Bedlam at the Wellcome Collection

Back in January I caught the last few days of the Wellcome Collection’s exhibition on the mental asylum, seen through various prisms including a contemporary art installation, historical documents, videos and sculpture and a modern re-imagining of asylum space. The exhibition highlighted a number of key points where music was considered in relation to madness. Robert Burton’s 1629 Anatomy of Melancholy, for example, recommended music along with drugs, bloodletting, prayer, exercise, diet, friendships and occupation as potential treatments for particular forms of mental illness. The following century, Benjamin Franklin’s glass armonica was invented with the intention of soothing distress, but was considered by many to be overstimulating and a possible cause of madness.

FRANKLIN: ARMONICA, 1761. – Musical instrument invented by Benjamin Franklin, 1761. Fine Art. Encyclopædia Britannica ImageQuest.

The final part of the exhibition focussed on a series of workshops and interviews in which the idea of a modern asylum had been investigated. The resulting artworks, models and displays considered the five senses alongside more practical elements of an ‘ideal’ asylum space in which mental health could be nurtured and healed. Rather than assimilating patients to the social norms of the nineteenth century, where participating in large-group activity was valued, here it was the individual needs that were being attended to. Yet I wondered how nineteenth-century practices might fit into the modern asylum being mooted. Would patients be invited to attend an asylum night club, where social anxieties and inhibitions could be faced (with or without the assistance of mood-altering substances)? Perhaps an upbeat asylum radio station offering performance and DJ-ing opportunities, or a resident samba band with visiting Strictly Come Dancing stars to accompany picnics and excursions? And what might modern health professionals think to being expected to join the band or the theatre group, or coach the football team? Music and dance are common practice in therapeutic treatment today, but transplanting nineteenth-century ideas into the modern conception of asylum certainly gives some food for thought.


Case books and the patient experience

It’s been a little tricky fitting in archive visits around part-time work and a toddler, so I’ve been delighted to find the Wellcome Collection have digitised some of the patient case books from Holloway Sanatorium, an asylum for middle-class men and women which opened in 1885. The asylum was housed in opulent buildings near Virginia Water in Surrey, and from the outset was equipped with the opportunities for recreation and entertainment that one might expect from its clientele. As most of the patients were unused to employment, recreational activities were all the more important in keeping them occupied and providing structure and discipline on a day-to-day basis. Concerts, choirs and bands were part of this, and the sanatorium employed ‘companions’ especially to help patients become engaged with a wide variety of activities.

Patient case books provide a rare opportunity for insight into the lives of individuals, their particular mental states and their responses to treatments and therapies. Each entry in the Holloway case books contains details of the patient’s background, age, marital state and occupation, together with a brief history of previous illnesses. There follows the two letters explaining the current complaint and reasons for certification. Finally, the asylum’s medical staff added a paragraph giving observations on arrival at the sanatorium. Following this, the pages were updated with relevant changes or, every couple of months, to note a lack of change. Case book A gives information on females certified between 1885 and 1887; reasons for illness include domestic trouble, inherited mental disorder and disappointment in love. One patient was convinced she was a steam engine. Women of all ages were represented, married women generally without occupation, but among the unmarried women were governesses and teachers.

The very first woman listed in the case book happened to be musical. Stella James was admitted in a state of Dementia, and took little part in activities. However, after a few months she began to sing and play the piano. Music was a sign of normality, engagement with others and mental functioning, but also became a subversive act for Stella: later on she is recorded as dancing and singing all night, her liveliness becoming ‘objectionable’. I find it interesting that music straddles the two sides in this way, reflecting both normality (for most women of this class would have learnt the piano) and disturbance. But this reflects in some ways the dual place of music throughout society. As an art form it could be refined, reflected in fashionable soirees or intellectual orchestral concerts; music was encouraged by philanthropists as a means of ‘rational recreation’ for the working classes. At the same time, music’s image suffered because of the link to the morally degrading activities of the music hall and tavern. Returning to health, music could both cause and cure madness. This dichotomy is one of the reasons music’s place in asylums is particularly interesting.

Link to Wellcome Collection digitised case books:


Music making at Worcester asylum is the only example widely known today, due to the involvement of Edward Elgar in the 1870s and 1880s. Elgar was appointed Band Master in 1878, succeeding his violin teacher. He rehearsed the band, led performances, and composed a small amount of dance music which survives.

As at other asylums, a band was formed in the 1860s, and the annual reports also attest to a choir in the chapel, both staffed largely by attendants. However, records for musical activity, with the exception of payments to band masters and the material associated with Elgar, are sparse.

View from Worcester Asylum site
View from Worcester Asylum site

The asylum site at Powick is beautifully situated, overlooking the Malvern Hills. Only the very central portion of the main building, and the house built for the medical superintendent, remain.

Main Asylum building, Worcester
Main Asylum building, Worcester
Superintendent’s House, Worcester

Worcester boasts two medical museums, and both of these contain exhibits dedicated to mental health and the work of the asylum. The George Marshall Medical Museum, contained within the Worcestershire Royal Hospital, includes medical instruments used within the Asylum, together with a death mask of one of the patients. See

The Infirmary Museum features a special corner devoted to the history of the asylum, including details on its use of music:

Singing and Health today

This week’s World Mental Health Day reminded me that singing is often linked with physical and mental health. We often see studies purporting to show the benefits of singing, particularly in a choir, and these opportunities are often part of life at hospitals and care homes. In 2012 Stephen Clift reviewed the literature on singing and health, concluding that there was little evidence for the positive effect on physical health, but that singing was clearly beneficial to overall health and wellbeing in many studies (see ‘Singing, Wellbeing, and Health’ in Macdonald et al. Music, Health, & Wellbeing (Oxford, 2012) pp. 113-121). A cross-national survey reported by Clift identified six key ‘mechanisms’ which resonate with some of the reports of patients and attendants  experiencing music in the asylum:

  • positive affect
  • focused concentration
  • controlled breathing
  • social support
  • cognitive stimulation
  • regular commitment


SSHM and RMA conferences

Over the summer I’ve had the privilege of sharing my early research at a number of conferences. In July I travelled to Canterbury to the Society for the Social History of Medicine, a large conference with an international flavour. It was great to be part of a session on asylums – in Venice, Sydney and North India as well as my own contribution on Norfolk.

conference programme:

The Royal Musical Association Annual Conference in September provided a very different context, with a session on music therapy at which I was the only historical scholar. It’s fascinating to find, though, that there is still plenty of debate about the overall aims of music therapy and the different roles music can play, whether as a means to an end or a goal in itself.

conference programme:

York Retreat

The York Retreat asylum represents a very different institution from the county-run pauper asylums I have previously visited. York also had a county asylum, and it was the unfortunate death of a young Quaker woman there in 1790 that prompted the local Society of Friends to set up a private charitable institution, run on Quaker principles, and intended to provide individual care to a small number of patients. The Retreat is most famous for its dedication to ‘moral treatment’, under the influence of the Tuke family, who were instrumental in its foundation and throughout the nineteenth century. From the mid-nineteenth century it came to resemble more closely the practice of the County asylums, though catered for a combination of Quakers of all social classes, and middle class private patients from non-Quaker backgrounds.

York Retreat Main Building
York Retreat Main Building

Due to the Quaker principles and the small initial size of the asylum, music does not feature in early records. However, as more affluent and non-Quaker patients were admitted, pianos and musical entertainments became more common.