Listening in the Asylum

The listening experiences of asylum patients were, naturally, of a different order from those of many men and women living outside the institution. Patients had limited control over their physical surroundings, and this extended to the auditory environment. When music was on offer, patients might be given a choice regarding attendance, but at times events such as concerts and dances were used as a reward, and no doubt others were present against their will. The choice of repertoire was dictated by asylum staff, as well as by the resources available and the talent of those performing. While many asylums aimed to offer comfort by replicating some of the features of patients’ home environments, life in an institution was markedly different from the pleasures and privileges of the outside world.

I draw here on a range of printed records, largely annual reports, produced by a range of both public and private asylums in England during the nineteenth century.Footnote ² The listening described in formal reports reveals a range of types of engagement with music, from active participation via dancing or singing, to a more passive relationship as a member of an audience (whether formal or informal). The reports also suggest a variety of ways in which patients responded to the music, and in which it was beneficial for their care or treatment. The positive effect of music was reportedly achieved by its influence on patients’ intellectual capacity, by restoring a sense of self-control, or by redressing an imbalance in energy that was seen as a contributor to poor mental health. Where patients were considered to have lost control of their minds or bodies, engagement with music was an opportunity to regain this self-discipline. Besides this, music offered opportunities for diversion and entertainment, as well as a context for social meetings between the different groups of patients.

This twofold presentation of music – as entertainment and as control – reflects developing contemporary debates about musical appreciation via emotion and via intellect.Footnote ³ It also reflects conflicting interpretations of the nineteenth-century asylum system as a whole. While writers of the time emphasized the humanitarian, benevolent intentions of the new institutions (summed up in Leonard Smith's title Cure, Comfort and Safe Custody), Michel Foucault positions the emphasis on domestic moral values as a drive to suppress dissent and impose social norms.Footnote ⁴ This more ambivalent picture – perhaps of Care, Cure and Control – is echoed elsewhere in music's place within philanthropic endeavours, such as the association between the tonic sol-fa movement, dissenting Christianity and temperance examined by Charles Edward McGuire.Footnote ⁵ Music was linked to both moral and social impact, echoing concerns for rational recreation and self-improvement that saw music introduced in contexts from Mechanics’ Institutes to industrial mill and mining communities. Music was often placed uneasily between this drive for rationality and economic benefit on the one hand, and the alternative picture of the Romantic musical genius, where aestheticism and the imperfections of humanity took centre stage on the other.Footnote ⁶ The meanings of musical experience in the asylum therefore open further windows on much broader concerns for both medicine and society. The idea of ‘listening’ also takes on a variety of meanings in this context. Listening to music might be a deliberate, focused act, or something more incidental. It might also form part of a carefully managed social occasion, a reward or punishment, and bring expectations of certain behaviours. The ability to sit and listen to music, or to engage in appropriate social behaviours (such as a formal dance or religious service), was particularly relevant for asylum patients for whom control, and self-control, represented the achievement of restraint and order.

The evidence presented here adds a new dimension to discussion of listening experiences in everyday life during the nineteenth century, particularly outside the formal experience of the concert hall. It begins to suggest aspects of a philosophy of musical listening – an attempt to discuss the effects of music in a scientific way, particularly important within a medical setting. While the accounts are usually generalized – far from the specific, personal data discussed in the other articles in this issue – they give a picture of how musical listening among asylum patients was presented to the authorities, and how the place of music (particularly in pauper institutions) was justified to the taxpayer.Footnote ⁷ Within the development of a discourse of musical listening, primary reports by non-specialists, such as those considered here, add an important angle for consideration.

Evidence

The listening experiences examined here are evidenced largely by third-party writings, chiefly formal reports published annually by each Pauper Lunatic Asylum. The most extensive reports were written by the Medical Superintendent, who oversaw the institution as well as guiding its treatment. Additionally, reports by other officers such as the Chaplain offer insights into the everyday workings of the asylums. Further information comes from the reports of the Commissioners for Lunacy, inspectors who would visit the asylum twice annually to examine its management and patient welfare. My final piece of evidence is an article on experiments into patients’ musical experiences, published by the physician Richard Legge in 1894.Footnote ⁸

Very little patient testimony about the music available in lunatic asylums is available for inclusion here. While some material produced by patients survives in archives, the vast majority reflects little of the day-to-day life and conditions of the asylum, ranging instead from fantastical poetry to letters claiming false imprisonment and demanding release. Although many patients did recover and were released from the institutions, there is little written by former patients on their experiences. Mental health carried a heavy stigma during this period and few would have been willing to dwell on their time in the asylum, let alone produce extended memoirs or published material.Footnote ⁹ One exception is the memoir published in 1879 by Herman Charles Merivale, which describes his time in a private asylum, as well as his efforts to escape and outwit his captors.Footnote ¹⁰ Like many writings, however, the text is largely concerned with protesting against false imprisonment and gives little away about the asylum itself.

