Rethinking the Asylum: Dr Down and the History of Learning Disability

JLD

When an episode of BBC’s Panorama (2011) exposed shocking levels abuse at Winterbourne View, a care home for patients with learning disabilities, a number of commentators were quick to liken the home, and the cruelty that happened there, to a Victorian asylum.

The asylums and institutions of the nineteenth century have long loomed large in the public imagination. From private insane asylums, to workhouses and charity schools like Lowood in Jane Eyre, for many the Victorian period was characterised by soulless institutions where callousness and brutality were endemic.

It can be difficult to shake this image. When I picked up a guide to London’s medical museums the other month and heard about a museum celebrating the family of Dr John Langdon Down, who reportedly brought “a revolutionary and enlightened approach to the care of those with all forms of learning disability”, I have to admit I was somewhat sceptical. Would their approach really seem ‘enlightened’ to my modern mind?

Curious, I took a trip over to Teddington in Middlesex the other week, to visit the Langdon Down Museum of Learning Disability. Nestled in a lovely little town called Hampton Wick, it’s a small museum based in the old house of the Down family. For more than a century (starting from 1868), the Downs ran the estate – named Normansfield – as a residential home for children and adults with learning disabilities.

It was described by a contemporary advertisement as a place “for the care, education and treatment of those of good social position who present any degree of mental deficiency”.

Modern visitors might bristle at the mention of mental ‘deficiency’ and the suggestion that the home was only for those of a ‘good social position’. But my scepticism was soon overwhelmed by the extraordinary – and often touching – details of daily life at Normansfield during the nineteenth century.

Dr Down and the history of Normansfield

Normansfield has had a long (and not always illustrious) history as a residential home for patients with learning disabilities. It wasn’t finally closed until the 1990s, though it had fallen into a period of deep decline by the 1970s. Its heyday, however, was unmistakably its years under the auspices of the Down family – particularly Dr John Langdon Down and his wife Mary (or ‘Little Mother’ to the patients).

Dr Down (1828-1896) had no special training or experience in learning disabilities when he began his career in 1858, at the Royal Earlswood Asylum for Idiots. He was simply a medical graduate who had had a serendipitous experience. Aged 18, he had taken shelter from heavy rain at an inn in Devon, where he was served by a young woman with developmental disabilities. He credited this woman as his inspiration – one which eventually led him to open his own asylum, Normansfield, in the 1860s.

The museum describes how Dr Down’s Normansfield was run as a family home – albeit  one accommodating a rather extended family!  The diet seems to have been varied, the staff numerous and patients smartly dressed. They took daily baths and daily walks. The residents and staff shared dormitories and took meals together – even on Christmas Day. Indeed, Christmas seems to have been a particularly special time of year, with pantomimes and individual gifts from the Down parents. There are also records of Punch and Judy shows, donkey rides, and annual trips to Crystal Palace.

Moreover, patients were not just entertained, but educated and enriched.  Dr Down seems to have encouraged the development of life skills (such as dressing and using money), to physical activity and the enjoyment of hobbies.

If any staff member was found to be inflicting seclusion, restraint or any form of punishment on the residents, then they would be fined (for their first offence) and liable for dismissal on the second. Dr Down’s approach to discipline was, according to the museum, one of “responsive affection”, with good behaviour rewarded. This was light-years ahead of some nineteenth century institutions.

The care and compassion patients received can perhaps best be indicated by their comparatively remarkable life expectancy rates. One patient with Down’s syndrome, Walter Ridpath, lived until he was 61. Another, Mary Arnott, died at 57. This is impressive, even in the twenty-first century, when the life expectancy for people with Down’s syndrome is around the mid-50s.

Many patients seemed to have lived and died in Normansfield. It was open to all ages, from toddlers (there was a large playroom) to adults. When the institution first opened, there were 19 patients. By the time of Dr Down’s death, there were 160. Although the patients largely had what we would now term learning disabilities, others had physical disabilities, such as blindness or epilepsy.

