Editorial: Proper provision for thepenitent?

IS SERVICE PROVISION ANY BETTER INFORMED IN THE 1990s?

The late 18th to early 19th century was a period of philanthropy during whichmen and women expunged religion as a means to cure all ills. In this milieuthe idea of ‘moral management’ was born and resulted in the setting up of asy-lums for the mentally ill, based on the idea that religion-led rules and moralscould imbue the mentally sick with the boundaries and morals they werebelieved to lack. The first was the York Retreat set up by the Tuke family in1796. These regimes were put in place without knowledge of the pathophysio-logical and aetiological processes involved in mental disease.

Such approaches, however, were not limited to the mentally ill, but werealso applied to the ‘morally ill’. No one was deemed more depraved and moreon the fringe of society than the prostitute. At a time when women wereplaced on a pedestal – as chatelaine, wife and mother – the prostitute was seenas a menace to society and yet, at some level, was felt to be necessary to pro-tect virtuous, Christian women from man’s insatiable lust. Anthony Highmore(1822), in his account of the Guardian Society and Asylum, laid great empha-sis on the need to decrease the number of prostitutes, so that even if prostitu-tion could not be abolished it ‘might not at least be found in every publicstreet’. This ambivalence resulted in differential treatment of prostitutes. Inthe same way that the ‘deserving poor’ were highlighted as suitable recipientsfor charity, young ‘penitent’ prostitutes, but no others, were earmarked for sal-vation at the hands of an institution set up for that purpose. Without a ratio-nale for the proposed diet of prayer and penitence, the Lock Asylum was con-ceived.

The rules of the Lock Asylum were drawn up in May 1787. Only patientsfrom the Lock Hospital for ‘contagious’ (venereal) diseases were to be admit-ted, and immediately on their discharge from the hospital. The Lock Asylumopened close to the hospital, in Osnaburg Row (now Grosvenor Place), in1789. There were five women at first, rising to 21. An 18th-century ‘treatabil-ity’ clause specified that no one was to be admitted who had misbehaved inany way in the hospital, failed to go to church, had not remained until cured,or had not:

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…given sufficient proofs of sincere repentance. (Asylum Committee Minute Book.18.4.1787–3.3.1814. Entry 18.4.1787).

The chaplain of the asylum carried the responsibility for the admission selec-tions, another factor for consideration being age. Younger women werethought to be more amenable to reform.

The asylum was directly overseen by a matron who was responsible forinstructing the women in their work and keeping resultant accounts. She hadto present these accounts to the secretary, who in turn presented them to theweekly board. On admission she read the rules of the asylum to each woman,also presenting a written copy. Each woman was then on two months’ proba-tion. The board decided on punishment, reward or expulsion of inmates. Nogames were permitted in the asylum, nor any strong liquors of any kind, exceptwhen approved by the matron for medicinal purposes. The women weredressed at the expense of the asylum in plain, neat clothes. Their own clotheswere taken away by the matron and if worth keeping, were washed, ticketedand put by, to be returned to the inmates when they left the asylum.The daily regime of the asylum was built around prayer meetings, morning andevening, and the only leave allowed from the asylum was for chapel atten-dance, accompanied by matron. She was supposed to keep a careful watch overthe moral and religious conduct of the women generally, and to take care toprevent ‘all improper conversation’. No one was allowed to speak with thewomen, except in her presence, all correspondence was inspected and thewomen were not even permitted to be together out of working hours, exceptunder her supervision. She herself was not permitted to leave the asylum with-out approval from the weekly board. The street door of the asylum was lockedat eight in the evening, and opened at seven in the morning during the winter,and ten in the evening and six in the morning respectively in the summer.

Finance for such an institution proved to be a constant problem. Initiallyeach governor contributed at least two guineas a year or made a one-off benefac-tion of twenty guineas. The records of the Lock Asylum note frequent publicappeals for funds as well as publicised charity events. The Asylum General Courtin 1842 records over 20 individuals acting as Governors of the Lock Hospitaland Asylum. Perhaps philanthropy was not the only aim. Some may have soughtto raise their status in society through charitable works or fervent religious ormoral expression. Many of the reports have a self-congratulatory tone:

That this institution established 50 years since having sheltered within its walls nearly1,000 unfortunate females – placed several hundreds in respectable situations in life andbeen the means of restoring others to their friends – deserves the support of theChristian public. (Asylum General Court, 1 March 1837)

The governors almost certainly magnified success and minimised failure, as willbe more apparent below. One wonders whether there are dangers that the indi-vidualistic, competitive structure of hospital services delivery in the 1990s,through trusts, may result in a similar smokescreen of purported efficacy.