A final category of written evidence is the case notes kept for each patient. Case notes give a detailed account of the patient's condition on arrival, including the required recommendations for committal, and their state of physical and mental health during the first few weeks in the asylum. In general, it is the patient's condition rather than their activities which are given attention. The scant references to music in patient case notes usually cite playing the piano (usually an indication of mental well-being) and singing (usually a symptom of madness), but almost never refer explicitly to listening or reception of music. One female patient at the Holloway Sanatorium, for example, was reported to be ‘in a state of dull stupor’ for months, apart from occasional episodes ‘when she will suddenly change into a most lovely condition, dances and sings + plays the piano all day long’.Footnote ¹¹ Despite the behaviour being described as ‘eratic’ [sic], playing the piano, together with talking, was interpreted as a sign of improved liveliness. Later in her stay, however, the same individual was reported as having ‘wakened up suddenly, is very objectionably lively now, dances about + sings at night keeping other patients awake’.Footnote ¹² Thus a patient's engagement with music could form an important part in the indication of their mental state and wellbeing. The detail given in this report is unusual, however, and most patients are not recorded as engaging in musical activities or other entertainments as part of the medical reports.

The focus of formal reports is on the generalized effect of listening to music on the asylum's pauper patients, as viewed through the lens of the educated middle-class management. The evidence collected therefore presents a particular, perhaps idealized, slant on musical listening. It plays into other systems of philanthropy and control, whereby ‘wholesome’ entertainment was encouraged as a means of occupying the growing working classes.Footnote ¹³ We can gain an understanding of the ways in which musical listening and music psychology began to be theorized, both in terms of a form of treatment and as a moral or social good. Medical staff (and, on occasion, others such as the chaplain) were most interested in the social roles of music, its ability to calm or to agitate, and its restorative power. Legge's 1894 article demonstrates a particularly nuanced attempt to collate individual responses to music and move towards a more systematic understanding of music's power.

Authorities’ attempts to recreate some of the musical comforts of day-to-day life outside the asylum give us further information about the kinds of music prevalent in communities, whether real, or imagined by the asylums’ management. More immediately, the records of musical listening in asylums – both in the form of reports and written statements, and via concert programmes and other sources – provide some indication of the music available to a portion of the lower classes, where otherwise scant evidence is available. In some cases the musical experience of asylum patients was, no doubt, modelled heavily on the ideals of the asylum's managers and officers, usually from privileged backgrounds. Music had to be framed as part of treatment, rather than a luxury: pauper asylum patients were, after all, maintained at the ratepayer's expense. Engagement with music on an intellectual, moral level would have been more acceptable than an emotional, pleasurable response. Yet the evident responsiveness of both patients and the nursing and attendant staff, to both sacred and secular musical experience, is also a useful reminder of the richness of musical life among the lower classes.Footnote ¹⁴

The documents examined here were not written by trained musicians or the patients themselves, but largely by members of the medical staff of the asylums. Musical listening is therefore considered in its functional role, as part of the social and therapeutic regime of the institutions. Here it is the impact of music – different types of music, and in different settings – rather than the particularities of musical pieces that is under consideration. Both the intended and actual influences of music recorded give a colourful picture of the way listening to music functioned within the asylum environment. The different effects and functions of listening suggested by reports and anecdotes help to build up a picture of the aesthetic role of music within asylums. Yet it also highlights tensions. Music was used to control, to signal certain social norms, and to aid with religious observances. It contributed structure and provided points of focus for patients often adrift from the normal patterns of everyday life. At the same time it was an important signifier of the liberal attitude towards care for patients, together with improved surroundings and opportunities for rehabilitation.Footnote ¹⁵ The different ways in which music was used, and in which listening and experiencing were reported, reflect this tension as well as the diverse concepts of musical expression and impact live during the period.

