Recovery From Schizophrenia: Psychiatry And Political Economy

112 THE POLITICAL ECONOMY OF SCHIZOPHRENIATable 5.2 Recovery and mortality rates for British mental institutions, comparing privateand pauper establishments before 1845Source: Thurnam, J., Observations and Essays on the Statistics of Insanity, London: Simpkin,Marshall, 1845, Table 12.psychosis; on the other hand, many of those admitted to county asylums werechronic patients transferred from workhouses or were elderly people withdementia. Bearing these considerations in mind, the statistics published in 1845 byDr John Thurnam (see Table 5.2) are among the most useful. The figures showthat institutions receiving paupers consistently reported lower recovery rates andhigher mortality rates. Dr Thurnam argued that these results were not entirelydue to the condition of the patients on admission but were, in part, aconsequence of the differences in their management. 57The size of the institution may have been an important factor; asylums andlicensed houses receiving private patients were generally a good deal smaller.Metropolitan licensed houses for paupers held an average of 400 patients; thosefor private patients had an average capacity of 23 residents. 58 For this reason,perhaps, at the model pauper asylum of Hanwell in Middlesex—with a thousandbeds, far and away the largest mental institution in the country- the recovery ratewas well below average, despite the emphasis on moral management and nonrestraint.Daniel Hack Tuke’s figures show the recovery rate at Hanwellfluctuating between 25 per cent and 32 per cent of admissions during the first 45years of the hospital’s operation. 59 At Lancaster Asylum, Britain’s rapidlyexpanding, second-largest mental hospital, the introduction of more progressivetreatment methods in the early 1840s reduced mortality rates but failed toimprove discharge and cure rates; the percentage of recoveries, in fact, declinedafter the introduction of moral treatment. 60 The social policy that established