Chapters in the History of the Insane in the British Isles, Daniel Hack Tuke (1882)
By Grace Osborn
Daniel Hack Tuke (1817-1895) was one of the best-known Victorian psychiatrists of the 1800s. Beginning with a career in law in Bradford, he found himself unhappy, and his deteriorating mental health made Tuke take it upon himself to find a new career. He began to frequent the York Retreat, a facility focusing on the moral treatment of people with mental health needs founded by his great-grandfather, William Tuke. He began working as a steward at the asylum while attending lectures on chemistry and botany. He moved to London to continue his study of medicine at St. Bartholomew’s Hospital, gaining an M.R.C.S diploma (Membership of the Royal Colleges of Surgeons), then becoming an M.D. (Doctor of Medicine) a year later.
Returning to York, he became assistant physician to the Retreat and physician to the Dispensary, as well as professor of a psychological medicine course at York Medical School. From his endeavors in psychological medicine stemmed his interest in mental illness, and he assisted John Bucknill, psychiatrist and mental health reformer, with the creation of the Manual of Psychological Medicine (1878). This manual comprised the standard understanding of the mentally insane as it contained the history, nosology, description, statistics, diagnosis, pathology, and treatment of insanity and was used in classrooms as a textbook. Next came the publication of his book on the mentally unwell, Chapters in the History of the Insane in the British Isles (1882) [1].
Published in 1882 by Kegan Paul, Trench & Co. in London, Chapters in the History of the Insane, is available at the Ruth Lilly Medical Library as a first-edition print. Tuke composed this book on the history of the insane by obtaining information from manuscripts and books borrowed from the British Museum and the Edinburgh Royal Asylum. He sought to bring recognition to those who had endeavored to ameliorate the condition of the insane and shed light on forgotten institutions that assisted in leading the world to the humane treatment of the mentally unwell after centuries of unfair treatment by the British Isles’ Anglo-Saxon ancestors.
Chapters in the History of the Insane in the British Isles discusses an important topic in the history of medicine as it was written during the nineteenth century, a time when there was increased attention on mental health and the overall advancement of psychological medicine within the British Isles. This book acknowledges the wrongful treatment and the appropriate reforms and legislation implemented to benefit individuals with mental health challenges. The mentally ill were misunderstood individuals treated cruelly for many centuries due to the notable lack of knowledge of mental illness in the British Isles until the mid-1900s. What I found is those we would describe in modern times as a “person with mental health challenges” were instead called “mad”, “lunatic” “idiot”, and “insane”, etc — reflecting the attitudes towards those with mental illness during the time as these are seen as derogatory or offensive terms today [2].
According to Tuke, those residing within the British Isles during the Dark Ages used a variety of treatments. The Saxons adopted much of their healing and medicinal knowledge from the Romans, as the Roman Empire had established dominion over much of the Isles territory from 410 AD through 1066 AD – but the Saxons possessed some ideas of their own. Botany, medicinal baths, inhumane punishments, and even the flesh of animals were all used to treat those considered mentally unwell.
Botany was oftentimes used as medicine, following the ideas of Dioscorides, a physician and pharmacologist, and Pseudo-Apuleius, an herbalist who wrote texts containing the names and descriptions of plants, including information on their medicinal capabilities. Those who suffered from epilepsy, hallucinations, or other disabilities were told by physicians to eat the flesh of various animals to be healed. Some took medicated baths (cold water mixed with herbs) while both drinking a mixture made of herbs and eating the flesh of an animal or bread with cheese and garlic. Inhumane punishments were also set upon those who were mentally ill, such as whippings, being bound with chains, or even being drowned. Insanity, also known as the “devil sickness” — demonic possession and witchcraft/sorcery were widely believed to be the cause of insanity during this time — was treated through exorcism by the Church, using holy water to expel Satan [3].
Early mental institutions, notably Bethlem Royal Hospital, St. Luke’s Hospital for Lunatics, the York Asylum, and Lincoln Asylum, were notorious for their horrendous treatment of the mentally ill. Physicians believed madness was a disease of the body and not the brain, therefore strong “medicines” were used to cure the imbalance of the four humors. “Treatments” included, beatings, isolation, bloodletting, ice baths, rotational therapy, and more. At the Lincoln Asylum, a patient was even found dead from strangulation after being strapped to his bed in a straitjacket and left overnight [4]. Financial management of these facilities' living conditions was also poor.
According to Tuke, it was becoming apparent that asylums were being misused, and the patients mistreated. Scandals associated with the asylums influenced attitude changes towards mental illness and care of the mentally ill. Abusive treatments were replaced with warm baths, proper diet, meaningful work, and social interaction. With this came a new approach to mental healthcare, the moral treatment system [5], which stated people with mental illness should be treated like rational beings. State provisions of asylums became mandatory after legislators realized they had a responsibility for the care of the mentally ill, and mental illness was recognized as something that could be cured or alleviated. Hanwell Asylum, also known as St. Bernard’s Hospital, was created in Hanwell, England in 1831, and its main mission was patient recovery and rehabilitation. Taking a progressive approach to patient care, the principle of therapeutic employment (baking, brewery, farming, etc.) was created due to the belief that work was essential to accomplishing the mission. A non-restraint system was also established at Hanwell, influenced by the incident at Lincoln Asylum. Instead, they had constant surveillance, and staff were trained to provide manual restraint to uncooperative and violent patients. Isolation was still utilized as a last resort so unruly patients could not harm themselves or others – still going along with the “therapeutic” principle by removing the patient from the cause of their agitation.
Daniel Hack Tuke's Chapters in the History of the Insane in the British Isles is an exploration of the history of mental health care in the United Kingdom. Tuke's examination of the treatment of the mentally ill reveals a narrative spanning centuries while shedding light on societal attitudes and various approaches to mental health. This work provides a deeper understanding of the challenges faced by individuals with mental illnesses and the strides made in mental health care throughout history.
(This post was written for the course HIST H364/H546 The History of Medicine and Public Health. Instructor: Elizabeth Nelson, School of Liberal Arts, Indiana University, Indianapolis).
References:
[1] Thomas Bewley, Madness to Mental Illness: A History of the Royal College of Psychiatrists, Online archive 39, The Future of Psychiatry, accessed November 14, 2023, https://www.rcpsych.ac.uk/docs/default-source/about-us/library-archives/archives/madness-to-mental-illness-online-archive/people/the-future-of-psychiatry-by-dr-thomas-bewley.pdf?sfvrsn=749103ff_6.
[2] The National Archives, “How to look for Records of Asylums, Psychiatric Hospitals and Mental Health," September 14, 2021, https://www.nationalarchives.gov.uk/help-with-your-research/research-guides/mental-health/.
[3] Simon Kemp, "Modern Myth and Medieval Madness: Views of Mental Illness in the European Middle Ages and Renaissance," New Zealand Journal of Psychologica, 14, no. 1 (June 1985): 1-8, https://www.psychology.org.nz/journal-archive/NZJP-Vol141-1985-1-Kemp.pdf.
[4] Museum Science Group, “A Victorian Mental Asylum,” June 13, 2018, accessed November 14, 2023, https://www.sciencemuseum.org.uk/objects-and-stories/medicine/victorian-mental-asylum.
[5] The College of Physicians of Philadelphia, “Mental Health and ‘Moral Treatment,’” June 27, 2018, accessed November 14, 2023, https://collegeofphysicians.org/programs/education-blog/mental-health-and-moral-treatment.