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One principle of the asylum was :

That such women be received to protect them until they could be restored to friends orto the community at large in a way of industry according to their ability. (AsylumCommittee Minute Book, 1787–1814, Entry 21.4.1787)

There was also a principle, however, that the asylum should be self-support-ing, and, given the shortfall in charitable monies, the women were expectedto try and make up the difference, together with a very little for themselves.The premises were unsuitable for most employment, for example laundry on asufficient scale to make it attractive for prospective purchasers; needleworkwas brought in as almost the only option. There was a shortage of this too, butwhat little there was, the women were obliged to complete. Available work,regardless of its limited value in equipping the women for later employment,thus had to take priority over any rehabilitative needs. The needs of the insti-tution, albeit to maintain it as a safe haven for the women, were allowed tooutweigh the needs of the women themselves Again there have been uncom-fortable modern parallels.

In 1988 the women of Durham prison, in the north of England, faced asimilar issue (Lester & Taylor, 1989). ‘H’ Wing of Durham prison providesfacilities for Category A and life-sentenced women. Work is important tothem, for a small wage and the self-esteem it brings, but the work had to betaken in on fairly standard commercial contracts. As for the Lock Asylum, thenumbers of women on ‘H’ wing at any one time were small, rarely many morethan 30, and this is still not conducive to contracts for interesting or relevantwork. In order to sustain any contract that guaranteed work in these circum-stances, exercise and educational opportunities were severely curtailed. Thework? Plain needlework! The only real difference was the use of sewingmachines in the 1980s.

The records of the asylum show a great deal of ill health among the women.There was a constant to-ing and fro-ing between the asylum and the hospital.In 1840 it was reported between February and April of that year that at leastfour of the women were dangerously ill. Three of these had ‘inflammations’.Several examples will illustrate the sort of problems, some probably terminal.

On 30 April Katy Langley was taken into St George’s Hospital because of‘fits’, and on 7 May, Maria Evans complained of pains in her limbs as she haddone previously. Both remained ill for some time and Katy Langley was sent toher parish for a while. Maria Evans was diagnosed with rheumatic fever inMarch of 1840, remained ill throughout May and June and was sent to a hospi-tal in Brighton. She returned to the asylum in September, the matron record-ing that she was ‘not much better for the change’. She became more unwell inOctober and was finally sent home to live with her mother in Guildford. Thisseems to suggest that the asylum took steps to minimise the number of womendying in the asylum. There are no reports of suicides, but the selection processwas perhaps against this. What is perhaps rather shocking is a sense that society

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has progressed very little in this respect. Women at the fringes of society whofind their way into institutions still appear to suffer a disproportionate rate of illhealth. This is not to suggest that the institution is causative, but simply thatthere remain groups of women with remarkably similar problems.

Of the 36 women on ‘H’ Wing in Durham Prison at the time of Lester andTaylor’s report, 10 were identified as needing psychiatric inpatient care but ahospital bed had been found for only one. She was suffering from paranoidschizophrenia. The others had depression, personality disorders or eating dis-orders. A large number of the women had gynaecological disorders and therewas a higher rate than the national average of hysterectomies.Gastrointestinal problems were extremely common. Poor sanitary conditionson the wing, lack of privacy and exercise were all suggested as contributorycauses. Twelve to 18 months later, Gunn, Maden and Swinton (1991) com-pleted a case note and interview study of a cross-section comprising 25% of allwomen serving a prison sentence in England and Wales. They found that inthis respect the Durham prison women did not appear to be unusual as prison-ers, although emphasising particularly in this study the psychiatric problems(Maden, Swinton & Gunn, 1994).

Financial problems continued to beset the Asylum, in spite of borrowing£100 in 1834, particularly affecting the period from then until 1842. For theyear ending at Lady Day 1836 the following was reported:

Expenditure £373 11s 6d

Ordinary Income £309 0s 10d

Deficiency £64 10s 18d

It was thought that average annual expenditure was nearer to £450, estimat-ing a deficiency of £125 per year. In fact, in the years 1834, 1835 and 1836,the deficiencies were £221 5s, £218 17s and £188 17s respectively. The stateof the finances prompted the annual General Court Meeting to call for areview of outcome for the women.

There had been 981 women admitted to the institution in the 50 yearsbetween 1787 and 1837, of whom 282 had been sent to service, 171 restored tofriends and 17 remained in the asylum. This left 682 women unaccounted for.Could this imply a failure or recidivism rate of nearly 70%? Whether this wasthe case or not, the committee made four resolutions. First, that due to its pastrecord, the asylum should be continued; the governors were evidently not con-cerned about the ‘lost cases’. Second, as the income of the asylum was farbelow its expenditure, the number of women taken into the asylum must bereduced. Third, an appeal should be launched for funds. Last, that the resolu-tions of the committee and the subscriptions should be advertised in The Times,Post, Herald, Chronicle and Record. A number of members gave donations andothers promised sums of money. Circulars were printed to request funds.

