Therapeutic landscapes: the design and use of nineteenth-century lunatic asylum grounds

Therapeutic landscapes: the design and use of nineteenth-century lunatic asylum grounds

A man of rank comes in, ragged and, dirty, and unshaven and with the pallor of a dungeon upon him; wild in aspect, and as if crazed beyond recovery. He has passed months in a lonely apartment, looking out on a dead wall; generally fastened in a chair [...] Liberty to walk at all hours of the cheerful day in gardens or fields, and care and attention, metamorphose him into the well dressed and well bred gentleman he used to be.

John Connolly, Treatment of the Insane Without Mechanical Restraints, 1856.

Therapeutic Landscapes

Illustration of the Sanatorium for Consumption and Diseases of the Chest, Bournemouth, showing the buildings and landscaped grounds. Published in the Illustrated London News, December 1859.Figure 1: Illustration of the Sanatorium for Consumption and Diseases of the Chest, Bournemouth, showing the planted grounds, published in the 'Illustrated London News,' December 1859. Historically, landscapes and gardens have surrounded a variety of medical institutions and other healing places, and have often been considered part of the therapy. These have ranged from the Ancient Greek Temple of Aesclepius built in Epidaurus (now a World Heritage Site) with its pools and extensive views, to the Maggie's Centre at Charing Cross Hospital, which opened in spring 2008. Explanations for how the environment might benefit people in terms of well-being and recovery from disease have changed over time, but the notion that the landscape can have a therapeutic effect is arguably as valid now as it was in the 19th century.

During the 1800s a range of hospitals including general hospitals, convalescent homes and tuberculosis sanatoria were built within extensive grounds. These grounds were designed to be used by patients as part of their recovery or convalescence.

One type of institution that utilised landscapes and gardens possibly more than any other was the lunatic asylum. An overview of how asylum landscapes were designed and used will be described here, using case studies located in Northampton in the East Midlands. The term ‘lunatic asylum' was commonly used in the 19th century and so will be used in this article. However, those who were confined to the asylums will be referred to, using a more modern term, as patients.


The rise of the asylum

The 19th century witnessed the rise of the asylum as a specific method for treating the insane. During this period the asylum regime was often known as ‘moral therapy' or ‘moral management'. This is generally considered to have been pioneered as a treatment for insanity at The Retreat in York, which opened in 1796. It can basically be described as a mild regime which was centred on placing the patient in a carefully designed environment, and trying to minimise the use of physical forms of restraint.[1] Ultimately this meant that the asylum itself formed the method of treatment, which led to many 19th-century psychiatrists saying that they ‘confidently expected the asylum itself to be therapeutic'.[2]

This is a very brief summary but it establishes the fact that the landscape, and the location of the asylum within it, was important because every aspect of the patient's environment formed part of the therapeutic regime.


Homeliness and the asylum garden

W. A. F. Browne was the superintendent of the Montrose Asylum in Scotland. His vision of the utopian asylum bore strong similarities to grand private houses of the period:

Conceive a spacious building resembling the palace of a peer. Airy, and elevated, and elegantly surrounded by swelling grounds and gardens.[3]

W. A. F. Browne, What Asylums Are, Were and Ought to Be, 1837.

Illustration of the Colney Hatch Lunatic Asylum, Middlesex. Image courtesy of the Wellcome Medical Library.Figure 2: This illustration of the Colney Hatch Lunatic Asylum, Middlesex, dating from the mid- to late 19th century, portrays the asylum as a grand country house with fashionable ‘gardenesque'-style flower beds and people promenading in the grounds. Of course, this may reflect how the asylum would have wished the gardens to be depicted rather than what they were actually like (Image courtesy of the Wellcome Medical Library).

It also seems that the grounds and gardens formed a vital role in his utopian vision. There do appear to be similarities between his polemic description and the reality of the Victorian asylum, although this may be truer of private institutions than pauper asylums. During the 19th century institutions were run by private, charitable or public means (or even sometimes a combination of these), with the latter paid for out of local rates.

