the Insane, pp. 35-36. 56 Conolly, Treatment of the Insane, p. 137. 5 7 I b i d . , p. 148. 58 D I b i d . , p. 151. 5Q I b i d . , pp. 149-152; see a l s o Conolly, C o n s t r u c t i o n and Government, pp. 120-121. 141 ^ C o n o l l y , Treatment of the Insane, p. 79-^ 1 I b i d . , p. 164. 6 2 I b i d . , pp. 203-204. 63 Peter M i l l e r , "The T e r r i t o r y of the P s y c h i a t r i s t , " Ideology and Con- sciousness 7 (Autumn 1980): 68. Review of Robert C a s t e l , L'Ordre P s y c h i - a t r i q u e ( P a r i s : E d i t i o n s de M i n u i t , 1976). 64 Conolly, "On Some of the Forms of I n s a n i t y , " p. 7. 6 5 I b i d . 66 S i r James Cla r k , A Memoir of John Conolly, p. 23; D a n i e l Hack Tuke, Chapters i n the H i s t o r y of the Insane i n the B r i t i s h I s l e s (London: Kegan Pa u l , Trench & Co., 1882), p. 162. Maudsley, "Memoir of the Late John C o n o l l y , " p. 151. 68 Denis Leigh, The H i s t o r i c a l Development of B r i t i s h P s y c h i a t r y , v o l . 1 pp. 218, 222. 69 Hunter and MacAlpine, I n t r o d u c t i o n to I n q u i r y , pp. 1-2; idem, I n t r o -d u c t i o n to Con s t r u c t i o n and Government, pp. 7, 22, 32. 70 Hunter and MacAlpine, I n t r o d u c t i o n to I n q u i r y , p. 32; idem, I n t r o -duction to C o n s t r u c t i o n and Government, pp. 32-35. 7 1 S c u l l , "A B r i l l i a n t Career?:, pp. 204-217-7 2 I b i d . , pp. 204-235; S c u l l , Museums of Madness, pp. 102-124, 126-145, 163-180. 73 S c u l l , Museums of Madness, pp. 43-46. CHAPTER IV John Conolly, The Treatment of. the Insane Without Mechanical R e s t r a i n t s (London: Smith, E l d e r & Co., 1856; r e p r i n t ed., London: Dawsons of P a l l M a l l , 1973) , pp. 171-172. 2 Kurt Danziger, " O r i g i n s of the Schema of Stimulated Motion: Towards a P r e - H i s t o r y of Modern Psychology," H i s t o r y o f Science 21 (1983): 183-210. See a l s o Roger Smith, "The background of p h y s i o l o g i c a l psychology i n n a t u r a l philosophy," H i s t o r y of Science 11 (1973): 75-123. 'Danziger, "Schema'of Stimulated Motion," p. 189-142 A I b i d . , p. 190:. 5 I b i d . , p. 191 . 6 I b i d . , p. 203. 7 For the environmentalismoo'f eighteenth-century medicine, see L.J . Jordanova, "Earth science and environmental medicine: the s y n t h e s i s of the l a t e Enlightenment" i n Images of the Earth: Essays i n the H i s t o r y of the Environmental Sciences, ed- L. Jordanova and R. P o r t e r (England: B r i t i s h S o c i e t y f o r the H i s t o r y of Science, 1978), pp. 119-146. For the importance of the nervous system, see K a r l F i g l i o , "Theories of Per c e p t i o n and the Physiology of Mind i n the Late Eighteenth Century," H i s t o r y of Science 12 (1975): 177-212. g Danziger, "Schema of Stimulated Motion," pp. 203-205. For an extended treatment of the H a l l - A l i s o n controversy, see Ruth Leys, "Background to the Reflex Controversy: W i l l i a m A l i s o n and the Doctrine of Sympathy before H a l l , " S t udies i n the H i s t o r y of Biology,IV (1980): 1-66. 