© 1997 Tht Society for the Social History of Mediant DISCUSSION POINT Getting Out of the Asylum: Understanding the Confinement of the Insane in the Nineteenth Century By DAVID WRIGHT* SUMMARY This paper cntically re-examines our assumptions about the social role of asylums in the nineteenth century by separating the history of the confinement from the history of psychiatry. Rather than medical superintendents being central to the admission of patients, this paper will argue that control over confinement was predicated upon the desires of families to care for and control dependent and violent relatives The confinement of the insane can thus be seen not as a consequence of a professionalizing psychiatric elite, but rather as a strategic response of households to the stresses of industrialization. The sec- ond part of this paper surveys changing approaches to the social history of the asylum and directs these techmques to a combination of institutional and non-institutional sources which will shed new light on the dynamic between informal patterns of family canng 'in the community' and formal medical treatment in purpose-built institutions. Having set out the methodological possibilities of using new types of admission records, the last section of this paper explores different approaches to the history of the family and applies them to the question of why the insane were confined. This will provide an analytical framework for understanding the interface between the family and the formal medical institution. Throughout, this paper draws on more than three dozen international studies to illuminate some comparative aspects of confinement in different national contexts. KEYWORDS: asylums, confinement, psychiatry, family, insane, nineteenth century The confinement of the insane in purpose-built institutions spanned the modern western world. Between 1800 and 1914, no western country was spared the rapid construction of asylums and an apparently insatiable demand for institutional accommodation. Three hundred thousand persons were committed to asylums in England and Wales in the nineteenth century; by the Great War, close to one quarter of a million Americans occupied state mental hospitals. 1 The residential population in Ireland and New South Wales approached one in every 300 people. 2 Similar patterns of confinement appeared in France and Germany. Even *Department of History, University of Nottingham, University Park, Nottingham NG7 2RD, UK I would like to thank Len Smith, Roy Porter, Harriet Deacon, Cheryce Kramer, Peter Bartlett and two anonymous referees for their detailed comments on drafts of this paper This paper has been kindly supported by the Wellcome Trust. 1 This figure was derived from the Fifty-fourth Annual Report of the Commissioners in Lunacy to the Lord Chancellor, PP (1900) vol. 37, Appendix A; Gerald Grob, The Mad Among Us A History of the Care ofAmerica's Mentally III (Cambridge, Mass, 1994), p 166. 2 Mark Finnane, Insanity and the Insane in Post-Famine Ireland (London, 1981), Table F, pp 232-3; Stephen Garton, Medicine and Madness. A Social History of Insanity in New South Wales, 1880-1940 (Kensington, Aus., 1988), p. 37. 0951-631X Social History of Medicine 10/01/137-155 at McMaster University Library on April 28, 2010 http://shm.oxfordjournals.org Downloaded from