One of the many functions of the landscape was to help create the illusion that the asylum was more of a home than a prison. This can be seen in the entry in the visitors' book for Northampton General Lunatic Asylum (a charitable institution opened in 1839 and still functioning today as St Andrew's Hospital). On 16 June 1846 they record one of their concerns as being that the front airing courts had unsuitable iron bars, which they felt gave the house a ‘prison-like or menagerie appearance'.[4]

Photograph of Northampton General Lunatic Asylum, showing the croquet lawn in the foreground.Figure 3: The Northampton General Lunatic Asylum, now St Andrew's Hospital, with croquet lawn in the foreground. Photograph copyright: Clare Hickman, 2002

The theory that the asylum should be homely seems to have continued throughout the century, so that when the Northampton County Lunatic Asylum (publicly funded from 1876 to 1995) extended its open-door system in 1887, the annual report of that year stated that, ‘the more the Asylum can be made to resemble a home the greater will be the probability of such cases settling down and deriving benefit from the treatment'.[5]

There was, unsurprisingly, some controversy over the money spent on asylums and the design of the grounds. One instance, which occurred at Staffordshire General Lunatic Asylum, has been described by Leonard Smith. In 1818 an anonymous writer complained to the Lichfield Mercury about the expense of the new asylum. In particular they were unhappy about the

grand and splendid entrance, with a double flight of steps - an artificial serpentine river to meander in view...a sweeping and tasty carriage-road, lined with shrubberies, winding through the gay foliage, and a fine bridge, bestriding a made river, ornamented by jet d'eau.[6]

This was no doubt an exaggerated depiction of the gardens but it does suggest that some landscaping had taken place. According to Smith, the rebuttal from the magistrates included the statement that the building had been erected ‘in a style of plain and simple durability', with little pretension to elegance. The grounds had been laid out in a way that took account of the benefits of air, exercise, and amusement in promoting recovery.[7] This suggests that the landscapes were designed with patient recovery in mind from the beginning and also raises the issue of ratepayers' money and how it should be spent. It is no great surprise to find that the private asylums had far more ornate gardens and grounds than those for paupers.


Landscape design

There are a number of design features that nearly all asylum landscapes contained, both private and pauper. These included ‘airing courts', pleasure grounds, sports grounds, agricultural land and an estate farm.[8] These elements remained a part of the design of psychiatric institutions until the mid-20th century and were seen as playing a role in the general asylum regime, which included exercise and work out of doors.

Airing courts

An early feature of many asylums were walled areas adjoining the building known as airing courts. These were designed to allow patients to take the air (hence the name) and obtain a limited amount of exercise within a confined space. They were also often sub-divided into sections for patient use based on gender, level of illness and sometimes class. An example of these airing courts is illustrated in an unusual plan of Brislington House in Bristol. A lunatic asylum that catered to an elite clientele, Brislington House, was built by Dr. Edward Long Fox (1761-1835). Fox was concerned that the court walls prevented patients from being able to see the wider landscape while they were exercising.

Plan of Brislington House and grounds, 1843, showing the airing courts. Image courtesy of Somerset Record Office.

Figure 4: The 1843 plan of Brislington House (note the snail mount in the airing court second from left). The blue rectangular area between the central airing courts and the main block of the house contained the cold baths which the Doctors Fox felt were an important part of the therapeutic regime (Image courtesy of Somerset Record Office: Q/RLu 42/6).

To overcome this problem he designed the courts so that they had areas of elevated ground in the centre. According to him, these allowed the patients to ‘view the surrounding country, while a border sloping towards the wall secures them from escape'.[9] The elevated ground within these courts was not necessarily just a simple raised area in the centre. From the detailed plans made in 1843 it seems that one of the courts may even have had a snail mount (a spiralling type of earthwork used in Tudor gardens). They also seem to have planting and walks laid out within them.

Although Brislington is an unusual example, given its very elite clientele, mounts became a common feature within many asylum airing courts. This was, however, not without problems. At the Northampton General Lunatic Asylum there was a conflict between the need for mounts so that patients outside could see over the walls and the need for patients within the asylum to have an unobstructed view outside. In 1859 the comment that a mount was to be ‘raised or perfected in the large female airing court' was viewed as problematic because the Commissioners in Lunacy felt that it would ‘obstruct distant views without any internal advantage'.[10] This suggests that the aesthetic experience of viewing the landscape, even from within the building, was important at this time.