Victorian Asylums

Until the late eighteenth century provision for those suffering from mental health illnesses was scarce. With a stigma attached to insanity, only the very worst-afflicted would have treatment or special care sought on their behalf. For wealthier patients, private madhouses run as profitable concerns could offer respite to family members or friends. For the poor, lunatics were held together with paupers in workhouses, sometimes in separate accommodation, but with little distinction in terms of treatment. A small number of charitable institutions existed for the chronically unwell, but with limited space and availability often relying on patients meeting special criteria. Among these were the Bethlem and St Luke's hospitals in London, and the smaller Bethel in Norwich. The York Retreat, a Quaker charitable institution, was set up in 1796 with the express intention of addressing the poor conditions experienced by paupers in the public asylums. Medical treatment throughout these contexts was poor by today's standards. With little understanding of the causes of mental illness, the aim of many institutions was simply to keep patients secure, and to prevent them becoming a danger to themselves or others. Physical means of restraint were not unusual. Treatments were experimental and included leeching, cupping (draining blood), shaving and immersion in cold water. Leonard Smith notes that physical treatment was at the core of mental health care until the late eighteenth century:

As with other medical theories dating back to the Ancient Greeks, treatment was focused on restoring balance within the patient; mental illnesses were therefore addressed by removing excess energy via blood or heat.Footnote ¹⁷

The late eighteenth century saw an important change in the approach taken towards care of the mentally ill. A well-publicized patient death in a York asylum raised the profile of restraint as well as the poor conditions prevalent in many workhouses and charitable institutions.Footnote ¹⁸ New institutions, such as the York Retreat set up by a Quaker group headed by the prominent Tuke family, were focused on overall patient wellbeing, environment and cure. The Retreat's founders emphasized kindness, mildness and benevolence in their treatment of patients, using both the domestic routine and patient employment to recreate normal life as far as possible. The new approach was centred around an ‘apparently humane system, with its infrequent recourse to restraint and its attempt to re-create a sense of family’.Footnote ¹⁹

With changes in public health and social care in the early nineteenth century, the state began to take a new approach to provision for the mentally ill and a series of large, public institutions for the insane poor were established. From the mid-nineteenth century, therefore, asylums fell into three broad categories: Pauper asylums, Charity asylums, and Private asylums. Pauper lunatic asylums were set up as state-run bodies in each county between the 1810s and 1840s: an Act of 1808 gave local authorities the powers to set up asylums using ratepayers’ funds, while a later Act of 1845 compelled authorities to provide for their pauper lunatics in this way. By the end of the nineteenth century over one hundred pauper asylums had been founded, with over 100,000 patients in residence. Some counties and municipal areas set up several separate institutions as demand grew, while others shared provision between different districts; many institutions went from a couple of hundred patients in the 1840s to well over a thousand by the end of the century, with the expansion in living and sleeping accommodation, amenities and land that this required.Footnote ²⁰ Unlike the workhouse, asylum authorities increasingly aimed to avoid an association with punishment, although the stigma of mental health was unavoidable for both patients and their families.

Charity asylums were often endowed or descended from institutions originally based within religious establishments, although many grew in size and scope on the model of the larger pauper institutions. Some, such as Bethlem Hospital in London, found their traditional aim of helping the very poor was superseded by the new state institutions, and moved to support the impoverished middle classes. By the middle of the nineteenth century Bethlem was largely catering for educated and skilled workers, some of whom were able to support the charity further via their friends and relatives. Private asylums were perhaps the most variable. Small, privately run houses continued to exist on the same model as those found in the eighteenth century, providing a discreet home-from-home for the wealthy. Yet larger, purpose-built institutions also developed, some providing superior facilities (such as Ticehurst House in Kent, which gained a reputation for shielding the aristocracy), and others offering an affordable option for the middle classes (such as Holloway Sanatorium in Surrey).Footnote ²¹ The examples here are predominantly drawn from the superior formal records of the pauper asylums.

