The Most Solitary of Afflictions: Madness and Society in Britain, 1700-1900

Front Cover
Yale University Press, 1993 - Social Science - 442 pages
The routine confinement of the deranged in a network of specialized and purposely built asylums is essentially a 19th-century phenomenon. Likewise, it is only from the Victorian era that a newly self-conscious and organized profession of psychiatry emerged and sought to shut the mad away in "therapeutic isolation". In this book, Andrew Scull studies the evolution of the treatment of lunacy in England and Wales, tracing what lies behind the transformations in social practices and beliefs, examining how institutional management of the mad came to replace traditional systems of family and local care, and exploring the striking contrast between the utopian expectations of the asylum's founders and the harsh realities of life in these asylums. Scull locates the roots of the new ideas about lunacy and its treatment in pervasive changes in the political, economic and social structure of British society, and in the associated shifts in the intellectual and cultural horizons of its governing classes. He explains that a widening range of eccentric behaviour was accommodated under the label of madness so that asylums became a repository for the troublesome, senile and decrepit; the resulting overcrowding of asylums, says Scull, made the original goals of treatment and cure impossible to achieve. Scull's provocative account shows that the history of our responses to madness, while far from being an unrelieved parade of horrors and ever-increasing repression, is equally far from being a stirring tale of the progress of humanity and science. This book, based on Scull's study "Museums of Madness" is an extensive reworking and enlargement of that earlier text. Drawing on his own research and that of others over the last 15 years, Scull now adds new dimensions to this work in the history of psychiatry and 19th-century British society.
 

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Interesting review of the reasons and need for control in early asylums.

Contents

CHAPTER ONE The Rise of the Asylum
1
CHAPTER Two The Social Context of Reform
46
CHAPTER THREE The Chimera of the Curative Asylum
115
The Fate of the First Reform Bills
122
Renewed Parliamentary Investigation
125
The Elaboration of a ProInstitutional Ideology
132
The Asylums Critics
138
The Model Institution
146
Asylums for the Upper Classes
293
Warehousing the Patients
303
Pressures to Economize
310
The Critics of Asylumdom
315
Degeneration and Decay
324
The Outcome of Reform
332
CHAPTER SEVEN The Social Production of Insanity 1
334
Rising Numbers of Madmen
335

The Reformers Triumphant
155
The Ideal and the Reality
165
Controlling the Uncontrollable
169
Medical Men as Moral Entrepreneurs
175
Madness and Medicine
178
The Obstacles to a Medical Monopoly
185
The Threat Posed by Moral Treatment
188
The Weaknesses of Moral Treatment as a Professional Ideology
198
Medical Resistance to Reform
202
The Defence of Medical Hegemony
206
Persuasion at the Local Level
212
Madness as Mental Illness
216
Psychiatrys Struggle for Professional Autonomy
232
Managers of the Mad
244
ExtraInstitutional Practice
251
The Defence of Mental Medicine
259
Medical Authority in the Asylum
262
The Grouth of the County Asylum System The Accumulation of Chronic Cases
273
Mammoth Asylums
277
The Custodial Institution
284
The Maintenance of Order
289
Official Explanations of the Increase
338
5
342
An Alternative Explanation
344
The Multiplication of Madness
352
The Expanding Empire of Asylumdom and the Groupth
363
Lunacy
374
CHAPTER EIGHT The Legacy of Reform 1
375
2
376
Competing Accounts of Lunacy Reform
377
Experts and the Control of Deviance
381
Community Treatment
388
The Therapeutic State?
391
Bibliography
395
293
428
303
429
332
431
335
432
344
437
363
440
Index 395
441
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