9 As was noted i n footnote 54, Chapter I I of t h i s t h e s i s , moral i n s a n i t y was f i r s t described by P i n e l , under the t i t l e of manie sans d e l i r e . Smith comments th a t , " I t was a very p e c u l i a r human whom P i n e l d escribed,... General s c e p t i c i s m was r e i n f o r c e d by the law's view of what i t was to be human, which excluded such p o s s i b i l i t i e s . " (R. Smith, T r i a l by Medicine:-. I n s a n i t y and R e s p o n s i b i l i t y i n V i c t o r i a n T r i a l s (Edinburgh: Edinburgh Univer-s i t y Press, 1981): 36.) When J.C. P r i c h a r d enlarged upon the concept of moral i n s a n i t y i n h i s T r e a t i s e , he recognized that i t was d i f f i c u l t to d i s -t i n g u i s h between v i o l e n t and i l l e g a l a c t s committed under the i n f l u e n c e of an i r r e s i s t i b l e impulse, and s i m i l a r a c t s perpetrated as a r e s u l t of an un r e s i s t e d impulse. The d i f f e r e n c e was c r u c i a l i n the l e g a l defence of i n s a n i t y , but i t a l s o had an e f f e c t i n the medico-psychological realm. Moral i n s a n i t y presented the n o t i o n t t h a t madness could e x i s t i n a person without causing a c o g n i t i v e d i s o r d e r , and i t complicated the d i f f e r e n t i a t i o n of madness from e c c e n t r i c i t y , s i n c e moral i n s a n i t y might be present i n i n d i -v i d u a l s whose reasoning powers were unaffected, but whose behaviour was s o c i a l l y unacceptable. Moral i n s a n i t y a l s o had i m p l i c a t i o n s f o r moral treatment; because the d i s o r d e r was o f t e n defined as a defect i n v o l i t i o n , i t c a l l e d i n t o question the c o n t r a c t u a l b a s i s of moral management. Could a m o r a l l y insane i n d i v i d u a l make a commitment to increase h i s powers of s e l f - c o n t r o l by e x e r c i s i n g s e l f - r e s t r a i n t and submission to asylum a u t h o r i t y when h i s a b i l i t y to c o n t r o l h i s w i l l was attenuated or e n t i r e l y absent? As a r e s u l t of these c o m p l i c a t i o n s , moral i n s a n i t y was be l i e v e d to present a poor prognosis. See J.C. P r i c h a r d , A T r e a t i s e on I n s a n i t y (London: Sherwood et a l , 1835; r e p r i n t ed., New York: Arno Press, 1973): p, 29; and Smith, T r i a l by Medicine, pp. 36-39. John Conolly, On Some of the Forms of I n s a n i t y (The Croonian Lec-t u r e s , 1848) ( S o u t h a l l : S t . Bernard's H o s p i t a l , 1960), pp. 43-44. 143 The emphasis upon eugenics and p r e v e n t a t i v e education which became a prominent fea t u r e of much medico-psychological w r i t i n g i n the l a t e nine-teenth century can a l s o be construed as evidence f o r a widely i n c l u s i v e outlook on the causes of i n s a n i t y . 12 Henry Maudsley, The Pathology of Mind (London: MacMillan and Co., 1879), PP- 172-173. "Disease not being, as i t was so long thought to be, a s p e c i f i c morbid e n t i t y which, l i k e some e v i l s p i r i t , takes h o s t i l e possession of the body or of a p a r t i c u l a r part of i t , and must be e x p e l l e d by a s p e c i f i c drug, but a s t a t e of greater or l e s s e r degeneration from healthy l i f e i n an organism whose d i f f e r e n t parts c o n s t i t u t e a complex and harmonius whole; i t i s p l a i n that a disease of one part of the body w i l l not only a f f e c t the whole s y m p a t h e t i c a l l y at the time, but may w e l l lead to a more general i n f i r m i t y of the c o n s t i t u t i o n i n the next generation.... In a c e r t a i n sense then one may take com-f o r t and be glad i n t e l l e c t u a l l y that f a i l u r e s should f a i l ; f o r i f the weak were not defeated i n the s t r u g g l e f o r existence i t would be because the strong, h o l d i n g back to the slower pace of t h e i r i n f i r m i t i e s used not t h e i r s t r e n g t h , and so robbed the world of the r i g h t which i t has t o , and the advantages i t would get from, the f u l l use of t h e i r s u p e r i o r powers." 