Negotiating the asylum : patient agency and institutional authority in Lancaster County Asylum: 1840 to 1915

Mullen, Natalie and Welshman, John (2019) Negotiating the asylum : patient agency and institutional authority in Lancaster County Asylum: 1840 to 1915. PhD thesis, Lancaster University.

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Abstract

This thesis examines the history of Lancaster Asylum, Lancashire’s first county asylum, from 1840 to 1915 to explore the relationship between asylum authority and patient agency in the institution. Whereas current historiography has dichotomized patients’ responses to asylum life as passive or resistant, this thesis advocates for a more nuanced definition of agency. A broader framework for thinking about the agency of marginalized groups, including asylum patients, is suggested. Patient resistance, coping mechanisms and engagement are considered as mechanisms of agentive behaviour. The relationship of patient agency and asylum authority is explored to illuminate the implications of power relationships in the asylum for the development of the institution. By focussing on a single institution over a 75-year period, this thesis traces the impact of patient agency on the development of psychiatric medicine in Lancaster Asylum. The relationship between patient agency and asylum authority is explored through two interconnected levels. Firstly, an in-depth qualitative analysis of casebooks permits a discussion of incidents of conflict, accommodation, and cooperation between patients and asylum authorities. Secondly, these incidents are related to the built and material world of the institution. By analysing visual and material sources alongside patients’ casebooks this thesis highlights the gap between intention and practice in the material world of the asylum. Despite being arranged to control patients’ behaviour, the spaces and objects of the asylum could be appropriated by patients to facilitate agency. This affords a more active role to the patient in the history of psychiatry than previous research, underlining the collaborative, as well as the paternalistic, aspects of the medical encounter. The asylum is re-positioned, not just as the product of the medical profession, nineteenth-century reformers, or the Poor Law, but as a negotiated entity which was shaped by the complex interaction of a range of agendas, including those of patients.