The ‘non-restraint’ movement came to characterize developments in public asylum provision during the early nineteenth century.Footnote ²² The idea of ‘moral management’ encapsulated a new attitude towards caring for, and potentially curing, asylum patients, rather than merely keeping them away from the rest of society. This was to be achieved both through medical means, and through new therapies, such as employment and recreation, as well as the interactions between patients, staff and management. In other words, the whole of a patient's life was to be ordered in a way that would help to manage their mental state, from diet to surroundings to day-to-day activities. Although asylums were run on tight budgets, a healthy diet, access to the outdoors, clean accommodation and engagement in work or other activities were seen as part of the potential cure. The carefully controlled environment of moral management was not always extended to the aural environment; where instruments were provided for patient amusement there is no indication that their ‘performances’ were directed in any way. However, the development of asylum bands, and in particular the regular organization of dances and religious services, and occasional fêtes, shows and visiting performers, formed a part of the larger scheme for structuring day-to-day life in a controlled, ordered manner. The intended patient response – also controlled and carefully regulated – was, similarly, part of this larger scheme.

As already noted, asylum management aimed to offer comfort to patients by replicating some of the familiar features of everyday life outside the institutional walls. At the same time, it was an idealized, sanitized version of ‘everyday life’ that was propagated by the middle- and upper-class physicians, clergy and staff and supported by local philanthropists as well as the body of taxpayers and politicians responsible for poor relief. Reports of musical activity, as well as other provision, therefore give us insights into both actual and ideal roles for music and healthcare during the period.

In addition to the variety of institutions used to house and treat people suffering from mental illness, medical terminology accounted for a range of different conditions. These were recorded at a patient's admission into the asylum, together with the apparent cause of the affliction. The main categories were generally used to describe patients: the term ‘idiot’ was used to describe patients with a permanent and serious condition of lack of understanding; ‘imbecile’ was a category used to describe patients who had acquired a permanent cognitive impairment after birth; finally, ‘lunatic’, while also used as a general term, referred to patients with an acquired condition who also experienced lucid intervals.Footnote ²³ These conditions were not usually considered remediable and patients were therefore treated with kindness but no hope of a cure. Those considered to be suffering from an imbalance in humours could be melancholic (suffering from sadness or depression; an extreme case might exhibit paralysis) or manic (suffering from an excess of heat or energy leading to periods of insanity).Footnote ²⁴ Terms that would not be appropriate in modern-day medical or social use are reproduced here as they appear in the sources, but it must be remembered that formal definitions were not in place and most labels were used with a degree of fluidity.

Music in Asylums

The patients in asylums came from many different backgrounds, and their experience of music prior to admission would have varied enormously. Many of the middle- and upper-class patients in private institutions would have been familiar with events held in private rooms and salons, mixing with professional performers; a number would have been accomplished musicians themselves. Some might have been accustomed to attending larger concerts on a regular basis, particularly in the larger towns. Among the poorer patients in charitable and pauper asylums, musical experience might have included hearing military bands in public spaces, attending dances and festivals or learning folksongs. Many would have been familiar, either directly or indirectly, with music in the context of the church or chapel service. Poor patients were not necessarily unskilled or uneducated; among the patients admitted to pauper asylums were governesses, clerks and school teachers, as well as professional musicians, piano tuners and music dealers.Footnote ²⁵ Thus the musical experiences of patients within the asylums were linked to, and need to be set in the context of, their prior musical encounters.

Music found a place at the majority of Victorian asylums and patients were engaged in both listening and more active musical endeavours.Footnote ²⁶ Some music was present at many of the asylums during the first half of the century, in the form of ad hoc playing and hymn singing, but it is from the 1850s that this began to take on a more organized role. Asylum bands flourished at the pauper institutions and were common from the 1860s; these would typically play for a large dance every fortnight, and also accompany patients on expeditions such as picnics, as well as playing for annual fairs and celebrations. The band was usually made up of attendants, meaning patients took part via dancing (and perhaps singing along), rather than formal musical participation. Asylums, like workhouses and prisons, also offered Christian worship as part of their regime, and services were held either in purpose-built chapels or in communal areas such as the dining hall.Footnote ²⁷ An organ was not a given, and in some it was a temporary harmonium or piano that accompanied worship. The performer might be a patient, but was more often a female relative of one of the medical staff, or a local professional. In this case patients were active participants, joining in with hymns and other music. In some cases a specialist choir was formed but, like the asylum band, this tended to be made up of employees rather than patients.Footnote ²⁸

