This blog will look at mental health and reflect on how terminology and attitudes towards mental health change over time. Starting from the lawless mental health care of the 1700s and journeying through the legislation put in place over the last 250 years that regulates the care and treatment of mental illness.
Content warning: This blog uses outdated terminology and contemporary quotes that include offensive language, which some readers may find upsetting.
Before Public Legislation
Our earliest records touching on mental health are private acts, which only affected specific individuals or a small number of people. These early private acts would describe people as ‘lunaticks’ or ‘ideots’ and would assign money for the care of ‘lunatick’ nobles. These private acts were often primarily concerned with the management of the estates, debts, and inheritance. For example, this private act from 1702: “An Act for vesting the Lands of Henry Pawlet, a Lunatick, in Trustees, in order to make suitable Provision for him, his next Heir and next Relations.”
These acts were focused on the care and estates of individuals within the nobility and landed gentry. Legislation that dealt with ‘pauper lunatics’ were the poor laws, vagrancy laws or criminal laws and so most ‘pauper lunatics’ were likely to end up in workhouses or prisons.
At this time there was no legislation focused on the management or regulation of care of the public and their mental health. This was very plain to see in the 1763 House of Commons Committee investigating the state of private madhouses. Madhouses were private homes that charged to care for the mentally ill. However, it was discovered in the committee, women were being taken to madhouses and detained without reason and received no care.
“Mrs. Smith […] had been carried to Turlington’s Madhouse by her Husband who left her there, with an assurance that he would return very soon […] it was now two years since she had been carried to this house […] during her confinement she had been attended by no physician or apothecary” – 22 February 1763, House of Commons Journal, Volume 29 Part 1, pg. 487
When the committee interviewed Mr King, who managed Turlington Madhouse, he admitted that “he had never admitted One as a Lunatic during the Six Years” and that he would never refuse anyone brought to the Turlington Madhouse, as long as their board was paid.
This example shows that private madhouses before regulation and legislation often provided no medical help to any ‘insane people’ detained in the houses and essentially became private imprisonment for those falsely described as lunatics. Thomas Townshend MP for Whitchurch who chaired this committee was very vocal about this issue and after many years of advocating, his proposed bill was passed as the Madhouses Act 1774.
Early Legislation
The 1774 Madhouses Act required licenses for the madhouses which would receive regular inspections and would be fined for taking a lunatic patient without order from a doctor.
Later in 1845, the Lunacy Act and the County Asylums Act was passed. The County Asylums Act made county asylums compulsory, removing the ‘pauper lunatics’ from workhouses and prisons into the asylums. The Lunacy Act also established the Lunacy Commission to manage and supervise these asylums.
The 1845 Lunacy Act defined a Lunatic as “every Insane Person, and every Person being an Idiot or Lunatic of unsound Mind” but also referred to them as patients, an important change of status, with focus towards care rather than simply locking ‘lunatics’ away in madhouses.
Changing Terminology
Several acts of parliament were passed between the 1880s and the 1930s which changed and redefined lunacy and some of its surrounding terms. The Idiots Act passed in 1886 created a distinction between ‘Idiots’ and ‘Imbeciles’ from ‘Lunatics’. Whilst the Mental Deficiency Act 1913 further divided ‘defectives’ into four categories:
- ‘Idiots’ – “persons so deeply defective in mind from birth or from an early age as to be unable to guard themselves against common physical dangers.”
- ‘Imbeciles’ – “persons in whose case there exists from birth or from an early age mental defectiveness not amounting to idiocy, yet so pronounced that they are incapable of managing themselves or their affairs, or in the case of children, of being taught to do so.”
- ‘Feeble-minded persons’ – “persons in whose case there exists from birth or from an early age mental defectiveness not amounting to imbecility, yet so pronounced that they require care, supervision, and control for their own protection or for the protection of others, or, in the case of children, that they by reason of such defectiveness appear to be permanently incapable of receiving proper benefit from the instruction in ordinary schools.”
- ‘Moral imbeciles’ – “persons who from an early age display some permanent mental defect coupled with strong vicious or criminal propensities on which punishment has had little or no deterrent effect.”
The Mental Treatment Act 1930 completely discontinued the terms asylum and lunatic in legislation. Asylums were now referred to as a mental hospital and lunatics as a “Person of Unsound Mind”.
Mental Health
In 1959, the first Mental Health Act was passed. This was the first time the title of the legislation referred to mental health rather than lunacy. The 1959 Act replaced and repealed much of the previous legislation. The Act used a new term ‘mental disorder’ which was defined as “mental illness, arrested or incomplete development of mind, psychopathic disorder, and any other disorder or disability of mind”. The Act also included several other categories:
- ‘Severe subnormality’ – “a state of arrested or incomplete development of mind which includes subnormality of intelligence and is of such a nature or degree that the patient is incapable of living an independent life or of guarding himself against serious exploitation, or will be so incapable when of an age to do so.”
- ‘Subnormality’ – “a state of arrested or incomplete development of mind (not amounting to severe sub-normality) which includes subnormality of intelligence and is of a nature or degree which requires or is susceptible to medical treatment or other special care or training of the patient.”
- ‘Psychopathic disorder’ – “a persistent disorder or disability of mind (whether or not including sub-normality of intelligence) which results in abnormally aggressive or seriously irresponsible conduct on the part of the patient, and requires or is susceptible to medical treatment.”
A White Paper from 1978 reviewed the 1959 Mental Health Act and many of the suggested changes and proposals from the White Paper were incorporated into the 1983 Mental Health Act. The 1983 Act kept the same ‘mental disorder’ definition as the 1959 Act but renamed the other categories from ‘subnormality’ and ‘severe subnormality’ to ‘mental impairment’ and ‘severe mental impairment’. The most recent legislation, the 2007 Mental Health Act removed the categories entirely and broadened the definition of ‘mental disorder’ to “any disorder or disability of the mind”.
The language used in legislation relating to mental health has changed drastically since the 1774 Madhouses Act and the early private acts. The change in terminology reflects how societal attitudes towards mental health have changed over time. From Lunacy Acts to Mental Health Act, the words we use to describe mental health are important and can be powerful.
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