Views from an asylum: a retrospective case note analysis of a nineteenth century asylum

To investigate whether lifelong admission to psychiatric asylum care was usual practice before community psychiatric care was introduced.

Historical archives (1838-1938) for 50 patients at the Northampton General Lunatic Asylum in England were studied. Regression analyses were performed to investigate associations between predictor variables (age, gender, marital status, social class) and outcomes (diagnoses, length of stay and admission outcomes).

30 patients (70%) were discharged into the community. 15 (31%) patients were admitted longer than 1 year. Diagnosis of mania was significantly higher in patients who were married. Trend associations were observed for melancholia being diagnosed in higher social class patients and monomania being diagnosed in unmarried patients. No associations were found between predictor variables and length of stay or admission outcomes.

These findings challenge the myth that asylum incarceration was a usual practice before the advent of community care. Most patients were discharged from psychiatric asylum hospital within a year of admission even before the advent of psychotropic medication.