13 John Conolly, A Lecture on the Advantages of Popular Education (Northampton: Northampton Mechanics' I n s t i t u t e , 1836). 14 Samuel Tuke, D e s c r i p t i o n of the Retreat: An I n s t i t u t i o n near York  f o r Insane Persons of the S o c i e t y of Fri e n d s (York: W. Alexander, 1813; r e p r i n t ed., London: Dawsons of P a l l M a l l , 1964), pp. 82-83, 150, 159-160, 175-176, 223. 15 This i s i m p l i c i t i n Conolly's d i s c u s s i o n of the treatment ,of upper c l a s s l u n a t i c s i n Treatment of the Insane, pp. 143-174. S i m i l a r sentiments can be found i n CM. Burrows, Commentaries upon the Causes, Forms, Symptoms, and Treatment, Moral and Medical, of I n s a n i t y (London: Underwood, 1828; r e p r i n t ed., New York: Arno Press, 1976), pp. 18-23; J.M. B u c k n i l l and D.H. Tuke, A Manual of P s y c h o l o g i c a l Medicine ( P h i l a d e l p h i a : Blanchard and Lea, 1858; r e p r i n t ed., New York: Haffner P u b l i s h i n g Company, 1968), pp. 34-40; P r i c h a r d , A T r e a t i s e on I n s a n i t y , pp. 131-140. 16 See J . Conolly, The C o n s t r u c t i o n and Government of L u n a t i c Asylums (London: John C h u r c h i l l , 1847; r e p r i n t ed., London: Dawsons of P a l l M a l l , 1968), pp. 83-122; idem, Treatment of the Insane, pp. 94-105. 17 Ticehurst was a l a r g e p r i v a t e asylum w i t h a good r e p u t a t i o n f o r i t s care of wealthy p a t i e n t s . Set i n extensive and b e a u t i f u l l y landscaped grounds, i t o f f e r e d secluded houses on the e s t a t e , an a v i a r y , a bowling green and a summer house. Many p a t i e n t s had t h e i r own rooms and personal 144 attendants. See W i l l i a m Parry-Jones, The Trade i n Lunacy: A Study of P r i v a t e  Madhouses i n England i n t h e Eighteenth and Nineteenth Centuries (London: Routledge & Kegan Pau l , 1 9 7 2 ) , pp. 119-121. 18 When Conolly reduced h i s involvement at Hanwell i n 1845, he turned to p r i v a t e asylum management and c o n s u l t i n g . His home, Lawn House, was l i c e n s e d to r e c e i v e female l u n a t i c s , and a f t e r 1848 he ran a s i m i l a r asylum i n the nearby v i l l a g e of Hayes. In 1850, he jo i n e d w i t h h i s brother, W i l l i a m i n a j o i n t venture i n a l a r g e r house f o r both sexes i n Hayes. His c o n s u l t i n g i n v o l v e d him in..some c o n t r o v e r s i a l medico-legal work during the l a t e 1840's and 1850's. His courtroom appearances were not s u c c e s s f u l , a ccording to Hunter and MacAlpine. See R. Hunter and I . MacAlpine, I n t r o -d u c t i o n to Treatment of the Insane, by John Conolly, pp. 35-41. 19 In Conolly's accounts of the treatment of the higher ranks, there are frequent complaints that h a b i t s of lu x u r y common the the upper c l a s s e s must be broken i n order to strengthen t h e i r dormant powers o f s e l f - r e s t r a i n t . Thus, a simpler d i e t , l e s s elaborate f u r n i s h i n g s and l e s s subservient domestics were considered to be necessary agents of treatment. See Conolly, Treatment o f the Insane, pp. 143-175. 