Mental illness and the late Victorians: a study of patients admitted to three asylums in York, 1880-1884.

The case histories of the patients newly admitted to the Retreat Asylum in York between 1880-1884 were examined. Most patients were aged under 50 years, single and non-Quaker, and a majority satisfied the Research Diagnostic Criteria for a diagnosis of schizophrenia or affective disorder. It was found that 72.9% of the patients were deluded, the most common delusions being of persecution, grandeur and guilt; in 34.9% of the deluded patients, the delusion had a religious content. Suicidal ideation was recorded in the case records of 31.4% of the patients. Drug therapy was commonly prescribed, a history of assault on other patients or asylum staff was recorded in 38.1% of the patients, and 11% of patients were force fed at some stage during their illness. Within a year of admission 49.1% of the patients were discharged, the prognosis being better for patients with an affective illness than for schizophrenia, but 31.4% remained in the asylum for five or more years. The characteristics, alleged causes of mental illness, and treatment and outcome of the Retreat patients were compared with those of patients admitted during the same period to the two other York asylums which served different socio-economic groups of the population. Mortality rates were higher in the asylum admitting mainly pauper patients, and possible reasons for this are explored.