Other musical experience was to be found in a programme of events and entertainments. Choirs, handbell ringing groups, minstrels, string quartets and solo performers were all to be encountered visiting asylums. The budget set aside for such entertainments, even at the pauper institutions, was remarkably generous and confirms the dedication to providing a good quality of life as part of moral treatment.Footnote ²⁹ Towards the end of the century groups of patients might be found visiting concerts or the opera (particularly where the location of the asylum made for easy access), and in some asylums facilities were built to allow for large-scale dramatic performances, operettas and orchestral concerts.Footnote ³⁰

Musical performance by patients in the pauper asylums is less common, partly because of the lack of instruments. Charles Hills, a Medical Superintendent at the Norfolk County Asylum, reported in 1872 that several male patients were violinists, but had no opportunity to play.Footnote ³¹ One exception was Susanna Wilhemina Sargent, a patient at the Norfolk County Asylum. Sargent took an active role in asylum musical life during her brief stay in the asylum, playing the harmonium for chapel services during the summer of 1870.Footnote ³² The strict regimes and low numbers of staff may also have prevented the development of informal musical activity among patients. Pianos and other instruments were sometimes bought for patient use, and an orchestrone (a player-organ) was reported in the Worcester male ward in 1893.Footnote ³³ Later, gramophones began to appear. Formal patient music-making was, as might be expected, far more common among the middle- and upper-class patients at institutions such as the Holloway Sanatorium, where pianos and other instruments were provided, and patients often skilled in performing. The ‘salon’, familiar to many middle- and upper-class patients, was recreated, and talented residents organized and participated in salons, chamber music concerts and informal gatherings showcasing both classical and popular genres.

The Role of Music

The broad accounts of musical events contained in the formal reports of the asylum relate musical listening to asylum life in two key ways. First, the act of listening to music itself produced certain effects on the patients, and in many cases was linked to part of their mental recovery, whether in a specific or general sense. Second, the contexts in which musical listening took place were essential parts of the social rehabilitation process: music facilitated a wider form of recovery involving the re-enactment of social and behavioural norms. The latter examples reflect some of the ways in which musical listening (and the associated structures of musical and social life) was engaged as a tool by asylum management in the Victorian period. In many ways rehabilitation within the asylum was about control and conformation within social norms, and the physical activity of sitting and listening to music, or following accepted patterns of dance or social behaviour, were core to this social re-conditioning.

Music was primarily used in an entertainment function, to provide pleasure and relieve boredom among patients. Life in the asylum was frequently described as restrictive and monotonous, as much for employees as for patients. Both followed strict schedules with time set aside for work and for recreation. Although efforts were made to equip wards with games and diversions, such as aviaries, newspapers, books, pictures, and cards, musical events were among the few scheduled entertainments fully organized for patients. Reports from the Norfolk County Lunatic Asylum captured the importance of music to patients in the 1860s. On music in the chapel the temporary Medical Superintendent J.M. Bacon noted that ‘musical additions’ were ‘a pleasure and a benefit’; his replacement William Hills later noted that the patients ‘fully appreciate the music’.Footnote ³⁴ Hills recorded in December 1863 that ‘Some young men from Norwich gave gratuitous entertainment to the patients. The negro melodies afforded intense delight to the audience’.Footnote ³⁵ Later in the decade Hills reveals some details of patient responses to music. In January 1868, for example, he recorded ‘This evening six amateurs gave the patients an entertainment in the dining Hall; the programme was a miscellaneous one, and consisted of vocal and instrumental music, recitation reading from “Pickwick”, closing with a “Comedy on marriage” the patients evinced their great delight and satisfaction by frequent and hearty plaudits’.Footnote ³⁶

During the summer other contexts were available: in May 1868, for example, the Norwich records tell us that ‘About 60 female patients went this afternoon to Postwick Grove, where they had tea and afterwards joined in a dance to the strains of the violin and concertina, played by 2 male patients; they all enjoyed themselves greatly’.Footnote ³⁷ Music is repeatedly referred to as a diversion, agreeable, enjoyable, and well-received. In these examples listening to music produced clear responses in patients, from hearty applause to dancing. Although described in pleasurable terms, there is little suggestion in these accounts that music generated excess emotion in patients; the emphasis is on enjoyment within well-regulated environments similar to the social contexts found at all levels of society.