Asylums for ‘idiots’: a potted history

In Dr Down’s day the patients in his care would be usually classified as ‘idiots’. Normansfield opened only a couple of decades after the first asylums for ‘idiots’ began to appear in Britain. The concept seems to have derived from European models. Several Swiss and French residential homes offered the promise of educating ‘idiot’ patients, making them ‘fit’ to return to ‘normal’ life. These promises –it later emerged – were flawed (in some cases fraudulent) and the idea of the asylum as a ‘temporary’ arrangement seem to have been dropped fairly rapidly. While many continued to nurse hopes that some of the patients would gain independence outside of institutional life, for many this never happened.

Despite this ambiguity around the educational prospects in such asylums, there was nevertheless  a new focus on stimulation and activity for the learning disabled from the mid-nineteenth century onwards – an advance in itself. As Andy Merriman says, in his lovingly researched book on Normansfield, “the Victorian period witnessed a dramatic change in the education of the mentally disabled. Prior to the nineteenth century the ineducability of idiots had been a common belief”.

Moreover, the advent of these asylums was an important step towards recognising learning disabilities as distinct from mental illness. ‘Idiots’ had, after all, just fallen under the 1845 Lunacy Act.

Though the idyll at Normansfield was restricted to the upper classes (annual fees stood at around £200 per year in the 1870s), there were also asylums for the working classes. The Royal Earlswood Asylum –where Dr Down had worked prior to opening Normansfield – was largely a charitable establishment, with more beds for paupers than aristocrats. Indeed, there is some suggestion Dr Down opened his home precisely due to the lack of options for upper-class patients.

The Langdon Down Museum

Theatre

Although the Langdon Down Museum is small, it is a fantastic testament to this rich history of the development of Normansfield and care for the learning disabled. Whilst some of its exhibitions – particularly on the ground floor –are fairly sparse, there’s a valuable (and free!) guide and a rich development programme ahead. The museum is planning new displays on the lives of Normansfield residents and a timeline to show how the institution evolved.

At present, the reception hall offers a portrait of Dr Down (replicated here), and a family tree exploring the several generations who, together, looked after the home well into the twentieth century. (Dr Down’s children and grandchildren carried on the family tradition.)

The main corridor beyond offers a short history of the staff and residents. Visitors can see several of the extraordinary ‘clinical photographs’ taken by Dr Down. He seems to have been something of a pioneer in clinical photography, taking his first patient pictures in 1862. The notion of clinical photography may seem somewhat voyeuristic, with the patient objectified by the gaze of doctor-photographer. But the photographs weren’t cold and depersonalised, as I would have expected. Instead, they looked like the sort of photographs that might have been found in a family home: the subjects smartly dressed, sitting or standing, contemplative or looking curiously at the camera.  Indeed, many of these photographs do seem to have been shared with the residents’ families.

There are more photographs in the front room, where a PowerPoint runs continuously, showing pictures of Normansfield, the Down family and the other residents of the home. Staff invite you to sit down and help yourself to tea, coffee and biscuits whilst watching the slides.

The real gems of the museum, however, lie beyond the first few rooms. Here visitors can find the extraordinary private theatre (pictured above) and a wonderful exhibition about the so-called idiot savant, James Henry Pullen.

The private theatre (still in good working order!) is absolutely marvellous. Though I had heard about it prior to my visit, I was still struck by its grandeur. It first opened in 1879, able to seat three hundred people, and, remarkably, was designed by an architect with no previous experience of designing theatres. It remains a rare surviving example of an 1870s private theatre, and also retains an impressive collection of scenery.

In Dr Down’s day it functioned as both an entertainment hall and a Church, complete with regular Sunday services. Both pupils and staff participated in music and performance whilst at Normansfield. Indeed, the Downs actively searched for staff with musical abilities, and ended up with a staff orchestra of sixteen members.

If one is struck by the abilities of the staff, however, then they will be all the more impressed by the exhibition detailing the life and work of Pullen (1835-1916), known as the ‘Genius of Earlswood’. Here we take a step away from the life of the Downs, to focus instead on the remarkable achievements of one of their patients.

