Recovery From Schizophrenia: Psychiatry And Political Economy

25 patients, and on the more disturbed wards, one attendant to 15 refractorypatients. 49 The value of moral treatment in legitimizing social policy is illustratedhere—legitimizing the Poor Law Commission policy of categorizing thedestitute, providing poor relief in specialized institutions and cutting back onoutdoor relief. The task accomplished, the cost of care per patient was soonreduced through progressive cheeseparing and expansion of the size of theinstitutions. Mechanical restraints and solitary confinement returned, and by thelate 1860s moral treatment in the public asylums had again become a mere facade. 50In his description of nineteenth-century private madhouses, The Trade inLunacy, William Parry-Jones highlights the differences in treatment for the poor(paid out of the public purse) and for private patients. He remarks:With regard to the maltreatment of lunatics in madhouses, confined underbad, often appalling, physical conditions, the evidence is…substantial andrefers, especially to pauper departments during the first half of thenineteenth century. 51Again:MADNESS AND THE INDUSTRIAL REVOLUTION 111The various factors which operated to keep the charge for paupers as low aspossible…served to delay the introduction of the non-restraint system andto foster the continuance of the merely custodial confinement of lunatics. 52Mechanical restraint was rarely seen in licensed houses receiving only privatepatients, but was freely used in those houses taking paupers. 53 Some proprietors feltthat restraints should not be used on patients from the “respectable class: theirfeelings are more acute than those of the humbler grade.” 54 But the fact that nonrestrainttreatment required more and better trained staff and led to higher chargeswas generally recognized. 55 Whereas in the pauper establishments one keepermight care for ten or fifteen patients, in the houses for the wealthy the ratio wasone attendant or servant for every one or two patients. 56 Moral treatment inBritain, it is clear, was not generally for the poor. As we have seen, for a fewyears, from the 1850s to the 1860s, during the expansion of the asylum system, aform of moral treatment was made available to paupers in county asylums; butotherwise, humane care was for those who could afford it.CURE RATESDid the class bias in quality of care influence the outcome of insanity? Inattempting to answer this question, we have to be very cautious about using thepublished cure rates of the time. Where one madhouse proprietor talked of patientsbeing “cured” or “discharged recovered” another might have used the term“relieved” or “improved.” Again, patients admitted to one establishment mighthave included more who were young and early in the course of a functional