Listening to music took place within controlled environments, but even these supported a level of social freedom otherwise absent from asylum life. The fortnightly dances allowed for rare contact between the sexes, which were otherwise strictly segregated. Asylum architecture ensured that men and women were housed and worked in separate buildings or wings; outdoor areas were also kept separate and men and women would not share the same kind of work or location during the day. The music of the dance therefore had an important social function, and dancing itself was an important physical act. Exercise, along with employment and entertainment, was an important part of the ‘moral management’ philosophy that dominated asylum administration throughout the nineteenth century, with bodily movement essential for keeping patients physically healthy as well as having a beneficial effect on their mental state.Footnote ³⁸ Listening to music was also an action that brought patients together – whether formally, in the moves of the dance, or as bystanders. The social contact enabled by the music of the dance was carefully controlled through shared understandings of etiquette and the individual dance moves; thus listening to music helped to structure expectations and actions within this context.

This primary purpose of pleasure, relief and variety underscores one of the key principles of the asylum environment. Contrary to the workhouse, where the poor were treated as responsible for their own condition, attitudes to the mentally ill increasingly focused on affliction as an illness, and treatment as a form of medicine. While patients’ responses were kept within acceptable moral and social norms, a pleasurable response to musical listening and engagement was well within the purview of the pauper asylum institutions.

Engagement of the mind and body in the form of intellectual stimulation and physical control formed a second key feature of reports describing the place of music in the pauper asylums. This balanced the references to pleasure and enjoyment, relating musical activity closely to the asylum's aims of both care and cure. Reporting on an evening's entertainment at Norwich, for example, William Hills recorded that the music and recitation ‘was listened to attentively and appreciated’.Footnote ³⁹ Likewise the Chaplain at Gloucester, William George Box, noted in 1892 the close attention paid by patients to musical performances and the appropriate nature of their responses: ‘The discrimination, also, which they show at concerts, in according their applause to certain songs or singers, or to particular actors, passages, or situations in theatrical performances, has frequently struck me, and their judgment, in my opinion, has been mostly justified.’Footnote ⁴⁰ Box was clear that the afflictions suffered by the patients at Gloucester reduced neither their enjoyment nor their engagement with entertainments and amusements. Specifically, their ability to listen intently and critically to music or other performances, indicated through their applause or judgement, was an indication of their recovering mental abilities.

There is no indication that musical study was encouraged or cultivated in patients at the pauper lunatic asylums, but at institutions housing middle- and upper-class patients, innovations in the form of patient magazines or other publications supported a more intellectual relationship with the arts. At Bethlem Hospital, for example, the patient magazine Under The Dome, dating from the 1890s, included detailed reports of concerts given by both internal musicians and visiting performers, as well as chapel music and other musical and artistic entertainments.Footnote ⁴¹ The Reports of 31 March 1893, for example, included a record of a concert given by the Plowden Bijou Orchestra, an amateur ensemble featuring several of the institution's own medical staff. Bethlem's reporter noted that ‘the programme throughout bears strong evidence of the high aims of this Musical Society and the artistic manner in which the various pieces were rendered gave the utmost satisfaction to a large and enthusiastic audience’.Footnote ⁴² The programme included violin and cello solos together with orchestral pieces by Rossini, Mascagni and Hyslop, as well as Mozart's ‘D major Symphony’ ‘heard for the first time at a London Concert’. A later concert, reported in the same issue, was of miscellaneous character and featured chamber music, instrumental and vocal solos given by both internal amateur performers and visiting professionals. Here the correspondent reported that ‘The treat of the evening was given by Mdlle. Doria, who sang “Ah! Quel Giorno” from Rossini's Semiramide, as an encore to which she gave “Il Bacio”, and Arditi's “La Stella” Valtz [sic], followed by Jock O'Hazeldean for an encore. She has a voice of magnificent quality and compass, and the audience were greatly delighted.’Footnote ⁴³