Similarly, Dr. Maximillian Jacobi argued that Dr Falret, who had designed a private asylum at Vanves, near Paris, had done so in order to place the patients ‘in a situation which should agreeably affect both eye and mind'.[11] This concept may have developed from the view prevalent in the 18th century that nature had curative powers. It appears that the proprietors of these asylums believed it was fundamentally important that patients should be able to view and interact with the landscape.

Wider landscape

Black-and-white photograph of an aerial view of the Northampton County Lunatic Asylum.Figure 5: Aerial view of the Northampton County Lunatic Asylum (later St Crispin's Hospital) showing the extensive grounds including the areas of woodland (©Crown copyright NMR 890/140).The airing courts were not the only areas used by the patients; there were also wider pleasure grounds. At Northampton County Lunatic Asylum it was noted that, a year after it had opened, a considerable number of trees and shrubs were planted throughout the estate and there was ‘an extension of walks in the grounds to enable patients to take exercise beyond the airing courts'.[12] In this case there were two distinct areas of landscape outside the airing courts: the woodland area to the north and the parkland/agricultural land to the south. The woodland may have been inherited with the estate as the sales particulars describe the land as ‘finely timbered with oaks of good growth and ornamental appearance'.[13] A recent aboriculturalist's report on the site commented on the lack of woodland ground flora, which suggests that this area was managed as semi-parkland with mown grass between the trees.[14]


Use of the landscape by patients: work, exercise, recreation

There is a substantial amount of documentary evidence to suggest that patients did spend a considerable amount of time outdoors. One of many such examples is The New Regulations of Wonford House Hospital for the Insane Near Exeter (1880) which stated that ‘the gardens and pleasure grounds into which the several galleries open, shall be accessible to the patients at all suitable times, and at least three hours in the morning and, and two hours in the afternoon of everyday, when the weather is favourable'.[15] Similarly at the County Asylum in the 1880s:

Those who were not able to work were still encouraged to occupy themselves in some way and all were taken outside into the ‘airing courts' at about 10.30 a.m. and were not allowed to return until lunch at 12.30. Once outside, patients were goaded into ‘walking around sufficiently', and in damp weather they were to be prevented from lying down on the gravel or grass while in hot weather they were ushered into the shade. All were to be ‘carefully prevented from eating plants'.[16]

This regimented approach to the landscape has been related to the size of the asylum by the historian Andrew Scull. He has written that ‘large numbers [of patients] from the outset required the development of a bureaucratic routine'.[17]

Exercise outdoors remained important throughout the century and all of the Northampton asylums appear to have used this as part of the daily routine. In 1890 it was noted that at the General Lunatic Asylum, ‘several of the patients have carriages, many walk daily in the grounds and about double their number walk weekly from the male side beyond the estate and about 47 women'.[18] At Abington Abbey Retreat (a private asylum), the superintendent Thomas Prichard cited a number of cases where exercise outdoors had effected an alteration in the external behaviour of the patients. This provides evidence for the idea that the patients' recovery was measured by improvements in their external behaviour rather than their internal thought processes:

One case, a gentleman, had been a resident here for twenty years [...] he was for many years a harmless and incurable patient; was accustomed to walk in the grounds from day to day alone, never attempting to pass beyond the bounds of the park or to interfere with others taking exercise therein.[19]

His was a case of dementia and he resided here for fifteen years [...] he was always quiet and contented, walked out at his pleasure, and seemed to enjoy existence.[20]

These cases probably tell us more about Prichard's beliefs than whether exercise taken outdoors was an effective treatment, particularly as he was writing about his private asylum, whose continued existence relied on giving the impression that it could help patients recover by pursuing moral therapy within an attractive environment. The annual reports would have been a powerful form of rhetoric and superintendents would hope that the descriptions of their therapeutic approaches and recovery rates would encourage relatives to send patients to their particular asylum. In Northampton the competition would have been fierce between the General Lunatic Asylum and the Abbey Retreat, as they both accepted private patients.

