Asylum portraits

"Mental: a history of the madhouse" was a 60-minute television documentary in the BBC Four/Open University "Out of Mind" Season, broadcast in the UK in May 2010. [1] It told the story of the closure of Britain's mental asylums. To quote the press release, "In the post-war period, 150,000 people were hidden away in 120 of these vast Victorian institutions all across the country. Today, most mental patients, or service users as they are now called, live out in the community and the asylums have all but disappeared. Through powerful testimonies from patients, nurses and doctors, the film explores this seismic revolution and what it tells us about society's changing attitudes to mental illness over the last sixty years." Powerful? Overwhelming.

Among the interviewees were patients, members of medical and nursing staffs, the historian Dr Peter Barham, and Dr Henry Rollin FRCP FRCPsych, emeritus consultant psychiatrist at Horton Hospital, Epsom, and former Librarian of the Royal College of Psychiatrists. Dr Rollin described the grimly low levels of medical care in many of those asylums, and of care in general. Historic film footage of crude brain surgery was shown. Of prefrontal leucotomy Dr Rollin confessed "I had the misfortune to recommend sixteen patients [for the operation] ... it was of no benefit whatsoever, and some of them had the tragedy of personality change." It seemed at times that the only escape from the tyranny of routine lay in the menace of maltreatment. A former psychiatric nurse in Newcastle told of a difficult patient being dragged away and having a bucket of cold water being poured over him by a staff member who then jammed the bucket on the patient's head. A young woman who suffered panic attacks went to one asylum and ended up staying inside for thirty-three years.

As an illustration of a classic old-style asylum, the programme focused on High Royds near Leeds (illustration top), which had all the right qualifications: a Psycho-type silhouette at twilight, miles of corridors, once fine but now decayed Victorian decoration, the indispensable looming water-tower, and of course a proposal to turn it into luxury residences when it closed in 2003.

High Royds. Drawing by Paul Digby, 2003-4. Wellcome Library no. 643245i

The Wellcome Library has a large drawing made by an artist in High Royds in 2003-2004 as part of the ritual commemorations that were felt to be required at the time of its decommissioning. It looks like drawings done by patients to describe their gloomy life in the asylum. In fact, as film of the High Royds corridors showed, the drawing is merely an atmospheric representation of the actual interior in which patients spent their "empty and repetitive asylum life". There was a "quasi-prison atmosphere" (Dr Rollin again). The film-makers found articulate people who were able and willing to describe their experiences at High Royds and other asylums, whether as patients or as staff. These interviews are priceless.

The film-makers were careful not to make High Royds seem like a scapegoat: after describing episodes of brutality towards patients, the commentary stated that there was "no evidence of this kind of treatment at High Royds" which on the contrary was "in the forefront of the drugs revolution" in therapy. Some of the reminiscences on the High Royds website are quite complimentary, though others, it must be said, recall much unpleasantness. Other asylums in Newcastle, Sussex and Buckinghamshire also featured in the narrative, often with superb historic film footage.

The film showed the long process leading to the closure of the asylums. The first real "breaking point with the Victorian period" (Barham) was the 1959 Mental Health Act. Dame Pat Hornsby Smith MP called for "sympathy and understanding" to be the principles underlying treatment of the mentally ill. In 1961 Enoch Powell as Minister of Health 1960-1963 started a war on the asylums with a remarkable speech seizing on the image of the "looming water-tower and chimney combined" as the emblem of the asylum. Powell urged "the elimination of by far the greater part of this country's mental hospitals as they are today". He lost battles but won the war when Care in the Community was introduced. But Dr Rollin was no happier about the new arrangements than about the bad old days of the asylum. "The whole concept of Community Care is a disaster: I don't think the community cares" (NIMBYism was one of the problems he had in mind).

Mental illness is always with us, but individuals and institutions can be better than the film's account of what was offered in the asylum regime that Powell and others deplored. Last month I visited Bethlem Hospital to see an exhibition of a suite of portrait prints of patients and doctors at the Bethlem and Maudsley Hospitals in south London. Bethlem Royal Hospital is now in the London Borough of Bromley, and is approached by Monks Orchard Road, a leafy avenue with fine large houses down one side and the hospital's extensive grounds on the other, shielded by attractive woods and shrubberies. Inside the hospital grounds, as open as any ordinary hospital, one almost seems to be arriving at a National Trust country house: there's the chapel, there's the main house, where's the old stable block for cream teas?

On the other side of a meadow of wild flowers is a low building marked as The Bethlem Gallery, where the exhibition had been installed. (Note, behind the gallery, even here is the inevitable "looming" water-tower.) Most of the other people there are staff, and talking to them, it is striking how many of them are aware of the hospital's infamous history in formidable and less therapeutic buildings, first in Robert Hooke's palazzo in Finsbury (1676-1815: below left) and later in the building that now, shorn of its wings, houses the Imperial War Museum (1815-1930: below right). They appreciate the present environment of the hospital, and it is hard to believe the patients do not do so too, at least those in convalescent mode.