The ‘high aims’ of the soirees enjoyed by patients at Bethlem, where chamber music and Italian Opera were on offer alongside the popular band tunes more familiar to pauper patients, prompt further reflection on the kinds of music considered suitable for patients of different social backgrounds. For while the Medical Superintendents at pauper institutions wrote of the benefits of music in terms of intellectual engagement and control, music remained a rather raw tool, confined to large-scale gatherings in the dance hall or chapel, and probably of an unrefined quality. Where professional soloists graced the salons of the upper- and middle-class asylums, the pauper institutions relied heavily on the voluntary talents and efforts of their own staff, some of whom received only basic musical training in order to participate in the band or choir. Asylum bands offered a wide repertoire from popular tunes to opera overtures and medleys, and in some cases patients were exposed to visiting soloists or groups; but these tended to draw from opera and operetta repertoire or arrangements. Chamber and orchestral music were not to be found in the pauper institutions. In contrast to schemes of music instruction and participation elsewhere, the valued mental engagement with music was certainly not encouraged by any sense of educational endeavour. In this sense the intellectual connection meant simply that patients appeared to respond to music with an improvement in their mental faculties, rather than an emotional or physical response.

Although there is scant evidence of the kinds of intellectual engagement with musical listening engendered in the patients, the cognitive effect of music was one of the key aspects in its introduction as part of moral management. Reporting on a Twelfth-night event in the asylum at Hanwell, Middlesex, Dr Forbes noted that the celebrations were not ‘got up from any motives of display, but constitute part of the system of management adopted by Dr Conolly, one essential principle of which is – to endeavour to operate on the intellect through the affections’.Footnote ⁴⁴ Such statements both justified music's place as part of the state-funded asylum system, and helped to shore up the asylum's medical credentials. As medical practice became increasingly specialized and treatment of the insane developed according to scientific principles, Medical Superintendents at the pauper asylums sought to align their work with approved methods. The move to understand such features of asylum life as part of an overall medical scheme is parallel to developments set to formalize the profession of medical psychiatry, such as the establishment of journals and a professional body for those working in asylums and similar institutions.Footnote ⁴⁵ In addition to helping to advance the theoretical basis for treatment of mental illness, such bodies enabled greater communication and sharing of practice between Medical Officers involved in asylum management.

Intellectual engagement was closely linked to using music to develop self-control. This was the primary therapeutic role of music in the asylum during the period. The Annual Report of the York Retreat in 1908 commented that many visitors attending concerts alongside patients were ‘greatly surprised at the appreciative reception accorded to them’.Footnote ⁴⁶ The weekly balls at the Worcester Pauper Lunatic Asylum were credited with important changes in patients’ health, both directly and due to the self-discipline required in order to be allowed to attend:

Although self-control is cited as the key cause of recovery, the general entertainment and positive effect of music is also given credit. The Medical Superintendent, James Sherlock, is perhaps suggesting that discipline and self-control are the key benefits for manic patients, in contrast to the melancholic patients described subsequently. In 1864, Sherlock suggested a more direct relationship between music and treatment:

Whereas in the earlier report Sherlock is mainly referring to patients suffering from melancholic illness, here his comments are more applicable to patients in a manic, or over-excitable, state. Where patients could not be cured, at least they would be contained. Music promoted self-control by providing a focus for the attentions of patients unable to concentrate their minds or, perhaps, control their bodies. As music fitted within very carefully regulated social events, particularly the dance and the chapel service, it was perhaps the combined effect of music and of social or behavioural expectations that produced such a desirable effect. Nevertheless, if patients were unable to control their behaviour in other day-to-day situations (such as the dining hall or ward), their contrasting behaviour at musical events suggests the particular effect of musical listening (or participation via dance or religious worship) was an important factor in this element of therapeutic treatment.

Music's place in religious worship was likewise linked to self-control. The Chaplain at the Gloucester County Asylum reported in 1888 that

Here, listening to music helped to produce the reverent atmosphere suitable for chapel worship, again helping patients to act within expected social norms. Patients were able to join in through hymns, psalms and sung responses, but many chapels also supported choirs and a mix of participation and listening was therefore usual for chapel music.

