Asylum reform and its critics

On this plate (7 sections)

For much of the 1800s, building an asylum was what reform looked like. By the middle of the 1900s, critics were saying the asylum itself needed to be questioned. This page follows that arc in the United States and England: the early institutions, the moral treatment tradition, the campaigns of Dorothea Dix, the main English laws in outline, and the objections that followed. The editors flag points where sources differ or where historians disagree.

Before the purpose-built asylum

People in severe mental distress were often held wherever the authorities had space. In her 1843 memorial to the Massachusetts legislature, Dix described people kept in "cages, closets, cellars, stalls, pens," and she argued that such abuses grew mainly out of defective laws rather than the cruelty of individual keepers. Jails and poorhouses, she wrote, were not built to care for them.

England had a similar patchwork. A Warwick University history of Lancashire notes that in the early 1880s about 3,000 pauper patients there were in workhouses and private asylums, alongside roughly 4,000 in the county's four public asylums.

The York Retreat and moral treatment

The Retreat opened in 1796 outside York. It was founded by William Tuke and other Quakers after a Quaker woman died shortly after admission to the York Asylum. Sources place that death in 1790 or 1791, so the editors do not give a single year. The Retreat was deliberately small, with around thirty patients at first, mostly Quakers, and about one staff member for every ten patients.

Its approach, later called moral treatment, replaced chains and corporal punishment with routine, work, exercise and a household atmosphere in which patients took tea with the superintendent. The same Warwick history notes that restraint was still used occasionally, and it quotes the historian Roy Porter describing the regime as relying on "the therapeutic power of fear." Samuel Tuke's 1813 book about the Retreat helped spread the term "moral treatment," which he borrowed from the French "traitement moral."

Dorothea Dix's campaign in the United States

Dix wrote her memorial in 1843 after about two years of visiting prisons, almshouses and private homes in Massachusetts. Its request was funding to expand the state asylum at Worcester. Her later effort was national. A bill she backed proposed giving 10,000,000 acres of federal land to the states, to be sold to fund asylums for the insane. Congress passed it on March 9, 1854, but President Franklin Pierce vetoed it. His argument was constitutional: he held that the federal government should not take on responsibility for the nation's needy in this way.

Dix and most reformers condemned the veto. The history page cited below says Pierce's reasoning about federal power shaped national policy toward philanthropy and public health well into the twentieth century.

England's lunacy laws in outline

English asylum building rested on a series of Acts. The Lancashire history ties its county asylum system to the Lunacy Acts of 1808 and 1845. Lancaster County Asylum, the fourth opened under the 1808 Act, took just over 200 patients in 1816. The Lunacy Act 1845 created the Commissioners in Lunacy, who inspected and regulated asylums and reported each year to the Lord Chancellor and Parliament, according to The National Archives. In 1913 the Mental Deficiency Act merged them into a Board of Control.

The Mental Health Act 1959 closed this chapter. Its long title begins by repealing the Lunacy and Mental Treatment Acts of 1890 to 1930 and the Mental Deficiency Acts of 1913 to 1938. It received Royal Assent on July 29, 1959, and the Board of Control was dissolved with effect from November 1960. Laws have changed since, so a reader with a question about a current legal right should ask an official body or a qualified adviser.

Overcrowding and custodial care

Many asylums filled faster than planners expected. Rainhill and Prestwich in Lancashire opened in 1851, each built for roughly 400 to 500 patients, and admissions quickly overwhelmed them. Prestwich had 1,291 beds by 1883, and Rainhill gained an annex for 1,000 more in 1886. Whittingham, opened in 1873 for 1,100 patients, added a 674-bed annex within about a decade.

Goffman and the critique of the total institution

In 1961 the sociologist Erving Goffman published Asylums, essays on the social situation of mental patients. He had done fieldwork at St Elizabeth's Hospital in Washington, D.C., working as an assistant to the physical education instructor. He analyzed "total institutions," settings in which every aspect of residents' lives is controlled, a category that included prisons, boarding schools, ships and monasteries as well as asylums.

The book is often summarized as simple "antipsychiatry." A 2011 editorial in the British Journal of Psychiatry argues that this misses its richness. It suggests Goffman's main contribution was to humanize patients and to show the patterns of interaction that dehumanized them. The same editorial notes that Goffman thanked the hospital's psychiatrists, that his sources were as much literary as observational, and that the idea of the total institution had a sociological history before him.

Readers still disagree about how to weigh the book. The arguments for moving away from large hospitals that followed in the 1960s and later are covered in Deinstitutionalization and community care, and the people who had lived in these institutions began organizing themselves, as described in The consumer/survivor movement. Dated entries for all of this sit on the timeline, and the wider idea of speaking up for others is introduced in What is mental health advocacy?

The short version

Asylums were built as a humane answer to jails, poorhouses and private cruelty, and the York Retreat and Dorothea Dix gave that effort its best-known models and champions. Laws in England and state policy in the United States turned the idea into large systems. Overcrowding and, later, Goffman's account of institutional life led critics to ask whether size and control had defeated the original purpose.