How do
our surrounding affect our mental health? Access Officer Alice recently
attended a conference organised by the Churches Conservation Trust and [Mind
UK] to celebrate the opening of Quay Place, a new community mental health
resource in Ipswich. Throughout the conference, there was a lot of focus on the
impact our environment can have on us, and on the development of hospital
architecture. Here at LHSA, we’ve been working with a number of artists and
researchers involved in the redevelopment of hospital spaces across the Lothian
area, and this has got us thinking about hospital architecture in a bit more
depth. This week, Alice looks at Dr Thomas Clouston’s views on asylum design,
and how the physical space of the Royal Edinburgh Hospital in Morningside was
tied to its therapeutic outlook.
Dr TS Clouston was Physician
Superintendent of the Royal Edinburgh hospital (REH) between 1873 and 1908, and
during this time he also published extensively on the causes and treatments of
mental illness. One of Clouston’s preoccupations seems to have been asylum
design – indeed, whilst Physician Superintendent he undertook an expansive
rebuilding programme, with a key part of his legacy being the opening of Craig
House, a series of buildings specifically tailored for the treatment of
private, paying patients of the Royal Edinburgh Hospital. As part of our Royal
Edinburgh Hospital collection (LHB7), we hold two of his papers that give an
insight into his thinking on asylum design: these are “An Asylum or Hospital - Home for Two Hundred Patients” (Boston,
1879), and “How Pleasant Surroundings and
Conditions affect the Health and Happiness” (Edinburgh, [1887]).
As the title suggests, “An Asylum or Hospital…” was very much
concerned with how to make the buildings under his charge comfortable for its
inhabitants, and foster the community ideal that he felt was crucial to the
successful recovery of patients. In it, Clouston begins by pointing out how
attitudes to ‘insanity’ had changed over the years:
“In planning the asylums for the
insane, built 70 years ago, the dominant idea in the minds of their architects
was secure custody : in the case of those built 30 years ago, the idea of
curing the patients had modified in a marked degree the jail-like features of
the earlier buildings. Since that time, under the new regime in this country,
improvements in the character of the hospitals for the insane have been going
on steadily”.
The concept of custody was indeed
a key shift in the attitudes of the time. Although ‘open-door’ policies didn’t
find real traction until the mid-twentieth century, Clouston saw it as
important that patients didn’t feel like inmates, and effort was made to
obscure any necessary security features: “all the special arrangements of
rooms, window-shutting, strong-rooms, padded rooms, &c., should be as little
prominent and offensive as possible ; and above all, they should not be
suggestive of what they are intended to prevent”. Not only could these security
features be obscured, Clouston suggested, they could also become decorative
features in themselves that added to the general positive feeling of the
institution. For example, he details how to installed padded leather walls
in a secure room: “the surface of the
leather should be neatly stencilled, and coated with four coats of the best
varnish. It is then soft, impervious to urine, strong, and makes a
pleasant-looking room, just like an old library hung with stamped leather. In
this way the forbidding features of an ordinary “padded room” on the patient’s
mind are avoided”.
Indeed, Clouston seems to have
wanted his patients to think of themselves more as residents in a grand hotel
than patients in an institution: “in the general arrangements, furnishings,
&c., I took a first-class hotel as my model, and not any pre-existing
asylum at all”. In defending this relaxed and accommodating attitude, Clouston
argued that, even if there were accidents or escapes, and if some physicians
had relaxed their attitudes too far, “their indiscretion has done good. It has
had for its object the restoration to ordinary conditions of life a portion of
humanity that lay in fetters and chains 100 years ago”. By avoiding the tropes
of the ‘insane beast’, Clouston thought, the patients of the asylum would
develop a greater sense of self-respect, take more interest in their own
personal care and appearance.
LHB7/14/5 - A block plan for 'An Asylum or Hospital Home for 200 Insane Patients' |
In this respect, the social
aspect of the hospital was an important factor. By bringing patients together
to dine “in rooms … the general arrangements of which are precisely those of a table d’hote in a good Swiss hotel in
the summer”, Clouston relied on the enduring social nature of people to help
improve patients’ opinion of themselves and capacity for social intercourse. He
stated that “since we began to use a common dining-room … several inveterately
untidy patients have been cured of their slovenliness of dress [and]
self-control is taught. The public opinion of the room or the table won’t tolerate
noise or disturbance”. The greatest complaint of patients, he stated, tended to
be around their lack of control, lack of entertainment and often, their horror
at being locked up with ‘lunatics’, and he therefore tried to remedy this by
providing opportunities for what he considered “pleasant conditions of life”.
These included, in his view, “suitable work for the doer of it with some
leisure time, some agreeable companionship, games, amusements, newspapers,
books, baths, and liberty of action”.
Another key element of Clouston’s
design was to avoid “uniformity of accommodation and arrangements” throughout
the hospital: in an awareness of different types of mental illness, and the
illogicality of treating all patients in the same manner, Clouston stressed
that all patients had different needs based on a number of factors such as
their bodily health, their propensity to be dangerous to themselves or to
others, and their potential ‘curability’. Accordingly, “it should be a
principle, never departed from, that the structures and arrangements that are
necessary for the worst classes of patients should not be used for the best…”.
LHB7/14/5 - the ground plan for 'An Asylum or Hospital Home' |
In the same vein, Clouston
believed that this lack of uniformity should extend to the décor: “variety in
the shape, size, and aspect of buildings and rooms, tends to interest, rouse,
and cheer the patients, when they pass from one into the other”. He
acknowledged that architects and painters were often unwilling to expend their
talents on an asylum, whether their efforts might not be as well received as
they would be elsewhere in society, but stressed that variation and a lack of
monotony in surroundings had a greatly beneficial impact on the mental health
of patients.
Overall, Clouston was a strong
believer that health and happiness were improved by pleasant surroundings.
Furthermore, he saw the benefits of this for the professionals involved in the
care of patients, asserting that “the management of an asylum is necessarily
much affected by its construction … a cheerful, broken-up asylum is far more
apt to be managed on principles that are pleasant to its patients”.
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