"They're in the Trade . . . of Lunacy, They 'Cannot Interfere'-They Say": The Scottish Lunacy Commissioners and Lunacy Reform in Nineteenth-Century Scotland (review)

Jonathan Andrews. "They're in the Trade . . . of Lunacy, They 'Cannot Interfere' --They Say": The Scottish Lunacy Commissioners and Lunacy Reform in Nineteenth-Century Scotland. Wellcome Institute for the History of Medicine Occasional Publications, no. 8. London: Wellcome Trust, 1998. 108 pp. £8.00 (paperbound).

Scotland has always had a different, more communal way of approaching social welfare than its English cousin. This collectivist approach has expressed itself in many different forms, most conspicuously in the separate Poor Law, legal, and education systems that continued after the Union of 1707. In clinical medicine, the Scottish method of investigation was widely copied throughout the industrializing world. Less noticeable was the impact in the area of psychological medicine, where such prominent alienists as W. A. F. Browne and Thomas Clouston ensured that the Scottish approach to the care and control of the insane would always possess an enduring originality of purpose.

There were pressures from various quarters to force Scotland, however unwillingly, to adopt a more "English" approach to lunacy reform in the nineteenth century. In particular, the Lunacy (Scotland) Act of 1857, which sought to replicate the spirit of the English Asylums and Lunatics Acts of 1845, ushered in a public, tax-supported asylum system. Like its English counterpart, the Scottish Act established a central inspectorate (the Scottish Board of Lunacy Commissioners); brought the range of different private, charitable, and pauper asylums under a single authority; and initiated a comprehensive legal system of medical certification. It stipulated a regimen for inspecting lunatics kept in formal institutions as well as those remaining in the community. Despite the anglicization of lunacy institutions, the Scottish persisted in their tradition of encouraging the boarding-out, rather than institutional confinement, of significant numbers of "harmless insane persons" in the community.

Jonathan Andrews addresses the professional and administrative background to Scottish lunacy reform. In particular, he details meticulously the operation of the Scottish Lunacy Commissioners, from their creation in 1857 to the end of the century. Using their annual reports to Parliament and minutes of the Board, he explores both the personal and the political dimensions of lunacy inspection and regulation, including the composition of the Lunacy Commission, the respective roles of the different types of commissioners, and their changing relationship to the series of district asylums for the indigent, chartered lunacy hospitals for the respectable poor, and private madhouses for the affluent. The Commissioners were the central figures in the success of making "community care" work effectively in the lowlands and highlands of Scotland.

Needless to say, the establishment of a national (Scottish) inspectorate whose principal role was to enforce rules and regulations often passed in Westminster was unlikely to go unnoticed or unchallenged north of the border. Throughout the Scottish counties, there was a constant tension and negotiation between the reforming ambitions of urban and urbane inspectors and the more provincial sensibilities and desires of asylum keepers and guardians. Commissioners, many of whom were themselves former medical superintendents of asylums, wrote detailed briefs and provided extensive suggestions for bettering the condition of patients in large institutions. The task of inspecting "single" patients in the community was more complex. The imposing terrain and climate of the Scottish highlands made the inspection of boarded-out patients something of a feat of exploration and discovery. Commissioners traveled "by means of a one-horse-trap, by rowing and sailing boats, over moor, fen, bog, the fords, lochs, and channels" to inspect the insane "in the community" (p. 14). Andrews concludes that the glare of public scrutiny prevented at least the most abusive practices from (re)occurring.

Andrews modestly describes this brief book as a "cursory" overview of the role of the Scottish Lunacy Commissioners--yet quite to the contrary...