‘Prisoners or Patients?’ is the latest part of a major project I began in 2016, to use the lessons of history to stimulate awareness of mental health issues in the modern world.

Promoting mental health through the lessons of history
Promoting mental health through the lessons of history

Using free podcasts, social media, and photo exhibitions of asylum and prison patients I tried to reach out to sufferers and those close to them, medical professionals, and anyone with an interest in what is the fastest growing diagnostic category in global healthcare.

I did this using history because it is, I think, uniquely useful for enabling empathetic engagement. People a century or more ago seem very different to us. The rationale behind the photo exhibitions is that the further you get from an event or a person, the harder it is to know what they were actually like. The more you can keep of the physical reality, the more you keep of the mental reality. Seeing someone’s face engages us straight away.

Then you need to know why their image was taken. In this case it is because of a crime. What were their family circumstances? How did those around them see their mental state? Did they get a bad break or make a bad choice? How did the justice system deal with those who were not responsible because they were insane? What therapies were available to treat someone who went mad?

All these steps draw us into a material world that is different to our own – but a mental world that is more familiar than we might think, because the combination of genetic predisposition and life-stresses that produce mental disorders was almost certainly the same in the past as in the present.

William Porter
Image of prisoner-patient William Porter, taken from Perth Criminal Lunatic Department Prison Register, NRS, HH21/48/3

Britain’s present-day prison system was created by the Victorians. They built not only penitentiaries, some still housing prisoners, but also a national system of administration. What were called ‘criminal lunatics’ became part of an integrated system during Victorian times, rather than anomalies in both justice and health care.

Perth Prison’s Criminal Lunatic Department was created to house the most seriously disturbed offenders from across Scotland and it was the only facility of its kind until what is now The State Hospital, Carstairs, opened in 1948.

Report on the medical examination of John McFadyen, NRS, JC26/1860/2652277
Report on the medical examination of John McFadyen, NRS, JC26/1860/265

The problems the justice system faced then were similar to today. How to identify whether someone really was mad or feigning insanity in hope of more favourable treatment? Where to put criminal lunatics to prevent them harming themselves and others? How to balance the needs of society with the rights of individuals? How to help prisoner-patients recover and re-enter the community? Prison communities of all kinds had much higher levels of mental disorder than the general population in Victorian times, something which remains true today.

There are differences too. Victorians thought that institutions were the key to most social problems, whereas their successors today prefer smaller scale solutions. Most of the drugs now used to manage mental problems have only been available since the mid-20th century; Victorians had only sedatives and hypnotics. We have different ideas about the status of women and children, and the acceptability of violence in interpersonal relations.

But the difference is not as crude as we might think. The Victorians knew about social issues and mental disorders, dealing with them as best they could by the standards of their times. The past really is another country, where they do things differently. We should respect their efforts, even if, ultimately, we ourselves choose to do things differently.

What does all this mean? The famous British historian G. M. Trevelyan once wrote movingly:

‘The poetry of history lies in the quasi-miraculous fact, that once, on this earth, on this familiar spot of ground, walked other men and women, as actual as we are today, thinking their own thoughts, swayed by their own passions, but now all gone, one generation vanishing after another; gone as utterly as we ourselves shall shortly be gone, like ghosts at dawn.’

The exhibition helps us to reach out to them across time and to see ourselves and those around us in a different, more sympathetic light. It allows us to learn more about mental health through the lessons of history, because we are all migrants through time.

Edinburgh Fringe Festival Exhibition Poster

‘Prisoners or Patients? Criminal Insanity in Victorian Scotland’ is open until the 30 August, Monday to Friday, 10:00-16:30. As part of this exhibition National Records of Scotland is hosting a series of free public talks which expand upon some of the topics touched upon. More information can be found here.

Guest Writer

Professor Rab Houston

University of St Andrews

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