Introduction
The history of health and social care is deeply intertwined with the cultural and societal norms of its time. This essay explores mental health care practices in Victorian Britain (1837–1901), focusing on how prevailing cultural attitudes shaped the treatment of mental illness. Using Emile Durkheim’s sociological theory of social solidarity as an interpretive framework, this essay examines the societal context of mental health care, particularly the role of institutionalisation in asylums. It draws on a key historical source document, the Report of the Commissioners in Lunacy (1859), to provide a snapshot of Victorian perspectives on mental illness. By synthesising historical accounts, sociological literature, and reflections on modern UK practices, this essay aims to elucidate how Victorian cultural norms—rooted in moral judgement and social control—reflected and reinforced health care practices of the era. The discussion also briefly contrasts these historical practices with contemporary UK mental health care to highlight significant shifts in societal values.
Victorian Cultural Norms and Perceptions of Mental Illness
Victorian society was characterised by strict moral codes, rigid class structures, and a growing emphasis on industrial progress. Mental illness, often termed ‘lunacy’ or ‘insanity,’ was widely stigmatised and viewed through a moral and religious lens. Deviance from societal norms was frequently attributed to personal failings or divine punishment rather than biological or environmental factors (Porter, 2002). This cultural perspective is evident in the Report of the Commissioners in Lunacy (1859), a primary source document from the period, which reflects the state’s role in overseeing the care of the ‘insane.’ The report describes the need for confinement in asylums to protect society from individuals deemed dangerous or disorderly, highlighting a societal fear of mental difference (Commissioners in Lunacy, 1859, p. 12). Such language underscores the era’s view of mental illness as a threat to social order, necessitating exclusion rather than integration.
Moreover, gender norms played a significant role in shaping mental health diagnoses and treatments. Women, in particular, were often pathologised for behaviours that defied Victorian ideals of femininity, such as emotional expressiveness, leading to diagnoses like ‘hysteria’ (Showalter, 1987). This cultural framing of mental illness as a form of moral or social deviance directly influenced health care practices, prioritising control over compassion.
Health Care Practices: The Rise of Asylums
The Victorian response to mental illness was epitomised by the establishment of large public asylums following the Lunacy Act of 1845. Asylums were designed to segregate individuals with mental illnesses from the general population, reflecting the cultural belief that such individuals were incompatible with societal norms. The Report of the Commissioners in Lunacy (1859) details the conditions within these institutions, noting that while some asylums aimed to provide ‘moral treatment’—a therapeutic approach emphasising routine and discipline—many were overcrowded and under-resourced, leading to neglect and abuse (Commissioners in Lunacy, 1859, p. 18). This discrepancy between intent and reality suggests that, despite progressive rhetoric, the primary function of asylums was often custodial rather than curative.
Indeed, the practice of institutionalisation was arguably a manifestation of societal efforts to maintain order by marginalising those who did not conform. This aligns with the broader Victorian emphasis on discipline and productivity, where those unable to contribute to industrial society were deemed burdens. Therefore, health care practices of the time were not merely medical interventions but also mechanisms of social control, shaped by cultural attitudes towards difference and deviance.
Applying Durkheim’s Theory of Social Solidarity
To interpret these historical practices through a social science lens, this essay employs Emile Durkheim’s theory of social solidarity, which distinguishes between mechanical solidarity (based on similarity and shared values in pre-industrial societies) and organic solidarity (based on interdependence in industrial societies) (Durkheim, 1893). Victorian Britain, undergoing rapid industrialisation, was transitioning towards organic solidarity, yet retained elements of mechanical solidarity in its emphasis on moral conformity. Mental illness, as a deviation from shared norms, threatened this solidarity, prompting society to isolate affected individuals in asylums to preserve cohesion (Jones, 1993).
Durkheim’s framework helps explain why asylums were culturally acceptable: they served as a visible reinforcement of societal boundaries, distinguishing the ‘normal’ from the ‘abnormal.’ Furthermore, the stigmatisation of mental illness reinforced collective consciousness by unifying society against a common ‘other.’ This sociological perspective reveals how health care practices were not isolated medical decisions but deeply embedded in the cultural need for social order, reflecting the Victorian preoccupation with control and categorisation.
Contrasting with Contemporary UK Mental Health Care
Comparing Victorian practices with current UK mental health care highlights a profound shift in cultural values. Today, the UK’s National Health Service (NHS) and mental health policies, such as the Mental Capacity Act 2005, prioritise person-centred care, community integration, and destigmatisation (NHS England, 2021). Institutionalisation has largely been replaced by community-based support, reflecting a cultural move towards inclusivity and recognition of mental health as a public health concern rather than a moral failing. This contrast underscores how societal norms shape health care: while Victorian culture justified exclusion, modern UK values—grounded in human rights and equality—emphasise empathy and support. Although a detailed comparison is beyond the scope of this essay, this brief reflection illustrates the evolution of cultural attitudes towards mental illness and their impact on practice.
Conclusion
In conclusion, Victorian mental health care practices, particularly the reliance on asylums, were profoundly influenced by the era’s cultural norms of moral judgement, social control, and gender expectations. The Report of the Commissioners in Lunacy (1859) provides a critical snapshot of these attitudes, revealing a society that prioritised order over individual welfare. Through the lens of Durkheim’s theory of social solidarity, it becomes clear that such practices were mechanisms to maintain societal cohesion amidst industrial upheaval, reflecting a cultural fear of deviance. Contrasting these historical practices with modern UK approaches underscores the transformative impact of shifting societal values on health care. This exploration highlights the importance of understanding historical context in health and social care, as it reveals how deeply embedded cultural beliefs shape responses to human suffering. Future studies might further explore the lingering effects of such historical practices on contemporary stigma, ensuring that lessons from the past continue to inform compassionate care.
References
- Commissioners in Lunacy. (1859) *Report of the Commissioners in Lunacy to the Lord Chancellor*. HMSO.
- Durkheim, E. (1893) *The Division of Labour in Society*. Free Press.
- Jones, K. (1993) *Asylums and After: A Revised History of the Mental Health Services*. Athlone Press.
- NHS England. (2021) *Mental Health Implementation Plan 2019/20 – 2023/24*. NHS England.
- Porter, R. (2002) *Madness: A Brief History*. Oxford University Press.
- Showalter, E. (1987) *The Female Malady: Women, Madness, and English Culture, 1830-1980*. Virago Press.
Appendix
Extracts from the Report of the Commissioners in Lunacy (1859)
(Note: Due to the constraints of this format, the full text of the appendix cannot be reproduced here. In a real submission, relevant excerpts from the report would be included following the references to provide direct evidence of the cultural attitudes described. These excerpts would demonstrate the Victorian focus on confinement and moral treatment as discussed in the essay. The appendix is not included in the word count.)
[Total word count: approximately 1050 words, including references]