Recreational activities within the landscape also remained important throughout the century. In 1883 the Commissioners in Lunacy recorded that patients at the Northampton General Lunatic Asylum were able to participate in ‘tennis, bowls, archery, croquet'.[21] In fact the visitors were concerned that outdoor activities were curtailed during the winter and one member of the committee suggested that:

fives courts, asphalted Tennis courts, Bowling and Skittle Alleys, or at least some of these would be desirable additions to the Hospital. A covered promenade for walking exercise in wet weather would also be very useful.[22]

By 1890 the variety of amusements appear to have increased so that they now included

dances, and other concerts, theatrical entertainments, cricket matches, tennis, archery, football, billiard handicaps, fishing parties and excursions of various sorts. A few patients have joined hunts with hounds and beagles. There is a good band which plays frequently in the grounds.[23]

The colour photograph shows the bandstand against the brick buildings of the Northampton County Lunatic Asylum when it was St Crispin's Hospital in 2002.Figure 6: The bandstand at Northampton County Lunatic Asylum (later St Crispin's Hospital) photographed in 2002.A lesser programme of activities was also organised in the first year of the pauper Northampton County Lunatic Asylum's existence. There was dancing and cricket as well as an ample supply of books. Later, football pitches and tennis courts were added, and a bandstand situated in the grounds was testament to outdoor concerts.Another function of the landscape was to provide employment, particularly for the male patients. Both Andrew Scull and Sarah Rutherford have questioned the disparity between the amount of documentary evidence stressing the importance of employment, particularly outdoors, and the actual rates in practice, which appear to be very low. The visitors' books of the general and county asylums suggest that patients were employed on the land, even if the actual numbers were not as high as one would necessarily expect. At the Northampton General Lunatic Asylum in 1865, out of a possible 221 male patients, 27 were employed on the farm and in the garden.[24] By 1887 the situation had improved: out of 116 men, 20 were at Moulton Park (the farm estate) where they were employed in farm and garden work ‘with great advantage to themselves'.[25] A further 38 were working in the gardens surrounding the asylum and the remaining 18 ‘help in the workshop or domestic work'.[26]

It is clear that whatever work was carried out it was intended to be of therapeutic, as well as for economic, benefit. In 1891, the Commissioners in Lunacy report that 'as many as 81 male patients are induced to employ themselves, of these 61 help on the farm or in the garden'.[27] They go on to say that ‘Dr. Bayley is quite convinced of the value of out-door employment in the proper treatment of many male patients and hopes to give this exercise to many more gentlemen upon the land newly acquired'.[28] This suggests that class was not necessarily a barrier, at least by this point in the century, as Bayley appears to have thought exercise upon the land was suitable for ‘gentlemen'.

As would be expected, work at the pauper county asylum was economically essential as well as retaining some therapeutic value. These two factors are intertwined in the management of pauper asylums as has been discussed in great depth by Sarah Rutherford.[29] In 1884, according to Golby, records from the county asylum state that:

The Asylum Farm has been carried on with great advantage to the Asylum. A certain quantity of land must be attached to every Asylum and outdoor exercise is beneficial to the patients. It may indeed be said that independently of the great service rendered by the Farm towards the management and treatment of the patients, the Asylum has to farm from necessity as well as choice.[30]

The rates of employment at the county asylum seem to have been high. Within two years of the asylum opening,

60 per cent of the men were employed and 50 per cent of the women. For example, there were 75 men who worked as gardeners, six in the laundry, two as stokers, one as an engineer, seven as carpenters, 21 on domestic duties and a further 44 who undertook various jobs.[31]

It appears that outdoor employment was given to a greater number of the employable population than at the General Lunatic Asylum, but as Scull and Rutherford have suggested, one should be wary of such figures as they were sometimes manipulated for the benefit of the Commissioners in Lunacy who regularly inspected the asylums.

There is some evidence that some sort of distinction was made in terms of how work was divided according to social class. In Browne's utopian asylum, labour is ‘apportioned so that it may suit the powers and taste of each labourer'.[32] He goes on to describe the following as employment for patients of a higher class:

You may visit rooms where there are ladies reading, or at the harp or the piano, or flowering muslin, or engaged in some of those thousand ornamental productions in which female taste and ingenuity are displayed [...] Another wing contains those gentlemen who can engage in intellectual pursuits, or in the amusements of the station to which they belong.[33]

This idea of suiting the employment to the station and skills of the patient may explain why the poet John Clare was employed in the kitchen garden at Northampton General Lunatic Asylum even though he was a private patient.[34] He was registered as a gardener on admission to the asylum (although his occupation was later changed to poet in his case notes) because he had previously been employed as a gardener. This included a brief period as a temporary kitchen garden apprentice at Burghley House in Stamford, Lincolnshire.[35] As he was a ‘fifth class' or ‘harmless' patient he was allowed considerable freedom and was allowed to walk into Northampton unaccompanied.[36] This also provides evidence for the idea that employment on the land was mainly an activity for those who were seen as being in a state of recovery. This could also be a factor in the explanation for why actual employment numbers were so low in relation to the widespread rhetoric.


