The Confinement of the Insane: International Perspectives, 1800-1965

The Confinement of the Insane: International Perspectives, 1800-1965

The Confinement of the Insane: International Perspectives, 1800-1965

The Confinement of the Insane: International Perspectives, 1800-1965


The rise of the asylum constitutes one of the most profound, and controversial, events in the history of medicine. Academics around the world have begun to direct their attention to the origins of the confinement of those deemed 'insane', exploring patient records in an attempt to understand the rise of the asylum within the wider context of social and economic change of nations undergoing modernisation. Originally published in 2003, this edited volume brings together thirteen original research papers to answer key questions in the history of asylums. What forces led to the emergence of mental hospitals in different national contexts? To what extent did patient populations vary in terms of their psychiatric profile and socio-economic background? What was the role of families, communities and the medical profession in the confinement process? This volume therefore represents a landmark study in the history of psychiatry by examining asylum confinement in a global context.


Roy Porter

The closing decades of the twentieth century brought a rising and sustained critique of the welfare institutions of the modern state – one largely left-wing in origins but increasingly taken over and voiced by the radical right. Professions which professed to be 'enabling' were, claimed a rising chorus of critics, 'disabling'. Social services which presented themselves as benign were, in reality, 'insidious', serving the interests of providers not consumers, promoting professional dominance, policing deviance and intensifying the social control required to ensure the smooth running of multinational capitalist corporations – or, in the right-wing version, such institutions were wasting tax-payers' money on scroungers and so encouraging malingering.

Unsurprisingly, such political critiques of 'welfarism' (in its widest sense) spawned histories of their own. Replacing various kinds of Fabian, 'Whig' or celebratory historical interpretations which had treated the emergence of the 'caring professions' and social-security institutions as beneficial and progressive – as shifts from neglect to administrative attention, from cruelty to care, and from ignorance to expertise – a new brand of studies took altogether a more negative or jaundiced view of such social institutions and policies, and sought to blow their benevolent ideological cover.

In no field were the new and critical histories more critical, indeed more indignantly impassioned, than the history of psychiatry. Traditional 'in-house' and Whig histories of the care of the insane had never been particularly triumphalist – after all, psychiatry had always been a house divided against itself, uneasy in its stance towards both the public and the medical profession at

I. Illich, Limits to Medicine: The Expropriation of Health (Harmondsworth, 1977) and Disabling
(London, 1977).

The literature here is so vast, it would be impossible to begin citing it. Of great importance,
however, in clarifying the issues has been S. Cohen and A. Scull (eds.), Social Control and the
(New York, 1981).

Once again, 'humanitarianism or control' is a topic on which the survey literature is too vast even
to begin to cite, but see M. Micale and R. Porter (eds.), Discovering the History of Psychiatry
(New York and Oxford, 1994), especially N. Dain, 'Psychiatry and Anti-Psychiatry in the United
States', 415–44; G. Grob, 'The History of the Asylum Revisited: Personal Reflections', 260–81,
and the substantial introduction.

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