20 See John Conolly, Address to the E t h n o l o g i c a l S o c i e t y o f London (London: E t h n o l o g i c a l S o c i e t y of London, 1855); and idem, The E t h n o l o g i c a l E x h i b i t s of London (London: John C h u r c h i l l , 1855); and J.C. P r i c h a r d , Researches i n t o the P h y s i c a l H i s t o r y of Man (London: J . & A. Arch, 1813) 1st ed., e d i t e d w i t h an i n t r o d u c t i o n by George W. St o c k i n g (Chicago: U n i v e r s i t y of Chicago Press, 1973). 21 See P r i c h a r d , A T r e a t i s e on I n s a n i t y , pp. 133-135, 140-141; Buck-n i l l and Tuke, A Manual of P s y c h o l o g i c a l Medicine, pp. 16-20. 22 E t h n o l o g i c a l E x h i b i t s , pp. 12-14. Conolly disputed t h a t the two c h i l d r e n lacked a b r a i n because they lacked language, and he was f i r m l y convinced that they d i d not belong to an undiscovered race but were simply mentally handicapped c h i l d r e n . 23 Peter M i l l e r , "The T e r r i t o r y of the P s y c h i a t r i s t , " Ideology and  Consciousness 7 (Autumn 1980): 70. 24 Such a wide l y - ^ i n c l u s i v e concept o f the " n a t u r a l " was u s e f u l to doc-t o r s who would have argued that w hile nature and s o c i e t y were separate e n t i t i e s , they converged i n the experience of men to form what might be c a l l e d the " s o c i a l environment", a place i n which both personal h a b i t s of consumption and the s o c i a l o r g a n i z a t i o n of whole c i v i l i z a t i o n s had t h e i r importance. This n o t i o n of the n a t u r a l was derived i n part from the development of the concept of "hygiene" i n l a t e eighteenth-century France. The t h i r d great p r i n c i p l e of hygiene was c a l l e d regime and i t "contained a range of meanings from the medical one im p l y i n g the r e g u l a t i o n of d i e t e x e r c i s e , i n f a c t of mode of l i v i n g i n ge n e r a l , to the more general ones o f governing...." (Jordanova, "Earth Science and Enviornmental Medicine," p. 122). 145 This connection between the n a t u r a l and the s o c i a l a l s o owed something to the e f f e c t s of a n t h r o p o l o g i c a l i n v e s t i g a t i o n . In t h e i r study of- p h y s i c a l anthropology, nineteenth-century f i g u r e s l i k e J.C. P r i c h a r d u t i l i z e d an " a n a l o g i c a l method" which extended b a s i c s c i e n t i f i c . p r i n c i p l e s u s u a l l y employed i n the examination of other c r e a t u r e s t o man h i m s e l f . Since c u l -t u r e was a product of human endeavour, i t too could be s t u d i e d s c i e n t i f i -c a l l y . Moreover, nineteenth-century a n t h r o p o l o g i s t s demonstrated a p a r t i c u -l a r i n t e r e s t i n deviancy, being concerned, l i k e the p h y s i c i a n s who were o f t e n p a r t i c i p a n t s i n t h e i r research, w i t h p a t h o l o g i c a l phenomena, such as degeneration, deformation, and d e v i a t i o n . A l l of these were.categories of deviancy which, because of t h e i r medical overtones, possessed a s c i e n t i f i c aura, and they were a l s o f l e x i b l e enough to range from the behaviour of the i n d i v i d u a l to the s o c i a l p r a c t i c e s of e n t i r e r a c i a l groups. Thus, the insane man was.an anomaly i n t h i s s o c i a l environment, a deviant who was caught between nature and s o c i e t y . He could not be i n c o r -porated e n t i r e l y i n t o the realm of nature because, according to the dualism which s t i l l p r e v a i l e d , h i s mind was an immaterial essence separate from though connected to h i s body. Thoroughgoing n a t u r a l i s t s , such as Thomas Laycock, were m a t e r i a l i