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.
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.
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 http://www.medicalmuseum.org.uk/
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:
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.
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.
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.
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.
The West Riding Pauper Lunatic Asylum in Wakefield was set up in 1818, and became well-known for its advocacy of non-restraint on a large scale. The asylum made use of the model provided locally by the York Retreat, a much smaller and private institution, using the advice and experience of the Tuke family (who ran the Retreat) but implementing its principles on a much larger scale. As other public lunatic asylums were founded, they often made use of Wakefield as a model.
Work therapy was a central part of asylum management from the outset, and within a few years of its foundation almost all patients were able to participate in some kind of labour, whether outside in the cultivated gardens, or inside, helping with maintenance, cleaning and mending. The Asylum management recognised the importance of work for occupying the minds of the patients and providing a distraction from the melancholy and distress which characterised many patients.
Entertainments and recreations were much less quick to become part of moral treatment. In this case, the management were clear that ‘frivolous’ entertainment was usually not suitable for pauper patients. Not only would such activity provide only temporary relief from the trials of mental health problems (in contrast to the longer-lasting effects of regular employment), it was also morally problematic, given the low status and restricted means of pauper patients. In this case, re-creating life outside the asylum meant only careful use of music and other entertainments.
Music became more prominent under the medical director between 1866 and 1876, James Crichton Browne. As well as developing new approaches to the medical treatment of mental disorder, Brown encouraged music and theatre. A large detached hall was built for a variety of purposes, initially as a dining hall, but soon played host to visiting musicians and theatre companies as well as successful in-house groups.
Life in the asylum was, by modern standards, pretty unpleasant. Even by contemporary standards the regime of a large institution meant strict rules, lack of privacy, little independence and an uninspiring diet. The dangers of fire and disease were always close, with threats from poor sanitary conditions, unreliable supplies of water, cheap food, buildings in poor condition, and other patients. Enormous stigma was attached to insanity, so younger patients were often not admitted until they could no longer be kept at home. On the other hand, asylums were often used for elderly patients whose maintenance was beyond the means of friends and families. Paupers and charitable cases were maintained at the cost of their parish or subscribers, so conditions were kept as basic as possible.
Notwithstanding financial constraints, however, asylum officers took pains to make their wards as comfortable as possible. Regular work and recreation were seen as key parts of the therapeutic process. For paupers, occupation not only offered a connection to their lives in the outside world, and an opportunity for meaningful engagement, but also helped to defray the expenses of the asylum. In many asylums, large farms were cultivated, and patients contributed to all aspects of asylum life: laundry, cooking, baking and brewing, making furniture, clothes and shoes, maintenance and, for the convalescent, tending to other patients or administrative roles.
In the early part of the nineteenth century recreational activities were provided as an equivalent for wealthy, private patients: also providing continuity with ‘home’ life. Gradually this was extended to all patients, and wards and day rooms were provided with books, newspapers and games, with organised activities such as dances, walks and sport. Wards were decorated with pictures, plants and paint.
The chapel was another important feature of the asylum, with regular services as well as individual attention; some Chaplains took their roles as carers for spiritual and mental needs of the patients very seriously. For some patients, religion was an essential part of recovery, while for others it provided a diversion, opportunity for change in company or self-expression.