A Geographical History of Institutional Provision for the Insane from Medieval Times to the 1860's in England and Wales (review)

In the first pages of his monumental tome on the geography of the madhouse, Chris Philo explains that the early research for this lengthy text began more than a quarter of a century ago. Debates on the social and cultural history of insanity have advanced rapidly during that period. The seminal influence of Foucault's ideas may still be detected in a continuing concern among historians with the moral purpose of the lunatic asylum in the bourgeois social order. The radical revisionist history of the "mad business" compiled by Andrew Scull and others dismissed earlier interpretations of liberal progress and heroic philanthropy as Whiggish apologia for a system of physical and social control. Such regimentation was legitimated by a closed logic of scientific classification, leading relentlessly along utilitarian corridors to the modern asylum. A large crowd of critics of Foucault and of Scull's marxisant interpretation of asylum reform have gathered over the years, including Gerald Grob and Roy Porter. Such writers have acknowledged the importance of market forces in shaping the institutions of the modern state as well as civil society, but they reject suggestions of a hegemonic, unitary mentality in the formation of the asylum system. Many later writers similarly reject the view that asylum building marked the triumph of a commercializing rationality among poorer classes, often arguing that such facilities were effectively utilized by laboring communities and families that faced a range of challenges over their lives.

Philo attempts to grapple with at least a significant part of this large literature in developing an explanation of the peculiar significance of location and distance in the construction of what he usually terms madhouses across many centuries of English and Welsh history. His long story begins in an erudite account of medieval (and even pre-medieval) provisions and stretches across remote areas of Wales and northern England as well as the more familiar territory of Bethlem and the celebrated private establishments of the eighteenth and nineteenth centuries. The author offers a treasure of fascinating cameos and larger portraits of particular institutions and notable advocates, drawing on an enormous range of primary as well as secondary texts as he uncovers the archaeology of structures and expertise that decided the confinement of the "mad people" depicted here. An important element in the "modern" understanding of insanity was a growing awareness that the mentally deranged represented a different kind of social disorder to those identified as criminal, vagrant, or simply immoral. Punitive institutions traditionally managed their custody, but sensitivity to the demands of "care" as well as control is well drawn out in a careful discussion of Parliamentary enquiries from 1714 to 1807.

Acknowledging the limits of Foucault's understanding of these moral forces in the reform of institutional provision for the deluded, Philo presents his study as a validation of Foucault's thesis. The new isolated asylums were the expression of a patriarchal social power that reduced the patient to a childlike dependence on the rational authority of "mad doctors." This view is supported in extensive references to Scull's original research in a discussion of the reforms that culminated in the key 1845 lunacy legislation. Clearly aware of postmodern accounts that emphasize the extent to which our changing perceptions of the asylum must depend on current concerns about the threats represented by the insane, Philo still appears to share with more empirically minded scholars an assumption that the physical location of these institutions and their distance from centers of population casts an important light on their contemporary function and the role they have fulfilled in bourgeois society. Emphasizing the degree to which altruistic notables such as Lord Ashley and complex professional personas such as the asylum superintendent J. C. Bucknill figure in the long narrative of institutional reform, Philo draws the conclusion that the closure of bourgeois rationality laid the foundations...