Getting out of the asylum: Understanding the confinement of the insane in the nineteenth century

This paper critically 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 second part of this paper surveys changing approaches to the social history of the asylum and directs these techniques to a combination of institutional and non-institutional sources which will shed new light on the dynamic between informal patterns of family caring '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.