Admitted for:

To be admitted to one of these asylums, the local JP and a doctor had to certify you insane. To protect against corruption, the doctor who signed the certificate could not be affiliated with the asylum in any way. It was a massive improvement on the previous system. Patients included those with learning disabilities, epilepsy, senile dementia, and the grandiose delusions and physical paralysis that accompanied tertiary neuro-syphilis. Alcoholics and drug abusers often ended up in asylums as well. Many women passed through asylums too, usually suffering post-natal depression, or puerperal fever – then a common post-natal infection leading to mania and sometimes death. Thousands of people passed through the county asylums, but they actually tried hard to keep patients out, for one simple reason. The Victorians hated paying taxes for public services even more than we do. But there was simply so much medical need, and nowhere else for many needy people to go except the asylum. What, then, of the absurd diagnoses in the admissions table? Nineteenth century mad-doctors knew next to nothing about the mind. They tried to discover what had triggered a mental breakdown, and list that incident as the ’cause’ of the illness. This remained the case until Emil Kraepelin, a stereotypically logical German Professor of psychiatry, came out of leftfield with a wild new idea. He classified mental illness according to prognosis, instead of cause. He swept away the confused jumble of religious mania and excess novel-reading, and replaced it all with a logical, simple, practical, system. Apart from neurological disorders and diseases of old age, there were only two mental disorders. Manic-depressive disorders, from which patients would usually recover, if only at intervals, and schizophrenia – delusions with the mood being affected – which patients would never recover from. Kraepelin’s model of mental illness still forms the basis of all modern psychiatry.

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