Mental Health Care in Modern England: The Norfolk Lunatic Asylum/ St. Andrew's Hospital, 1810-1998 (review)

As the title suggests, this is an institutional history of the Norfolk Lunatic Asylum from its opening in 1810 to its eventual closure in 1998. This was one of the first English county asylums; its history therefore allows an overview of the full chronology of the institutional care of the insane—from Poor Law and other local roots, to large-scale asylum, through eugenics and two world wars, to its eventual erosion in the era of community care.

This is not a book that introduces grand new theories about asylumdom; its strength is instead in its assembly of detail. Steven Cherry bases his study primarily on the records of the asylum itself, particularly its annual reports, account books, and minutes of its governors' meetings. Case notes and other primary sources are referred to, but less extensively. In the course of more than three hundred pages, Cherry charts the changes in asylum administrative structure, changes to the asylum building, the staffing conditions, the treatments offered and their effectiveness, and the patient population. While he approaches his subject and his protagonists with a generosity of spirit, this is not a new Whiggish account. The historical context of change is acknowledged, and Cherry is careful and perceptive in acknowledging benefits, weaknesses, successes, and failures of provision. The book is particularly interesting in its account of the changes in administrative structures, and the expectations placed on nursing staff. There is also a good account of the development of the asylum farm, both as a source of occupation for the patients and as a practical benefit to the asylum diet and economy.

Particular mention is warranted of the discussion of the asylum during the war years, most notably the Great War. Other asylum histories tend to gloss over these years; Cherry instead provides a good account of the administration of the asylum during the war, and the ways in which the asylum coped with its occupation by the war effort as a military hospital.

The institutional history is a frustrating discursive form, for the coverage of two centuries of care inevitably turns the project into something of a historical survey, precluding detailed discussion of particular points. Inevitably, therefore, there were a number of tantalizing points that I felt were incompletely covered, perhaps because of space constraints. For example: (1) Cherry argues that the original design of the asylum can be understood as part of a spirit of moralization (p. 34). Such "moral architecture" is generally a later trend; its appearance in the second decade of the nineteenth century is therefore interesting, and it is unfortunate that it is not discussed at greater length. (2) Norfolk introduced a medical superintendent only in 1861, and the run-up to this appointment was controversial in its alleged neglect of medical viewpoints. This represented a complex transition for the asylum, and more detailed discussion would have furthered a variety of historical arguments regarding the role of the Poor Law and local administration in asylum management, the efficacy of the Lunacy Commission, and the professional status of asylum doctors in the period. (3) Cherry notes that medical personnel appear to have been dissuaded from pursuing their more radical ideas while at Norfolk. He points out that it was only after leaving Norfolk in 1863 that MacKenzie Bacon put his ideas regarding the importance of curbing masturbation into practice, and similarly that David Thomson (superintendent, 1887-1922) did not pursue his interest in sterilization at Norfolk (p. 307). While these may in hindsight have been fortunate outcomes, it suggests a dynamic of dissuading medical innovation in the asylum that is never fully explained. These examples are not given in the spirit of criticism; rather, I am pointing out some research and analysis that Cherry may yet wish to pursue.