Victorian lunatics: a social epidemiology of mental illness in mid-nineteenth-century England

MARLENE A. ARIENO, Victorian lunatics: a social epidemiology of mental illness in mid-nineteenth-century England, Selinsgrove, Susquehanna University Press, London and Toronto, Associated University Presses, 1989, 8vo, pp. 140, illus., £18.95. This is a rum work. Professor Arieno presents a history of English policy towards the insane that in effect reinstates the entrenched interpretations of a generation ago. Up to the end of the eighteenth century, she argues, lunatics were treated chiefly in an "inhumane" manner. Then, thanks to what she rather perplexingly labels the new "biological view of man that inspired the physiological psychological paradigm ofmental illness" advanced by the Tukes and later moral therapists, a period of therapeutic optimism set in, and inhumane treatment was replaced by "basic humanitarian values". Above all, addressing the rise of the asylum in the light of the long-term development of the British "social service delivery system", she argues that, whereas hitherto the "art ofpublic administration" was deficient, it was in the Victorian era that the state finally awoke to its responsibilities, setting up a nationwide system of county asylums as part of that "revolution in government" identified by Professor MacDonagh et al. In the process, Professor Arieno cocks a doodle at Michel Foucault, Thomas Szasz, and, above all, Andrew Scull, whose "flamboyant" book, Museums of madness, "uncritically" embraces the one and "unconditionally" endorses the other. In particular, she takes exception to what she depicts as the view jointly held by this daemonic trio that emergent policy towards the insane served the interests of "social control", and that reformers were "tools of the bourgeoisie". On the contrary: in a section entitled 'The myth of moral management', she contends that the Victorians were "in good faith" in their desire to help lunatics. Moreover, pace the "social control theorists" ("often sociologists", she reminds us), there cannot have been an imperialist move by medical practitioners to seize control ofthe mad in early Victorian England, because doctors did not form a coherent profession until the Medical Act of 1858. One of the reasons, she charitably adds, why Scull and others have so egregiously misrepresented the Victorians may be purely semantic: they may be unaware that the "moral" in "moral therapy" has changed its meaning, having in that context nothing to do with "moral" in its modern connotations. As this summary makes clear, Professor Arieno's analysis does not reach the level of sophistication required to advance the important debate around the meaning of the institutionalization of the insane. For one thing, Scull himself has cogently argued, in his Social order/mental disorder: Anglo-American psychiatry in historical perspective (1989) that questions of "sincerity" are not, and cannot, be what is at issue. (And for a reasoned assault on Scull's interpretation, see Gerald Grob's review of this book in History ofPsychiatry, 1 (2), June 1990). For another, it is extraordinary that Professor Arieno should lump Scull's reading with Foucault's and Szasz's, since Scull has long been an embattled critic of both of them (see several of the essays conveniently reprinted in the above-mentioned book). It is also bizarre that she should characterize Scull as an exponent of a vulgar "social control" hypthesis, since he has himself quite explicitly criticized such views in Social control and the state (1981), a work to which Professor Arieno does not refer. Professor Arieno's attempt to set the rise of the Victorian asylum in the context of the Victorian administrative state is to be welcomed-historians of psychiatry are often too myopic to see what was going on at Westminster. Nevertheless, her own account of such developments is not nearly so useful as that offered by D. J. Mellett in The prerogative ofasylumdom (1982), and in 'Bureaucracy and mental illness: the Commissioners in Lunacy 1845-90', (Med. Hist., 1981, 25: 221-50), works to which she does not refer. Oddly, she nowhere mentions numerous germane publications on the Victorian asylum by such scholars as Anne Digby, Charlotte Mackenzie, Nancy Tomes, Janet Saunders, and Nicholas Hervey. Professor Arieno's monograph does, however, contain one useful section of empirical analysis. An examination of some 2,000 admissions to three mid-Victorian asylums shows that, although for official purposes they were all designated "paupers", in terms of actual social and occupational background the inmates formed a representative cross-section of the contemporary population at large. In other words, the impression often conveyed by Scull and others that the inmates of the public asylum constituted some sort of outcast group ("the great