Epilepsy in the Lunatic Asylums of South Australia (1852-1913)

Abstract

Epilepsy is a common and sometimes life-threatening condition that can have profound physical, psychological and social consequences. Whilst much has been written about how the medical understanding of epilepsy changed during the nineteenth century, little is known of the individual experiences of people. This thesis addresses this by questioning why people with epilepsy were placed in lunatic asylums. In so doing it engages with the scholarly debate about whether the purpose of lunatic asylums was for cure or custody. Some scholarship describes asylums in humanitarian terms, stressing the importance of ‘moral treatment’ and situating it as a forerunner to psychiatry. This view was challenged by Michel Foucault who contended that moral treatment merely replaced physical restraints with another form of repression, imposed by power-seeking doctors. Materialist scholars also reject the idea that asylums were curative, describing them as places of social control and citing low cure rates and the accumulation of ‘hopeless’ cases. Using a ‘bottom-up’ approach, social historians regard families as central to the admission and discharge process. Opinions vary however, as to whether families sought cure or custody. In this study, patient information obtained from two South Australian lunatic asylums has been used. South Australia provides a useful case study as there were no private lunatic asylums, union workhouses or poor law. Nevertheless, as with asylums elsewhere, epileptic patients accounted for nearly ten percent of the asylum population between 1852 and 1913. Only the worst cases were admitted; the majority of people with epilepsy remaining in the community. Those admitted posed a significant burden to poorer families as they exhibited difficult behaviours and had little or no capacity to look after themselves. However, their families (if indeed they had families) did not readily relinquish their epileptic charges to the asylum, typically only seeking admission after years of home care. My thesis argues that the asylum was used for three purposes: respite care, palliative care and long-term care. The argument proposed is that moral treatment benefitted incurable patients, such as those with epilepsy. Families did not place kin in the lunatic asylum for custodial purposes. Instead they recognised that it provided a safe and caring environment for those debilitated by the condition.