Two views of Bethlem: above left, drawing by Thomas Rowlandson, 1789; above right, coloured aquatint, 1817. Wellcome Library nos. 536228i and 39200i.

Access to the Gallery and to occupational art-activities is provided. The portraits on show in the Gallery are colour etchings by Gemma Anderson, a talented artist from Northern Ireland who trained in printmaking in London at the Royal College of Art. The artist is present (right), and it is touching to see her talking to a former patient, "Frederick", who sat to her for his portrait (below). In the clear light of the white-walled gallery, the etchings are beautifully exhibited in frames, each one a finely wrought tribute to an individual person.


So striking are the portraits, and so unusual, that the Wellcome Library has bought the sixteen prints that form the complete set Portraits: patients and psychiatrists. They mark a new step in psychiatric portraiture that mirrors the transition from the closed asylums of the past to the hope for a better present and future. They deserve a notice of their own, if not more than one: watch this space.

[1] Director: Chris Boulding. Producer: Adam Jessel. Executive Producer: Denys Blakeway. Archive Researcher: Peter Scott, for Blakeway Productions. No longer available on television but the Wellcome Library has a DVD of it.

Tribulations of Father Bernardo

Etching by Jeremiasz Falck after Bernardo Strozzi. Wellcome Library no. 35207i

Bernardo Strozzi (1581-1644) of Genoa was a painter whose works include this portrayal of an old lady sitting at her dressing table, assisted by two slightly mocking younger women. One of the carers holds upright the heavily-framed mirror while the other sticks a feather in the lady's hair. Strozzi's oil painting of this subject is now in the Pushkin Museum in Moscow, but in the seventeenth century it was owned by the Reynst brothers in Amsterdam. There it was recorded in this etching attributed to the engraver Jeremiasz Falck (1619-1677) from Gdansk, who sometimes worked in Amsterdam [1].

Falck's print has been discussed as a representation of "the lustful old woman", a type identified in terms of humoral physiology [2]. Women's bodies were phlegmatic because they were cold and wet, whereas men's were choleric because they were hot and dry. In later life, women became either colder or drier, leading them to become "merry widows". While it would be anachronistic to label her "osteoporotic", how appropriate is it even to label her using terms from specialist medical books of her time? Let's come back to this question after considering the life of Bernardo Strozzi.

Strozzi had two occupations: he was both a professional painter and a Capuchin friar. In 1625-1626 this unusual combination brought him into the courts, where he was accused of conduct unbecoming his religious status. His main defense was that he was painting not to acquire riches –- the Capuchins were a mendicant order –- but to support yet a third role in his life, which was as breadwinner for his aged mother and his impoverished sister Ginetta.

An article published in January 2009 reveals new documents in the Genoa archives about Father Bernardo's complicated life [3]. They show that, four years after the trial, Strozzi was still trying to exculpate himself, for he arranged for four witnesses to testify for him before a notary on 8 May 1630. They testified that Bernardo, having obtained temporary exemption from his duties with the Capuchins, was in too poor a state of health to return to them, and still needed to support his relatives by painting.

The third and fourth witnesses were both physicians, and a paraphrase of the newly discovered documents follows. First, Giovanni Agostino Balbano, who had already given evidence for Bernardo in 1625-1626, now stated that he had known Reverend Father Bernardo and been his medical adviser for about 16 years, and had treated him in his infirmities, and knew that he was of weak constitution; that in entering a strict religious order he would not be able to persevere in it, and his life would be curtailed. Moreover he had been found to have an illness of the left leg in the form of a huge varicose vein which increased the gravity of his state of health. Moreover Balbano continued, Ginetta, the sister of Father Bernardo, had also long been in a very bad state of health, and was heading towards a chronic incurable wasting state (etica). He added that Ginetta (who was married, but to a husband who did not provide for her) had a son of four years old who was virtually blind.

Then in the evening the fourth and last witness testified: he was Giovanni Battista Schratino, Doctor of Arts and Medicine. He declared that he had visited Strozzi earlier that day, and found that he was troubled with a flux of phlegmatic and melancholy humours in the left thigh and leg, which was manifested in a lesion formed by a very large dilatation of the veins of the whole leg and part of the thigh, so that the limb was damaged by a sore which had not been cured. And if it was not cured, and particularly if greater exercise and movement occurred, it would cause many lesions, incurable ones at that, even more so if he entered a strict order like the Capuchins or similar, who go barefoot or wear rough shoes, that would accelerate the opening up of the sores with danger to his life, since he had a very delicate and weak constitution. And on the same day Dr Schratino said he had visited Bernardo's nephew who was four or five years old, and who was troubled by a disturbance of cold and wet humours in the head, with great weakness in the eyes which made him almost blind. Moreover, the boy's mother was unhealthy and was bleeding with distillation of humours from the brain (catarro), and was running a risk of becoming phthisic (another generic term for a wasting disease). Asked for the grounds of his evidence, he replied that he was a physician and a practitioner, and that that was the truth.

