Did psychiatry emerge as a rational response to England's growing mental health crisis, or was there a more sinister motive?
What does it mean to be ‘mentally ill’? A universal definition remains elusive today, so it’s no wonder that perceptions of mental illness have changed so much across history.
In the 18th century, England gained a reputation as the ‘melancholy capital’ of Europe and had disturbingly high suicide rates, which for physicians was creating a sense of a nation in crisis. One of the most popular physicians of the time, George Cheyne, published his text The English Malady in 1733, in which he described how urbanisation and rising living standards were weakening people’s constitutions and making them vulnerable to depression and nervous complaints. In response to this perceived crisis, psychiatry as a profession began to develop in Britain, encouraged by the first ‘mad-doctors’– physicians who specialised in the treatment of mental disorders. This trend received a further impetus from the ‘madness’ of King George III in the late 18th century, which both brought the issue of mental health into the spotlight and provided a powerful incentive for mad-doctors to produce a proven ‘cure’. If successful, they could be appointed as the King’s own head-doctor.
King George III was blighted with mental health problems in later life - and debates continue over what exactly he suffered from
Prior to this time, the vast majority of those considered to be lunatics were cared for discreetly at home and there was only one public asylum, Bethlem, which, despite its notorious reputation, had no more than two dozen patients at any one time. Yet fast-forward 100 years and the foundations were being laid for a system of asylums capable of institutionalising thousands of Britain’s most vulnerable citizens. So why was this increasingly seen as the only answer to Britain’s growing insanity crisis?
Despite being an impressive 32 stone, Cheyne prescribed dieting and temperance as his cure
An argument popularised by those referred to as the ‘anti-psychiatrists’ in the 1960s and 1970s outlined how psychiatry developed in the 18th century as a state-sponsored form of social control, and that institutionalisation in an asylum was seen as the best method of dealing with those individuals who were a nuisance to their family or had rebellious ideas. This included people deemed dangerous enough to society’s ideals to concern physicians, but not dangerous enough to be imprisoned. Asylums thus became a convenient place to incarcerate inconvenient people.
This argument gained a particular resonance among feminist historians, who argued that many of the women officially diagnosed as mentally ill in the 18th and 19th centuries were merely rebellious and strong-willed, for instance, refusing to marry or exhibiting unfeminine behaviours like fits of temper. To many of these feminist historians, the label of mental illness was used to subjugate women and reinforce acceptable social behaviour. Case studies taken from the notebooks of 18th-century physicians describe the symptoms of their female patients as involving angry outbursts or an unkempt appearance, which a few historians have referred to as evidence that some of the women diagnosed with mental health problems, in particular hysteria, would not be seen as mentally ill today. Others argue that many of the women, particularly working women, were suffering from acute stress and simply needed a break from their work, not a spell in an asylum.
A depiction of Bethlem from William Hogarth's 'A Rake's Progress' published in 1735
Despite this, the idea of any sinister motive behind the growth of psychiatry has been largely discounted by credible historians today and it was very much a product of the anti-establishment climate of the 60s and 70s. For one, most asylums in the 18th century were set up by private individuals with very different agendas and had little involvement from the state. Yet the concept of psychiatry being used as a way to suppress rather than cure continues to have a certain dramatic appeal for many, evidenced by the continued popularity of novels such as One Flew Over the Cuckoo’s Nest.
There is no doubt that mental illness is a fluid term and has meant different things at different times, and though some unfortunate individuals were most certainly misdiagnosed, this was more through ignorance than deliberate intent. Indeed, any confusion in the 18th century over which symptoms should be included under hysteria or any other nervous disorder can surely be forgiven when we consider how much our own understanding of mental illness has changed in the last ten years alone.