Armut und Wahnsinn: “Arme Irre” und ihre Familien im Spannungsfeld von Psychiatrie und Armenfürsorge in Glasgow, 1875–1921 by Jens Gründler (review)

In the introduction to this study of the Woodilee asylum in Scotland, Jens Gründler cites several cases of patients and families that availed themselves of psychiatric services. The cases illustrate that, far from simply warehousing the mad, the asylum was often called upon only as a last resort and for relatively short periods of crisis in the lives of patients and their families: some patients were brought to the asylum only when their families could no longer cope; others were retrieved from it by relatives wishing to care for them at home. This emphasis on the role and agency of families makes Gründler’s monograph an important and timely addition to the historiography of psychiatric institutions.

The book begins with essential background information on the administration of Scottish poor laws, the institutional setting, and debates on the construction of the Woodilee asylum, which opened in 1875. It then turns to the official agencies and actors in charge of overseeing and operating the facility, stressing their specific roles and jurisdictions alongside those of family members, relatives, and friends. Drawing on the asylum’s patient records and the case files of the local poverty relief board, Gründler describes a complex web of historical actors who were subject to checks and balances and to overlapping supervisory controls.

The book’s architecture mimics the passage of patients through the asylum. Gründler examines patients’ institutional trajectories, tracing the situations they encountered and paths they traversed on their way into, through, and out of the asylum. He argues that, at every stage along the way, patients’ families and relatives had important roles to play. And when it comes to institutionalization, his conclusions are remarkable: asylums were more often a welcome resource for overburdened families than instruments of social control; many patients were not impoverished; sudden changes in a family’s structure (death, marriage) or financial wherewithal prompted psychiatric institutionalization; and more generally, families—more so than medical experts—determined whether, when, and why someone became mentally ill. Concerning patients’ lives in the Woodilee asylum regime, Gründler stresses that patients were enmeshed in an asymmetric web of power relations in which they—far from being mere objects of institutional discipline—could sometimes check the behavior of medical and nursing staff, subvert reward systems, and mobilize the solidarity and support of their families. In his analysis of patients discharged from Woodilee, Gründler argues that stable family structures improved the chances of patients being discharged as cured. Furthermore, Gründler examines several cases of patients who were retrieved from the asylum by their families, demonstrating how the asylum’s totalizing impetus could be disrupted by a variety of pragmatic considerations and external pressures: the “binary logic of the medical system (sickness-health)” (pp. 296–97) was called into question by the logics of other competing internal and external priorities (overcrowding, orderly wards, cost) and by the pragmatic and emotional calculations of patients’ relatives.

The final two chapters exploit files of the local welfare agency to move outside the asylum and to assess both the “careers” (pp. 269–97) of discharged patients and the often desperate circumstances of their families and relatives. While asylums sometimes served as receptacles for the incorrigibly mad, they also fulfilled their charge of curing and resocializing many patients. Significantly, it was the familial and social dynamics of reintegration—often more so than the mental illness itself—that led to recidivism and impoverishment. And the example of so-called “casuals” and “ins and outs,” who were repeatedly admitted to Woodilee during temporary episodes of crisis in their lives, indicates that patients and families sought asylum care in the expectation that they would be healed.

This is a solidly documented, well-structured, and cogently...