In this case we see traditional western medicine in action. Humoral practice really did exist outside the pages of vellum-bound tomes of Galen! Despite the evidence of the two doctors, the court was not sympathetic, for in 1631 Bernardo was sentenced to eighteen months' harsh confinement in the Capuchin convent in Genoa. However, in July 1633, while allowed out on compassionate leave to visit Ginetta, the Reverend Father did a runner and sought asylum in the rival republic of Venice. There the ex-friar Bernardo continued painting unhindered [4].

Between the trials of 1625-6 and these new witness statements of May 1630, mention of the painter's aged mother disappears. It was she who, many years before, had sent the boy Bernardo to train as a painter. She seems to have died in February 1630. Could she have been the old lady who was shown making up in front of her dressing table mirror – freed at last from the ebb and flow of humours, and the indignities of old age?

[1] Wellcome Library catalogue no. 35207i

[2] Anouk Janssen, Grijsaards in zwart-wit: de verbeelding van de ouderdom in de Nederlandse prentkunst (1550-1650), Zutphen 2007, p. 285, fig. 190 (the same print attributed to Theodoor Matham)

[3] Andaleeb Badiee Banta, 'Trials and tribulations: new documentary evidence for Bernardo Strozzi in Genoa', The Burlington magazine, January 2009: 14-18

[4] Ezia Gavazza et al., Bernardo Strozzi: Genova 1581/82-Venezia 1644, Milan 1995, p. 367.

Item of the Month – February 2009

A toast in Abyssinia. Wellcome Library no. 667946i

It could be said without fear of contradiction that wherever you are in the Wellcome Library you are never more then ten feet away from a reference to Aristotle, the Virgin Mary, Queen Victoria or the River Nile. The Nile features in many roles: as the channel whose flooding fed the civilization of the ancient Egyptians; as the waters which supported the infant Moses and thus enabled the exodus of the Jews from Egypt with momentous consequences; as a place for research into schistosomiasis with the aid of a floating laboratory commissioned by Henry S. Wellcome; or more frivolously as the holiday resort of Europeans and North Americans such as Florence Nightingale, the Prince of Wales, William Osler, and the many others who enjoyed the views from the Nile dahabeeyahs.

Many references involve the obsession with finding "the" source of the Nile, exemplified in the Victorian expeditions of Sir Samuel Baker, and John Hanning Speke. There were however earlier explorers of the source of the Nile, one of the most distinctive being James Bruce of Kinnaird (1730–1794), whose many massive volumes Travels to discover the source of the Nile in the years 1768–73 (1790) weigh heavily on the Library's shelves. Their pages record the political and tribal history as well as the fauna, flora, and natural features of the regions which Bruce, disguised as a Syrian savant and physician, passed through in his quest for the fons et origo of the river. They also include a report on the Abyssinian custom of eating raw beef cut from living cattle.

Among the Bruce of Kinnaird documents in the Wellcome Library is an unusually large etching (above). It shows Bruce at his moment of triumph in November 1770, when he and his Greek assistant Strates reach a fountain at Gisha in Abyssinia, regarded by the locals as the sole source of the Nile. Bruce described it as "an island of green turf which was in the form of an altar … I stood in rapture over the principal fountain which rises in the middle of it". To mark the occasion, Bruce and Strates raise a coconut to drink the Nile water to the health of King George III of Great Britain and to Empress Catherine the Great of Russia (the champion of the Greeks against the Ottomans).

The print must be exceptionally rare, for it is mentioned neither among the likenesses in Bruce's Oxford Dictionary of National Biography entry nor in the recent biography of Bruce by Miles Bredin, which does however describe the episode [1]. Another impression in the British Museum bears lettering which records the date 1793 and the names of the authors: the composition was attributed to Richard Morton Paye (1750-1821), and the etching to none other than James Gillray (1756–1815), the well-known caricaturist. In support of that surprising attribution, the fuzzy etched lineation is similar to Gillray's caricatures: a specialist history engraver would have used bolder and thicker lines to differentiate between the principal figures and the background. It is nevertheless strange that this work is not included in Thomas Wright's list of works by Gillray "not belonging to the province of caricature or satire" [2].

This heroic history picture of the Scottish explorer at his moment of glory in Africa must be one of Gillray's least-known works. It deserves to be drawn to the attention of historians of Nile exploration, matters Abyssinian, and Scotland.

[1] Miles Bredin, The pale Abyssinian: a life of James Bruce, African explorer and adventurer, London: HarperCollins, 2000, pp. 160-163

[2] Thomas Wright, The works of James Gillray, the caricaturist, London: Chatto and Windus, 1873, appendix pp. 372-374, 'Works, not belonging to the province of caricature or satire, executed by James Gillray as an engraver'