The patient's view

It is rare to hear the voice of the patient in relation to their asylum experience, however a letter survives from a Mrs Capron who stayed at the Abington Abbey Retreat in which she writes about the gardens. Written in 1884 and addressed to the Visitors' Committee, she wrote:

when I came here nearly three years ago, I was told I should find nice gardens and grounds to walk in. I have always been accustomed to these pleasures and amusements and appreciate them. For the first year and a half the Gardens were open and I enjoyed them; but, for the last few months the Gardens have been kept closely locked giving the surroundings a dismal and prison-like appearance; and very much interfering with the enjoyment of the peace.[37]

Sadly there is no mention of this letter or her complaint in the visitors' books, which means there is no extant explanation as to why the gardens were locked or whether this situation was ever resolved. Her letter implies that there were ornamental gardens and that she enjoyed these while she had access to them. What is perhaps of more interest is that her concerns reflected the views of the medical profession at this time. They too believed that the landscape did much to relieve the sensation of confinement and prevented patients feeling that they were held within a prison. This also suggests that some patients did appreciate the landscape and felt that it was of some therapeutic value to them. The sentiments expressed by Mrs Capron have also been echoed by some 20th-century psychiatric patients.[38]

Colour photograph of aerial view of Colney Hatch Asylum showing the size that institutions could become. Crown copyright (NMR 14995/30).Figure 7: Aerial view of Colney Hatch Asylum showing the size that institutions could become (©Crown copyright NMR 14995/30). Designed gardens and landscapes seem to have formed part of the therapeutic regime of asylums throughout the 19th century. There is no doubt a large gap between the rhetoric employed by superintendents and the reality of asylum life. From Mrs Capron's letter it appears that even in private asylums gardens could be inaccessible. The homeliness and domesticity that asylums were intended to mimic at the beginning became impossible to maintain as they grew ever larger, and with a large patient-to-staff ratio in many institutions it must have been difficult to use the landscape in the way it was intended to be utilised, however strong the intentions were.


Endnotes

1) For a detailed study of The Retreat, York and its use of moral therapy see Anne Digby, Madness, Morality and Medicine (Cambridge: Cambridge University Press, 1985).

2) Roy Porter, Mind Forg'd Manacles: A History of Madness in England from the Reformation to the Regency (London: Penguin Books, 1987), p.222.

3) W. A. F. Browne, What Asylums Are, Were and Ought to Be (1837), ed. with an introduction by Andrew Scull in The Asylum as Utopia (London and New York: Routledge, 1991), p. 229.

4) Northampton General Lunatic Asylum (hereafter NGLA), Visitor Books, 16 June 1846 (St Andrew's Hospital Archives, Northampton).

5) Henrietta Ayres, A Changing Community: St Crispin Hospital 1876-1976 (Northampton: The Northamptonshire Area Health Authority, 1976) p. 12.

6) Leonard Smith, ‘‘The Brightest Ornament of our Native County': The Staffordshire General Lunatic Asylum, 1818-1855' in Staffordshire Studies, 11, 1991, p.88.

7) Leonard Smith, ‘‘The Brightest Ornament of our Native County': The Staffordshire General Lunatic Asylum, 1818-1855' in Staffordshire Studies, 11, 1991, p.88.

8) As discussed by Sarah Rutherford, The Landscapes of Public Lunatic Asylums in England, 1808-1914, 3 vols (PhD Thesis: De Montfort University, Leicester, 2003). See also Sarah Rutherford, The Victorian Asylum (Shire Publications, 2008)

9) Brislington House, An Asylum for Lunatics: Situated near Bristol on the Road from Bath and Lately Erected by Edward Long Fox M.D.: An Account of the Establishment, c.1804-9, (Somerset Record Office: T/PH/fx/2), p.2.

10) NGLA, Visitors' Book, 18 Feb 1859 (St Andrew's Hospital Archives, Northampton).