Idiot savant is French for a ‘knowledgeable idiot’ or ‘learned idiot’ and has been used to describe patients with severe mental disabilities who show remarkable capabilities in a particular field. Pullen was an expert craftsman, who had a special workroom and exhibition room set aside at Earlswood just for him. It is difficult to convey the richness of his work, which ranges from large model ships to paintings and even a homemade exercise bed.

My favourite amongst his works were ‘The State Barge (Fantasy Boat)’, intended as a model vessel Queen Victoria could have ruled her empire from, and ‘the Giant’, a large carnival figure almost fifteen feet high.  The first is made from exotic materials (including ebony and ivory) and depicts angelic and Satanic figures. The latter is a rambunctious creation, with moving parts and a revolving head, which has delighted children for generations.

There’s also a documentary about Pullen as a patient, an artist and a man.  Although the exhibition is primarily a celebration of his work, it also touches on more problematic aspects of his care, such as the way in which the institution used his gift as something of a money-spinner for themselves.

Rethinking the asylum

Ultimately, the whole tone of the museum is celebratory, and rightly so, for as Patrick McDonagh recognises, Dr Down “played a central role in advancing the medical study of idiocy”.

That is not to say that there aren’t many aspects of his life and work which do not sit quite so well in the twenty-first century. Although Down’s syndrome is now named after him, this was a posthumous decision taken in the 1960s. He himself referred to patients with this syndrome as ‘Mongolian’; for in his 1866 paper ‘Observations on the Ethnic Classification of Idiots’, he advanced a theory that those with learning disabilities were throwbacks to earlier, supposedly less evolved races.

In his own words he saw them as “examples of retrogression”, bearing “ethnic features” which were the “result of degeneration”. For a modern reader, the racism underpinning this theory is almost overwhelming. Yet Down, in his own day, was by no means intolerant. He was in favour of the abolition of slavery and (unlike some other theorists) believed that all races originated from the same evolutionary lineage.

It can also be difficult to escape one’s own disinclination towards the idea of an asylum or institution, which seems calculated to denote its inhabitants as ‘different’ or ‘Other’. One cannot help but wonder why parents – particularly those who could afford good care for their children and servants to assist – would have wanted them removed to an asylum. Was it because they were ashamed of their children, whom they wanted safely hidden away?

Yet this assumption seems simplistic when one reads some of the touching correspondence between the Downs (particularly Mary Down) and residents’ parents. Whilst some parents were more detached, there were others who seemed to have been extremely anxiously about the welfare of their children, and volubly grateful to the Downs for the care they bestowed.

The museum does not really interrogate why parents may have wished to place their children in residential care or dwell on Normansfield’s later decline. But this, in many ways, seems a boon rather than a drawback. It seems rather fitting that the tone of this museum is celebratory rather than elegiac.

As modern visitors we are all too aware of the cruelties that can happen in institutionalised care, and the prejudices that still run deep, even amongst some in the medical profession. (A recent report by the Health Service Ombudsman found a doctor still using the term ‘subnormal’ to describe a learning disabled patient.)  When I visited the Langdon Down museum I did not allow myself to forget this, nor my aversion to the conception of an ‘asylum’. But I did open my mind to the idea that a truly enlightened approach to care for the learning disabled could have had its origins further back than I had originally imagined.

Visiting the museum

The museum is open from 2-5pm on Mondays and 9.30am-1.30pm on Saturdays. Bank Holiday opening times may vary.

The museum is free to access.

Visit the website for further details and the museum’s blog for more information on their current projects.

Pictures are reproduced here with the kind permission of the Langdon Down Museum of Learning Disability.

Select Bibliography

McDonagh, Patrick, Idiocy: A Cultural History, (Liverpool: Liverpool University Press, 2008)

Merriman, Andy, Tales of Normansfield: The Langdon Down Legacy, (Middlesex: Down’s Syndrome Association, 2007)

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3 thoughts on “Rethinking the Asylum: Dr Down and the History of Learning Disability

  1. Pingback: Rethinking the Asylum: Dr Down and the History of Learning Disability | Langdon Down Museum of Learning Disability

  2. Pingback: Museum Review: The Old Operating Theatre | The Victorian Clinic

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