What is the history of psychiatry in Great Britain?

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M.P. Ossa | College Teacher | (Level 1) Distinguished Educator

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The history of psychiatry in Great Britain can be traced back to the 13th century with the creation of the first hospitals that would treat more than just patients of leprosy. The establishments of Saint Nicholas Hospital in Carlilsle (1201) and the Saint Mary of Bethlehem Hospital in 1247, we start to see the tendency in expanding care for a number of maladies. 

The first of many formal acknowledgments of psychiatric conditions is evident in the Preragoratoria Regis, drafted in 1290 for King Edward II. This document permitted the king to deploy "exchequers" among the lands. These men would determine (to the utmost convenience to the king) whether the landlords among the country were to be considered "insane". If the exchequer determined a cause for insanity then the king could claim the land and possessions of the landlord all for himself. Clearly the cause for sanity could have been a negotiating factor between the king and his subjects. 

Mental incapacity is was also used during Edward II's time to negotiate motives for committing crimes, no differently than lawyers do today. If a person close to the king committed the crime of murder, namely, of a wife, mistress, or servant, the reason of insanity could have been used conveniently to obtain pardon from the king. 

The first actual "insane asylum" traces back to 1368 where a license was given to Robert Denton to open a home in London that would serve those 

 who suddenly fall into a frenzy and lose their memory, who were to reside there until cured.

Shortly after this, more homes became available acknowledging that there was a need for such services. The priory of St. Mary of Bethlem was used during the 1370s as a formal asylum and, by order of the king, it was the "central" asylum to which the unwanted of the city would be sent directly. 

Moving further, the Tudor kingdom of Henry VIII witnessed huge changes to the view of mental illness. King Henry donated the Bethlem and St. Bartholomew priories to the city of London to serve "undesirables". Moreover, a plot to kill Henry lend to the idea that those involved may have had a spell of momentary insanity, bringing on the differentiation between a "furor", and "dementia" to cite a few.

After Charles II was restored to the English throne, a prerogative regis was drafted releasing the king from the responsibility of lunatics. The Lord Chancellor was now in charge of determining services. 

However a huge drawback to what could have been progress in the field came about in the mid 1700s when advances in the studies made mentally challenged individuals curious to the medical field. Since the field of sociology was not in place, there was neither a field of psychology. Hence, psychiatry in itself consisted mainly on the study of associated behaviors, and the human body. As a result, the mentally insane were often placed in public view of the people. This happened at the now-known-as Bedlam facility, or the former Bethlem: the same priory that King Henry VIII had given to the city of London along with St. Bartholomew. 

Toward the end of the 17th century there were already several well-established workhouses that housed what by then was known as "madmen": Saint Peter's,  Hoxton, Bedlam, and about 15 others. 

It is during the 18th century, the Age of Reason, that the writings of Rousseau and other philosophers prompt the question of the rights of all men, resulting in the 1774 MadHouse Act.

The 1774 Madhouse Act regulated not only the asylums themselves, but the conditions of entrance of the patients. Some privately owned "madhouses" offered food, lodging and warmth for just about anyone that acted or was declared "insane". For this reason, the act demanded that proper diagnosis, proper identification, and a veritable source should decide who gets in and out.

Eventually, the 1845 Lunacy Act ratified that any new madhouse or change to the definition of insanity would have to undergo strict rules and regulations. 

The Madhouse Act continued to be revised to the words: 

The Lord Chancellor or the Lord Keeper or Commissioners of the Great Seal of Great Britain, or other person or persons (*) for the time being intrusted by virtue of the King's Sign Manual with care and commitment of the Custody of the Persons and Estates of Persons found idiot, lunatic or of unsound mind.

For current information to the 20th and 21st century changes made to the 19th century Act can be found in the most current National Health Service (NHS) UK website, which is entirely responsible for the current provision of services.

http://www.nhs.uk/NHSEngland/AboutNHSservices/mentalhealthservices/Pages/Mentalhealthfacilities.aspx

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