Patient Perspectives

A history of the London Asylum for the Insane (LAI) would not be complete without considering the patients' perspective. Not only did patients constitute the overwhelming majority of the asylum community, they were the reason for its existence. The structure of the asylum - from its physical design to the composition of its staff to the organization of daily life - as well as the changes that it experienced as legislation, social views, and treatment methods evolved, had a direct impact on the lives of patients. Yet their perspectives are rarely represented in historical accounts.

This oversight reflects a challenge that confronts researchers of asylum life: the lack of documents that reveal the experience of patients in their own words. Annual Reports detailed the asylum's progress and typically reflected optimistic viewpoints because they were created as reports to employers, the government, and taxpayers who were responsible for funding the asylum. Unlike the Annual Reports that the Medical Superintendents prepared, the perspectives of patients at the LAI were not systematically sought or recorded. What direct evidence remains of patients' experience and how they understood it lie largely in the letters that they wrote to family members, friends, asylum staff, and others. These letters cannot illustrate the complete picture of life at the LAI (some were, in fact, confiscated), but the letters that have survived provide valuable insight into the patient experience.

Less direct sources that reveal the patient perspective also exist. One of them is the artwork created by patients. From paintings to embroidery, these pieces are a tangible form of patient expression. Yet another source lies in the day-to-day letters that the Superintendents wrote. As private documents not intended for publication - in contrast to the Annual Reports whose authors were inclined to present a positive image of the asylum - these letters may provide a more accurate indication of how patients responded to institutional care. Finally, the photographs taken of patients constitute another indirect source documenting their experience. It is important to note that photographs, like any piece of historical evidence, need to be approached critically.They are interpretations of reality rather than a mirror reflection of it. What they do not show is often just as important as what they do show. In public institutions, photographs typically captured the positive aspects of life; rarely do we see negative images caught on film. For example, we are more likely to see photos of patients involved in occupational therapy than shock therapy, or of patients housed in the open door wards as opposed to those residing in the refractory branch. It is important to keep the selectivity of photography in mind when looking at the pictures in this exhibit.

We invite you to explore the patient letters and artwork that represent the diversity of experience and response to life inside the walls of the LAI.