11) Dr Maximilian Jacobi, On the Construction and Management of Hospitals for the Insane with a Particular Notice of the Institution at Siegburg, translated by John Kitching and with introductory observations by Samuel Tuke (London: John Churchill, 1841), p.43.

12) Henrietta Ayres, A Changing Community: St Crispin Hospital 1876-1976 (Northampton: The Northamptonshire Area Health Authority, 1976), pp. 10-13.

13) Quoted in Henrietta Ayres, A Changing Community: St Crispin Hospital 1876-1976 (Northampton: The Northamptonshire Area Health Authority, 1976), p. 8.

14) As reported in John Thompson and Partners, ‘Cultural Heritage Study', p. 15.

15) The New Regulations of Wonford House Hospital for the Insane Near Exeter, Adopted at a general Court of Governors Held on the 11 February 1880 (Exeter: William Pollard Printer, 1880).

16) Henrietta Ayres, A Changing Community: St Crispin Hospital 1876-1976 (Northampton: The Northamptonshire Area Health Authority, 1976), p. 13.

17) Andrew Scull, The Most Solitary of Afflictions: Madness and Society in Britain 1700-1900 (New Haven and London: Yale University Press, 1993), p. 169.

18) NGLA, Visitor Books, Commissioners in Lunacy Report, 16 July 1890 (St Andrew's Hospital Archives, Northampton).

19) Thomas Prichard, Report of Cases of Insanity Treated at Abington Abbey, Northampton from 1 January 1862 to 31 December 1867, 4 (Northampton: Cordeux and Sons, 1868, p. 28-29 (Northampton Local Studies Library).

20) Thomas Prichard, Report of Cases of Insanity Treated at Abington Abbey, Northampton from 1 January 1862 to 31 December 1867, 4 (Northampton: Cordeux and Sons, 1868, p. 29 (Northampton Local Studies Library).

21) NGLA, Visitor Books, Commissioners in Lunacy Report, 24 May 1883 (St Andrew's Hospital Archives, Northampton).

22) NGLA, Visitor Books, 12 November 1891 (St Andrew's Hospital Archives, Northampton).

23) NGLA, Visitor Books, Commissioners in Lunacy Report, 16 July 1890 (St Andrew's Hospital Archives, Northampton).

24) NGLA, Visitor Books, Commissioners in Lunacy Report 9 May 1865 (St Andrew's Hospital Archives, Northampton).

25) NGLA, Visitor Books, 6 May 1887 (St Andrew's Hospital Archives, Northampton).

26) NGLA, Visitor Books, 6 May 1887 (St Andrew's Hospital Archives, Northampton).

27) NGLA, Visitor Books, 16 February 1891 (St Andrew's Hospital Archives, Northampton).

28) NGLA, Visitor Books, 16 February 1891 (St Andrew's Hospital Archives, Northampton).

29) See Sarah Rutherford, The Landscapes of Public Lunatic Asylums in England, 1808-1914, 3 vols (PhD Thesis: De Montfort University, Leicester, 2003).

30) Fred Golby, The History of Upton and Berrywood (Warwick: Warwick Printing Company Limited, 1994), p. 73.

31) Henrietta Ayres, A Changing Community: St Crispin Hospital 1876-1976 (Northampton: The Northamptonshire Area Health Authority, 1976), p. 12.

32) W. A. F. Browne, What Asylums Are, Were and Ought to Be (1837), ed. with an introduction by Andrew Scull in The Asylum as Utopia (London and New York: Routledge, 1991), p. 229.

33) W. A. F. Browne, What Asylums Are, Were and Ought to Be (1837), ed. with an introduction by Andrew Scull in The Asylum as Utopia (London and New York: Routledge, 1991), p. 230.

34) Jonathan Bate, John Clare: A Biography (London: Picador, 2003), p. 71.

35) Jonathan Bate, John Clare: A Biography (London: Picador, 2003).

36) Jonathan Bate, John Clare: A Biography (London: Picador, 2003), p. 469.

37) Letter to the Visitors of Abington Abbey Retreat from Mrs Capron, 1884 (Northampton Record Office: Bundle of Correspondence with the Visitors Covering the Years 1876-1885, x3323 C).

38) See Diana Gittins, Madness in its Place: Narratives of Severalls Hospital, 1913-1997 (London: Routledge, 1998).