Recovery From Schizophrenia: Psychiatry And Political Economy

110 THE POLITICAL ECONOMY OF SCHIZOPHRENIATable 5.1 Moral treatment and the post-Second World War social psychiatry revolutioncompareddecent standard of care. Consequently, many patients slept on straw, mechanicalrestraints were commonly used and opportunities for patients to work or enjoysocial diversion were restricted. 46 The high annual mortality rates at the asylums ofLancaster and the West Riding of Yorkshire (17 per cent and 18 per cent,respectively, of the resident population) were the result, argued John Thurnam, aphysician at the York Retreat, of poor nutrition and hygiene. Even greatermortality rates at the Norfolk County Asylum (19 per cent) and at St Peter’sHospital for paupers in Bristol (20 per cent) were the consequence of lack ofadequate medical care and “the want of a proper amount of land for the exerciseand employment of the patients.” 47By the mid-1840s only five of the seventeen county asylums had abandonedmechanical restraint. Foremost amongst them were Lincoln Asylum, under thedirection of Robert Gardiner Hill, and the massive new asylum at Hanwell,Middlesex, where John Conolly was the superintendent. The limited acceptanceof moral treatment at that time is illustrated by the fact that Hill was forced toresign his post owing to public opposition; and Conolly was unable to persuadehis governing committee to meet the expense of two of his innovative ideas—basic education classes for patients and professional training for the staff. With therestriction of outdoor relief and the great expansion of the asylum system duringthe next decade, the situation was reversed. By the mid-1850s, nearly all the 30county asylums had discarded mechanical restraints and adopted some features ofmoral management. 48 Staffing patterns, at least in some asylums, improved. AtLancaster Asylum in 1846, on the “tranquil” wards, there was one attendant for