s t s ; they were attempting to argue from the develop-ments i n neurophysiology that mind and b r a i n were i d e n t i c a l , and f u r t h e r , that the soul d i d not e x i s t . By and l a r g e , asylum p h y s i c i a n s r e t a i n e d a fundamental b e l i e f i n the soul because atheism and m a t e r i a l i s m were, l i n k e d to a p o l i t i c a l r a d i c a l i s m which sought to undermine s o c i a l h i e r a r c h i e s . Metaphysical dualism depended upon the concept of a created u n i v e r s e , d i r e c t e d by an omnipotent God who had ordained s o c i a l h i e r a r c h i e s f o r the good of man. (See £'..S. Jacyna, "The Physiology of Mind, the Unity of Nature, and the Moral Order i n V i c t o r i a n Thought," B r i t i s h Journal f o r the  H i s t o r y of Science 14 ( 1981) : ., 1 1 0-132; L. Jordanova, "Earth Science and Environmental Medicine," pp. 120-146; G. Weber, "Science and S o c i e t y i n Nineteenth-Century Anthropology," H i s t o r y of Science"-12, (1974): 260-283.. 25 K a r l F i g l i o , "The Metaphor of O r g a n i z a t i o n : An H i s t o r i o g r a p h i c a l P e r s p e c t i v e on the Bio-Medical Sciences of the E a r l y Nineteenth Century," H i s t o r y of Science H4 (1976): 21. 2 6 I b i d . , p. 38. 2 7 I b i d . , p. 41. 2 8 T . . . I b i d . 2 9 I b i d . , p. 43. 30 Phrenology a l s o gave c r e d i b i l i t y to the t h e o r e t i c a l p r i n c i p l e s of moral management. Recent work on t h i s subject has uncovered the extent to which nineteenth-century medico-psychologists were i n v o l v e d i n support of the p h r e n o l o g i c a l movement, and a c a r e f u l study has demonstrated the u t i l i t y of G a l l ' s d o c t r i n e s i n the development of nineteenth-century neur-ology. Much of the contemporary research has concentrated upon the s o c i a l and i n t e l l e c t u a l r a m i f i c a t i o n s of the debate between advocates and opponents, and has i t s source i n a broader concern w i t h the d e f i n i t i o n of " s c i e n t i f i c " 146 as i t i s a p p l i e d to e a r l y nineteenth-century medicine. There has been a tendency to l o c a t e nineteenth-century p s y c h i a t r i s t s i n t h e i r response to phrenology by r e s e a r c h i n g t h e i r c o n t r i b u t i o n s to s p e c i f i c p h r e n o l o g i c a l j o u r n a l s and s o c i e t i e s , as w e l l as t h e i r involvement i n c e r t a i n h i g h l y pub-l i c i z e d j o u r n a l i s t i c debates. In these contexts, John Conolly i s o f t e n c i t e d as an i n f l u e n t i a l adherent. However, a c a r e f u l reading of Conolly's. works on mental disease does not r e v e a l a preoccupation w i t h the s p e c i f i c s of p h r e n o l o g i c a l d o c t r i n e . There: are no r e c a p i t u l a t i o n s of the indexes of organs, no diagnoses on the b a s i s of e x t e r n a l s i g n s of over- or under-development. There i s a volume of photographs accompanied by physiognomical a n a l y s i s i n which Conolly f i g u r e s prominently; but there i s nothing of comparable q u a l i t y about any aspect of phrneology. What do e x i s t are a number of general comments on the l o c a l i z a -t i o n of f u n c t i o n s i n the b r a i n , and statements about the p h y s i c a l b a s i s of mental disease. These remarks are not incompatible w i t h h i s orthodox d i s -c u s s i o n of f a c u l t y psychology and the r e l a t i o n s between reason, w i l l and the passions. Indeed, there