Alleged Lunatics' Friend Society

The Alleged Lunatics' Friend Society (ALFS) was a pressure group started by ex-patients in 19th century Britain that campaigned for the human rights of people alleged to have mental disorders (who were known then as lunatics). It is recognized today as a pioneer of peer support and the Consumer/Survivor/Ex-Patient Movement.

Background

There was increasing concern in the 19th century at the ease with which people could be confined to the system of private and public madhouses (known as asylums or psychiatric hospitals), often leading to reports and literary accounts of abuse and illegal confinement. There was also concern that physicians were undermining personhood by arguing that mental disorder was physical and hereditary. Civil libertarians were in favor of granting more self-determination and responsibility to the insane, and increasingly concerned with the assumption that custody was the appropriate way to deal with them. A process of certification was introduced for detaining people, but there were protests at the ease with which behaviors were being defined as sufficiently disturbed to justify detention, and suspicion of the motives behind the expansion of asylums and financial incentives for the recruitment of patients. The boundaries of diagnosis seemed to be expanding to include issues of morality, eccentricity and criminality as well as insanity, with doctors increasingly claiming the expertise to distinguish the mad from the sane.N Hervey (1986) [http://www.pubmedcentral.nih.gov/pagerender.fcgi?artid=1139650&pageindex=1#page Advocacy or folly: the Alleged Lunatics' Friend Society, 1845-63.] Med Hist. 1986 July; 30(3): 245–275.]

In 1838, Richard Paternoster was discharged after 41 days in a London madhouse (Dr Finch's madhouse at Kensington) having been detained following a disagreement with his father over money. He advertised in The Times newspaper for fellow survivors to join him in a campaign against abuses of the madhouses. He was initially joined by four men, the most noted being John Thomas Perceval, son of the assassinated prime minister. Even though he had been treated in the most esteemed private asylums (Brislington House in Bristol, run by Quaker Edward Long Fox, and Ticehurst Asylum in Sussex) he felt he had not been treated as a gentleman or an individual. The men published their experiences of asylum care, including lack of discussion about treatment, and punishment with solitary confinement, straitjackets and cold baths. They argued that inspectors were not doing a proper job, and failing to see things for a moment from the perspective of patients. Others who joined the cause were William Bailey (an inventor who'd spent five years in madhouses), Captain Richard Saumarez (whose two brothers has been incarcerated in Chancery asylum by his father, and he couldn't see them or challenge their detention), and Dr John Parkin, another ex-patient.

Formation

On the 7th July 1845 they and a number of others formed the Alleged Lunatics Friends Society. In the first year it campaigned for changes to lunacy laws to reduce illegal incarceration and improve asylum conditions, to offer help to discharged patients, and to raise awareness of christian duties and sympathies in this regard. During that year the Society had 18 vice-presidents and 17 directors. The number of members is not known but as well as ex-patients this included politicians (e.g. Thomas Wakley, Thomas Duncombe, William Sharman Crawford, Benjamin Bond Cabbell, R. A. Christopher) and 10 lawyers (including Gilbert Bolden, who helped draw together disparate elements and develop a a common set of demands that would have a wider appeal; C. P. Villiers, James Russell). The name reflects the fact that each member of the society was considered to be a friend of those alleged to be insane, whether the member was an expatient, family member or other concerned party.

Views and actions

The Society argued that patients should have more of a voice in their confinement and care, and access to legal representation. The predominant moral treatment was seen as repression achieved by mildness, coaxing and solitary confinement. Its emphasis on reeducation was seen as treating people like children or mental defectives, and lack of chance to exert their own will or judgement was thought to impede recovery. The Society was suspicious of the tranquility admired by asylum inspectors, suggesting patients were simply being crushed and then discharged to live a meak existence in society. They suggested that rules and expected conduct in society created irritations of the will, and many mental problems stemmed from disappointments and rejections in life. They challenged the prevailing practice of cutting people off from associations with their home, and argued that more attention needed to be paid to what patients were saying. They accused people of being hypocritical in deeming themselves sane by a servile following of the rules. They advocated on behalf of paupers (the poor) generally. They gave attention to the plight of "single lunatics" (those confined (often in secret) to their own homes by relatives, or placed in some other isolated place to be forgotten and not cause scandal [Smith, R. (2005) [http://www.bristol.ac.uk/sps/downloads/working_papers/sps09_rs.doc Human Rights, Anti-Discrimination and Disability in Britain] School for Policy Studies Working Paper Series Paper Number 9] ). They promoted the use of clergy to visit and protect patient rights, by representing community and connection rather than lock and key. They opposed the enlargement of asylums.

From 1845 to 1863 the Society bombarded the government with literature. Gradually many of its ideas were adopted, often without credit. This included protections added to laws, for example that diagnoses must be stated on asylum certifications, deaths in asylums must be reported promptly, abused or neglected patients should get a copy of their certification which could result in prosecutions, and patients could get a legal hearing before admission. The Society also argued for patients' legal rights to be displayed in every asylum, and that medical documents should record if an inmate objected, that patient's property should be sealed, and that voluntary halfway houses should be created.

