A great book for researchers of the topic and anybody curious about the history of psychiatry and psychiatric treatment in the UK in the XIXc

Lunatics, Imbeciles and Idiots: A History of Insanity in Nineteenth-Century Britain and Ireland - John R F Burt, Kathryn Burtinshaw

Thanks to Pen & Sword for gifting me a copy of this book that I freely chose to review.

I have read and reviewed several books by Pen & Sword and have commented on their great catalogue before. As you know, I’m a psychiatrist and could not resist it when I saw this book.

The authors, who are well-known for writing about genealogy, note in their introduction that when people try to trace their ancestors and find that some of them seem to have disappeared from records or be lost, a possibility worth considering is that they might have had a history of mental health problems or epilepsy. If that is the case, checking the records of lunatic asylums, workhouses and the poor law records might provide plenty of information not available elsewhere. Their book focuses on mental health care during the XIX c. although there is a chapter about the pre-nineteenth century situation (that chapter, in particular, is very hard, and the way patients were cared for at the time until new reformers came along, is scary to read).

The book is divided into chapters that revise the laws in different areas of the United Kingdom, the asylums that were built, who run them, how they worked, and always offers some case studies, that share the stories of some of those patients, for the most part, voiceless and lost to history.

Later chapters look at the life in asylums (that as a psychiatrist, I found fascinating), the staff and their work, and then at different types of patients (the criminal lunatic, imbeciles and idiots, epilepsy, general paralysis of the insane, puerperal insanity, suicide). The chapters on diagnostic and causes, and treatments were particularly illuminating for me (even though I had read of some of them, the case studies and the details brought it to life).

I started working in psychiatry in the UK in 1993 and by then many of the asylums had disappeared, but, although I’ve only ever talked to people who had worked in them in the late XX century, I’ve had a chance to visit some of those fascinating buildings (some are listed buildings now and have been transformed into apartments and offices) and some are still dedicated to caring for people with mental health disorders, although, evidently in a very different form. With the changes to the philosophy and theory of caring for people with mental health problems, the discovery of new medications and a more enlightened attitude towards learning difficulties, it is important to record and revise how much the situation has changed, and not lose sight of the history of those places and particularly of the people (reformers and especially patients). In my professional capacity I’ve heard many discussions as to the advantages and disadvantages of the different models of care, and after reading this book I have gained perspective and feel much better informed.

As I read, I highlighted many points and quotes I wanted to share, but some are so extreme (when talking about ‘care’ pre-asylums) that they put horror movies and books to shame. I did not want to sensationalise a book that is, above all, a chronicle and a study that reflects changed social attitudes and laws, and that is invaluable to anybody who wants to have a good overview of mental health care in the UK in the XIX c.  and part of the XX (a recent book about R.D. Laing reminded me that even with the discovery of new medications, some things had changed little regarding the care of the mentally ill until the later part of the XX century).

This is a good compendium of the care of people with mental health illnesses, learning disabilities and epilepsy in the XIX century, and it encompasses laws, reformers, workers, buildings, and more importantly, patients. It is a great resource for researchers looking to gain a general view of the subject and offers biographies of the main players, a glossary and bibliography. The paperback copy also has great drawings and also pictures of ledgers, buildings, patients. I recommend it to anybody looking for information on the subject, to genealogists interested in researching in depth some of the lesser known records and to anybody interested in the history of psychiatry and psychiatric care, in particular in the UK.