are more unequivocal references to phrenology present i n B u c k n i l l and Tuke's 1858 Manual of P s y c h o l o g i c a l Medicine. They endorse Andrew Combe's d e f i n i t i o n of mental i l l n e s s , and they d i s c u s s at l e n g t h the pros and cons of the phrenology debate. In the end, they con-clude t h a t , w h i l s t the d e t a i l s of the d o c t r i n e s are questionable, c e r t a i n general c h a r a c t e r i s t i c s are of value i n t h e i r understanding of mental disease. In p a r t i c u l a r , they c i t e the idea of f u n c t i o n a l organs and the importance of the b r a i n as the locus of disturbance. James P r i c h a r d argues at l e n g t h against the proponents of phrenology, but he too acknowledges the u t i l i t y of some p o i n t s . I t i s c l e a r that phrenology, by connecting mental to p h y s i c a l e n t i t i e s , was a great boon to nineteenth-century p h y s i c i a n s . I t not only underscored t h e i r t h e o r i e s , e s p e c i a l l y w i t h regard to the necessary connection between b r a i n and mind, but i t p o s i t e d a d o c t r i n e which accounted f o r a number of observations about b r a i n i n j u r y and consequent p s y c h o l o g i c a l problems. L i k e p r e d i s p o s i t i o n , a general tenet of phrenology appeared to have an e m p i r i c a l j u s t i f i c a t i o n , and nineteenth-century medico-psychologists harboured a deep a f f e c t i o n f o r e m p i r i c a l evidence. Moreover, phrenology provided support f o r the p r i n c i p l e s of moral management, si n c e i t could be asserted t h a t spe-c i f i c a c t i v i t i e s could strengthen or weaken c e r t a i n organs of the mind, which l e n t medical c r e d i b i l i t y to attempts to strengthen s e l f - c o n t r o l . Thus phrenology provided a way i n t o the s t r u c t u r e of the mind from e x t e r n a l signs and behaviours, and r e i n f o r c e d what was considered to be the most e f f e c t i v e method:of reaching i n t o the diseased mind and r e s t o r i n g i t s h e a l t h . An extensive b i b l i o g r a p h y on the subject of phrenology and nineteenth-century medical psychology i s now a v a i l a b l e . For s p e c i a l r e f e r e n c e , see Roger Cooter, "Phrenology: the provocation of progress," H i s t o r y of Science 14 (1976): 211-234; and idem, "Phrenology and B r i t i s h A l i e n i s t s , " i n A. S c u l l , ed., Madhouses, Maddoctors and Madmen: The S o c i a l H i s t o r y of P s y c h i - a t r y i n the V i c t o r i a n Era ( P h i l a d e l p h i a : U n i v e r s i t y of Pennsylvania Press, 1981): 58-104. For a wider treatment, see Robert Young, Mind, B r a i n and  and Adaptation i n the Nineteenth-Century (Oxford: Clarendon Press, 1970). For nineteenth-century references c i t e d above, see B u c k n i l l and Tuke, A Manual of P s y c h o l o g i c a l Medicine, pp. 86-89; and P r i c h a r d , A T r e a t i s e on  I n s a n i t y , pp. 325-334. 147 F i g l i o , "Metaphor of O r g a n i z a t i o n , " p. 39-32 Roger Smith, T r i a l by Medicine, pp. 56-57. 33 Harvey M i t c h e l l , " P o l i t i c s , Power and P s y c h i a t r y : A Review of L'Ordre P s y c h i a t r i q u e : L'TAge d'Or de L'Alienisme by Robert Castel, 1'! I n t e r - n a t i o n a l Review of Law and P s y c h i a t r y 2 (1979): 256. 34 P. M i l l e r , "The T e r r i t o r y of the P s y c h i a t r i s t , " p. 78. 3 5 I b i d . , p. 88. 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