Five fascinating facts about fictional asylums

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By Anne Goodwin

In my professional life as a clinical psychologist, I visited around a dozen of the hundred or so long-stay psychiatric hospitals in England and Wales. Since then, I’ve been to about twice that number on the page. Although the Victorian asylums are now extinct, they make a fascinating setting for fiction. Let me guide you around some I can recommend.

1. You might meet someone famous

I’ve read a few novels about the hospitalisation of famous historical figures and one with an eminent therapist on the staff. 

Adam Foulds’ novel , The Quickening Maze, is about the period the poet John Clare spent in a private asylum in Epping Forest. Set during the First World War, Pat Barker’s Regeneration features Wilfred Owen and Siegfried Sassoon. In Saving Lucia, Anna Vaught reimagines the psychiatric careers of James Joyce’s daughter Lucia; Freud’s ‘Anna O’; Queen of the Hysterics, Blanche Wittmann; and would-be assassin of Mussolini, Lady Violet Gibson. Alex Pheby’s Playthings is about Daniel Paul Schreber, the retired High Court judge who published a memoir of his psychotic breakdown in 1903. Let Me Tell You About A Man I Knew is author Susan Fletcher’s account of Vincent van Gogh’s stay in a more benign institution in Provence.

Set in 1948, I Never Promised You a Rose Garden, based on the real-life experiences of Joanne Greenberg as a teenager and young adult, introduces readers to a fictional version of psychoanalyst Frieda Fromm-Reichmann, a contemporary of Sigmund Freud.

Although neither staff nor patient, Samuel Beckett wheedles his way onto a hospital ward to research his first novel in Sam Thompson’s  Jott.

2. You’ll find dungeons and glittery ballrooms

I was surprised by the underground cells for the more disturbed patients in Playthings, not having heard of them in the long-stay hospitals in the UK. I’ve been unable to verify whether the similar chambers in a fictionalised version of an asylum in northern England – see Anna Hope’s The Ballroom – was imaginary, or a dark secret kept from later generations of staff. However, you can find images of the ballroom, both in its heyday and in ruin, which resembles the theatre in the hospital where I used to work.

3. You’ll encounter a little kindness and a lot of cruelty

In 1792, William Tuke founded the York Retreat, with the radical idea of treating patients with compassion, the hospital mirroring, as far as possible, the rhythms of ordinary life. Elizabeth Lowry’s novel, Dark Water, illustrates the strengths and limitations of this philosophy – known as moral treatment – in a Boston mental hospital in 1833.

The Retreat’s success was one of the drivers of the 1845 Asylums Act, which made asylum provision for ‘pauper lunatics’ compulsory in all English counties. However, the asylums quickly became overcrowded and the regime anti-therapeutic. One factor that catalysed the closure of the long-stay hospitals was the public outcry about institutional abuse. 

Villainous staff can create page-turning fiction: who could forget the sadistic Nurse Ratched in Ken Kesey’s One Flew over the Cuckoo’s Nest? In Beyond the Glass, the final novel in Antonia White’s semi-autobiographical trilogy, the attitudes of the nurses run counter to what is needed to soothe troubled minds. Even when Clara is on the road to recovery, her doctor’s patronising paternalism would spike anyone’s rage.

Kindness is rare in twentieth-century fictional asylums but, in I Never Promised You a Rose Garden, Deborah is rescued from insanity by the patience of her therapist. As mentioned above, Dr Fried is based on Frieda Fromm-Reichmann who promulgated the view that psychotic illness could be understood as an adaptation to adverse experience. Similarly, in The Girl Behind the Gates by Brenda Davies, Nora reconnects with her buried self, after decades of bullying that is painful to read, through the kindness of a new psychiatrist.

4. You’ll meet staff as messed-up as the patients

It’s often said that those who work in mental health services need the patients as much as the patients need the staff. It’s not only that mental distress provides the means of earning a living, but also for the sense of security of being on the ‘right’ side of the illusionary boundary between the ‘mad’ and the ‘sane’.

So I appreciate those novels that depict the staff’s vulnerability, such as deluded doctor, Hiram Carver, in Dark Water ; Charles Fuller who uses his work to escape his own demons in The Ballroom; and the failing psychiatrist, Arthur Bourne, in  Jott. A scene in I Never Promised You a Rose Garden shows how the patients can have a deeper understanding than the supposedly expert staff of how staff disturbance can provoke acts of violence among their charges.

5. You could be admitted for having an ‘illegitimate’ child

As clearly articulated in The Girl Behind the Gates, the Mental Deficiency Act of 1913 enabled people considered morally defective to be segregated from the rest of society. Until 1959, when abortion was still illegal, women who conceived a child out of wedlock could be put away. In practice, I believe this wasn’t often the sole reason for admission to a psychiatric hospital, but I certainly came across women whose lives had been ruined in this way. Their tragedy can make for poignant fiction as in girl gates, Sebastian Barry’s The Secret Scripture and my own recently-published novel, Matilda Windsor Is Coming Home.

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Anne Goodwin is a former clinical psychologist who writes entertaining fiction about identity, mental health and social justice. After reading and reviewing numerous novels set in long-stay psychiatric hospitals, none of which accurately portrayed the process of closure, she decided to write her own. Matilda Windsor Is Coming Home is the result.

Read too: Victoria’s Review of Anne’s debut novel Sugar and Snails.