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Again the modern parallels are worrying. Crises in service provision stillprompt reviews, for example The Review of Services for Mentally DisorderedOffenders and Others with Similar Needs (Department of Health/HomeOffice, 1992). Still, they are principally informed by prevalence and, at best,crude outcome data. It appears that purchasers of services, in modern par-lance, still have little interest in fostering the more basic research that mightyield a more fundamental understanding of the problems. The Lock Asylumwas set up with clear rules and guidelines as to the criteria for admission andthe day-to-day running of the institution, and the governors were even imagi-native enough to institute a sort of outcome study, but there was no real ratio-nale for ‘treatment’ of these women. It is not clear that in these respects theapproach to women currently regarded by society as deviant has changedmuch.

That might be bad enough, but there is also a sense that then, and now,important evidence about potentially remediable causes of forays into prosti-tution or deviancy are being missed or disregarded. The Lock Asylum failed torecognise either the evidence presented directly by the women, or indirectlyby the difficulties that it had in sustaining them. The women were in poorhealth, as shown by the asylum’s own records. Because of this, they wereunable to undertake gruelling physical work, which was the only kind avail-able to unskilled, poorly educated women. Mayhew’s survey of prostitutesbetween 1850 and 1860 found that approximately 98% either could not readand write or could only read and write poorly. Prostitution was a way ofobtaining income in a sporadic way. It could be taken up when the womanwas well, but left her able to rest up when she was ill. The only other occupa-tion which allowed this was piecework, but this was difficult to come by andpoorly paid. In spite of the establishment figures involved, the Lock Asylumitself was no more successful than these women in finding sufficient ‘morallyacceptable’ work. In the 1990s, prostitution is still an important source ofincome for many women whose circumstances preclude earning a living wageby other means. The other substantial problem of 200 years later, however, isinvolvement with illicit substances (Maden, Swinton & Gunn, 1994). Over25% of women in prison are substance misusers. It has been suggested thatinvolvement with illicit drugs in the 1980s and 1990s may have as much to dowith providing an employment and wage structure for some of the users aswith the actual taking of substances. Box and Hale (1983) found that femaleconviction rates were related to female unemployment as well as changes inlaw enforcement practice. When the health of these women deteriorates fur-ther, or the criminal justice system catches up with them, there is little evi-dence of institutional understanding of likely causation backed with trueinformation-based programmes.

Society’s ‘moral management’ in the 1990s means more imprisonment ofwomen. There has been some increase in women’s participation in crime(Morris, 1987), but still convictions for violence, sexual assaults or robbery are

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rare, and of the 3714 women remanded into custody in 1994, 71% were givennon-custodial sentences or acquitted (Penal Affairs Consortium, 1996). Thetotal prison population at any one time has risen from 40 606 at the end of1992, to 52 731 on 1 December 1995. The numbers of women within thesefigures were 1353 and 2125 respectively, a rise of 57%. By 28 June 1996 thefigures were 55 249 overall, inclusive of 2293 women, thus showing littleremission of the trend. Not only is a much clearer understanding needed ofthe multiplicity of forces that come together to marginalise a small group ofdisordered women, together with evidence of factors which may have beenprotective for others, but application of that understanding is vital in theinterests of wider society as well as the women themselves. At least the phil-anthropists believed in the possibility of reform; nearly 200 years of opportuni-ty later, it is surprising that services are not more soundly based.

Caroline HolmesBroadmoor Hospital

CrowthorneBerks

REFERENCES

A Short History of the London Lock Hospital and Rescue Home 1746–1906. London: The Hospital1907 (Anon) (Pamphlet).

BOX, S. & HALE, C. (1983). Liberation and Female Criminality in England and Wales. BritishJournal of Criminology 12, 35–49.

DEPARTMENT OF HEALTH/HOME OFFICE (1992). Review of Service for the Mentally DisorderedOffender and others with Similar Needs (The Reed Report). London: HMSO.

GUNN, J., MADEN, A. & SWINTON, M. (1991). Psychiatric Disorder in Prisoners. London: HomeOffice.

HIGHMORE, A. (1822). Philanthropia Metropolitania. London.LESTER, A. & TAYLOR, P.J. (1989). Report on Durham Prison. London: Women in Prison.MADEN, A., SWINTON, M. & GUNN, J. (1994). Psychiatric disorder in women serving a prison sen-

tence. British Journal of Psychiatry 164, 44–54.MAYHEW, H. (1968). London Labour and the London Poor (1861–1862 unabridged edition) 164.MORRIS, A. (1987). Women, Crime and Criminal Justice. Oxford: Blackwell.PENAL AFFAIRS CONSORTIUM (1996). The Imprisonment of Women – Some Facts and Figures.

London: Penal Affairs Consortium (169 Clapham Road, London SW9 OPU).

Archives, The London Lock Hospital and Asylum Records (LondonCollege of Surgeons

The Asylum Special Committee Minute, 18.4.1787–3.3.1814.The Asylum Committee Book, 19.10.1815–23.6.1842.The Asylum General Court Records, 5.2.1815–26.1.1943.The Asylum Special Committee Book, 1836–December 1942.

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