Between 1845 and 1863 the Society took up the cases of at least 70 patients. They monitored particular institutions for years and consistently drew attention to abuses that inspectors were unaware of. They held public meetings and lectures around the country that helped uncover abuses, although they were often poorly attended. They obtained a special government investigation (Select Committee) in 1859. They exposed many illegitimate and illegal admissions, including brutality in detention procedures; confinement by relatives in order to avoid to social embarrasment or financial loss (for example when someone might otherwise lose an inheritence, or married a servant, or wanted to give money to a religious sect); irregularities in certification related to financial conflicts of interest; infringements of patients' rights (e.g. defrauding a Bedlam patient of his savings; family reducing patient's trust fund while he was inside); family promoting indefinite detention with minimal publicity; postal correspondence being interferred with; physicians relying on physical treatments and neglecting to spend time with patients; hearings being superficially legal but prejudiced in advance and ignoring rules of evidence.

Difficulties

The Society faced a number of difficulties. Throughout its history it attracted gratuitous abuse from the popular press and medical journals. The negative personal accounts of their treatment published by Paternoster and Perceval alienated the medical profession, though at the same time physicians gave it a mixed reception, with some staunchly opposed and many asylum owners refusing to cooperate, while most thought it brought in some beneficial reforms.The Society itself included some physicians, who tended towards concessions and sometimes undermined the Society. Its efforts were continually hampered by the disdainful attitude, narrow views and obstructionist beauraucracy of the government, who often didn't credit it, only helped minimally with documents, and didn't adequately protect informant's names. The Society also faced obstruction from asylum owners and generally had to use habeas corpus to bring cases before the courts. They helped discharged patients seek redress for their sufferings in asylums. Although these cases were not often successful, they did cause embarrassment to asylums.

The Society had flaws. It often lacked subtlety, inviting rejections and disparagement. In general the issue of illegal incarceration of the sane gained support, but other suggestions were often derided. Perceval often advocated heavily in favor of church involvement, and the superiority of private madhouses with personal attendents for the better off. In public meetings his extrovert manner sometimes rode roughshod over others or stoked up allegations, and the personal nature of his attacks undermined the sense of the Society's objectivity; he was sometimes venting personal frustrations with society and convention. The Society sometimes alienated potential supporters with a persecutory flavor to its comments. It produced enemies by its exposure of upper class sensibilities and flaws of the lunacy commission, hardline approach to social inclusion of ex-patients, alighnment with radical groups, and emphasis on localist rather than centralist supervision of asylums. The government wanted control over the asylums but was wary of alienting the medical profession by curbing its powers in favor of patients' rights.

Legacy

The Society's activities came to a natural end in the mid 1860s with the deaths of key members, including Bolden and Saumarez. Perceval had lost three brothers between 1856 and 1861, and promotion of his nephew to a position of influence in the government and lunacy commission may have given him some peace of mind.

The Society had continually challenged the boundaries of mental disorder that others were seeking to set down. It questioned the growing faith placed in medical expertise. Although often seeking publicity, it did most of its effective work out of the limelight in exchanges with the government. It has been argued that it was held back by myths about mental illness, and deserved more support than it attracted for its achievements. It may never have been able to gain more widespread support due to public disinterest or avoidance of the issues, and some of its following has been attributed to the reputation it gained for intrusive and insensitive investigations. However, while it sometimes overstated its case, more often than not very real abuses were uncovered. It kept up continual questionning about the adequacy of long-term care, whether in asylums, workhouses, or private lodgings. It was the only group prepared to bring test cases to court in this area of civil liberties, while most Victorians wanted it kept out of the public eye. It has been said that patients' rights, asylum care, and medical accountability all suffered with its demise in the 1860s. It was a predecessor to other UK organizations such as the Lunacy Law Reform Association the National Society for Lunacy Reform and the current national charity MIND, and is recognized as a pioneer of advocacy and peer support [ P Deegan (2006) [http://www.patdeegan.com/blog/archives/000018.php The legacy of peer support] Retrieved on Aug-06-2008] and the consumer/survivor movement. [Laura Van Tosh, Ruth O. Ralph, Ph.D., & Jean Campbell, Ph.D. (2000) The [http://www.wecancolorado.org/pdfs/rise.pdf Rise of Consumerism: A Contribution to the Surgeon General’s Report on Mental Health.] Psychiatric Rehabilitation Skills, Volume 4, Number 3, pages 383-409]

ee also

*Consumer/Survivor/Ex-Patient Movement
*Moral treatment
*Deinstitutionalization
*Recovery model
*Antipsychiatry
*MindFreedom
*WNUSP

References