A Duke by Any Other Name by Grace Burrowes Page 0,125
shall we?”
They were, gloriously so, and when Nathaniel came down to breakfast hand in hand with Althea, not even her brothers dared offer a remark, though they, Millicent, and Her Grace of Walden did smile. Both Quinn and Stephen passed the duchess a coin, while Nathaniel passed Althea the teapot and the entire basket of cinnamon buns.
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Author’s Note
How likely is it that wealthy late-Georgian families would stash an inconvenient or mentally infirm relation in a “private madhouse”? To answer that question, we need some context.
Most readers will be familiar with the infamous Bethlehem Royal Hospital, an institution established in 1337 that by Regency days was notorious for its inhumane confinement of the (allegedly) mentally ill. Bethlehem, or Bedlam, as it came to be known, was a paupers’ hospital. People with means were not generally admitted, and people with any compassion didn’t want to see their relatives in such a place. Until the Madhouse Act of 1774, admission to any place of confinement on mental illness grounds was mostly based on the common law tenet that allowed a relative to “confine a person disordered in mind, who seems disposed to do mischief to himself, or another person.” [Unsworth, Clive (1991). “Mental Disorder and the Tutelary Relationship: From Pre- to Post-Carceral Legal Order.” Journal of Law and Society. 18 (2): 254–278. doi:10.2307/1410140. JSTOR 1410140.]
If the family could not keep the patient at home, the private madhouse—using the terminology of the day—was the only alternative. For a sum, the patient was housed and cared for by somebody who professed to have relevant knowledge and ability. Two problems arose. First, sane people were warehoused against their will, and second, conditions in these private institutions varied greatly. (Note the euphemism.)
The Madhouse Act of 1774 came about in part because of what is known as the Hawley case, which transpired in 1762. A Mrs. Hawley had been confined in a madhouse and a friend sought her release on the grounds that she was not, in fact, mad. The case was initially dismissed because the friend had no standing to bring the petition for a writ of habeas corpus (which would have required Mrs. Hawley to appear in person before the judge). The judge instead sent a physician to visit with Mrs. Hawley, who was apparently quite sane.
She had been incarcerated at the madhouse on the word of her husband alone, could not leave the place, and was to be kept there, no questions asked, as long as the husband paid the monthly fee. Further investigation revealed that the madhouse where she’d been confined hadn’t admitted a truly mentally ill person for years. No one who could pay was turned away.
When a House of Commons committee investigated this case in 1763, they reported that the situation Mrs. Hawley found herself in was typical of many such institutions. No physicians attended the patients, they were refused all communication with people outside the institution walls, and they were treated as if insane without anybody in authority finding them so.
It took a few false starts, but in 1774 Parliament passed an act requiring that any place holding more than one allegedly insane person had to be licensed by a committee of the Royal College of Physicians, all such private madhouses were to be inspected annually, and the Royal College would keep a register of who was housed where. Outside of London, the task of ensuring an annual inspection of these facilities fell to the judges presiding at the Quarter Sessions.
All better, right?
Well, not exactly. The Madhouse Act of 1774 made no reforms as to how patients were to be treated or the rigor of the admissions process, and—typical of much Georgian and Victorian reform legislation—made no provision for funding enforcement of the law. Various subsequent acts chipped away at the inhumane and over-use of restraints, isolation, and “lowering regimens” (subsistence diets or worse), but no legal process could address the fact that Georgian and Regency mental health care, generally, was by modern standards terrible.
Dr. Benjamin Rush, known to some readers as a signer of the Declaration of Independence, was also an Edinburgh-educated physician and social reformer based mostly in the Philadelphia area. He is considered a founder of American psychiatric medicine, and corresponded extensively with physicians all over the United States, the United Kingdom, and Europe. In 1813, he published “Medical Inquiries and Observations Upon Diseases of the Mind,” and therein enumerated