As asylum management took on a more formal role, with medical professionals at the helm, the place of music received further attention. John D. Cleaton, the Medical Director at Wakefield, noted in 1858 that ‘amusements and recreation repeated periodically and with moderate frequency are now generally recognized as Elements of Medical Treatment in insanity’.Footnote ⁵⁰

One important feature of music was its ability to act differently on different patients. Reporting generally on music within the institution, the Gloucester Chaplain suggested that ‘there can be no question that the various amusements and recreations provided for [the patients] are great factors in appeasing the unstrung mental faculties, and in drawing the morbid mind into healthier channels of thought’.Footnote ⁵¹ Cleaton similarly reported the powerful effects of music in restoring balance of energies in patients:

Cleaton's observations also echo the suggestions made by Sherlock at Worcester, linking music both with raising the spirits of the melancholic patients, and with fixing the attentions of patients suffering from mania. It is interesting to note that the same musical events could have such markedly different effects on different groups of patients. In contrast to the generalized, large-scale nature of musical events in nineteenth-century asylums, Cleaton's account suggests that music did, indeed, work in a personal manner for his patients. Those suffering from an excess of energy found that music could focus their attention and improve their self-control, while those depleted of energy experienced an uplifting, energizing response. Although asylum reports tended to focus on the self-control and intellectual fixing engendered by music, this suggests that the emotional and pleasurable aspects were equally important for depressive and melancholic patients.

There is little discussion about the kinds of music, or musical events, suitable for patients in the asylum or suffering from different forms of mental illness. As psychiatric treatment began to receive more scientific attention and a medicalized approach adopted from the 1870s, music's role as informal therapy continued, but received little further investment or attention. Asylums continued to host bands and choirs, but increasing patient populations and financial pressure meant that this aspect of asylum life, and indeed the broader question of moral management, was not further developed. The general idea of music as therapy was, however, taken up on occasion, perhaps most notably by the late-nineteenth-century innovator Frederick Kill Harford, whose 1890s organization, The Guild of St Cecilia, experimented with music as a formal component in hospital treatment. In contrast to earlier practitioners, Harford did consider different types and genres of music to be suitable for the treatment of different ailments, particularly where patients suffered from mental illness.Footnote ⁵³

The overall positive reports of music in asylums are countered by occasional suggestions that music had a potential negative effect. Music was not encouraged during the early days at the York Retreat: it was unsuitable given the Quaker foundation of the institution and the wish to provide a simple lifestyle free from over-stimulation. An 1850 letter from Samuel Tuke reflects the continuation of these views. Tuke was descended from the Retreat's founders and maintained a close interest in its management. He writes

Tuke's cautionary words reflect the impact of musical listening on patients, particularly the energy produced in melancholic patients and reported by Sherlock and Cleaton. On the other hand, he does not appear to consider the potential of music or drama to produce self-control or intellectual stimulation. In this case he is perhaps referring to a more complex and participatory form of event, but the question of the overall effect of musical listening, particularly when linked to a single event, remains. Where other writers have argued for the long-lasting impact of a musical performance (beginning from the anticipation several days beforehand and perhaps leading to eventual recovery), Tuke sees entertainments as individual events which, while producing strong and perhaps positive effects on the patients, would only serve to exacerbate the feelings of melancholy or dissatisfaction felt in the rest of life.

The Retreat's religious foundation meant that music, along with many other recreational activities, remained outside the scope of its provisions for patients until the influx of a broader selection of classes and religions in the second half of the nineteenth century. Prior to this, the Retreat ran on a simple combination of work, exercise and religious observance; its charitable foundation meant patients’ skills were put to use in domestic work and simple crafts with no provision for recreation.

One patient record of musical activities further critiques the place of music in the asylum. Elizabeth Naish Capper, who had been a patient at the Retreat in the first half of the nineteenth century, wrote later reporting on the afternoon religious meetings that

Boredom and melancholy were significant problems at institutions, where little was done to provide for the day-to-day activities of patients; as with Harford's patients, the wrong kind of music could, perhaps, have a negative effect. At the Retreat it was not until the late 1830s that land for farming and outdoor occupations was purchased. From the 1850s wealthier private patients were accepted, in part to ameliorate the financial difficulties of the charity. With them came a more open approach to music and recreation that gradually saw the adoption of carefully controlled entertainments as part of the asylum's offer.

Musical listening and its reporting clearly sat within very carefully constrained social and institutions boundaries – whether the need to justify spending on the arts and pleasurable activities in state-funded institutions or the religious convictions of the Quaker foundation at the York Retreat. As medical activity formalized there was an impetus to include theoretical and scientific bases for music, as well as other aspects of ‘moral management’. The development of scientific method from the 1870s meant the day-to-day aspects of patient treatment began to receive less attention, particularly in formal reports. An article by Richard Legge, published in 1894, provides further indications of the ways in which music and musical experience, particularly listening, interacted with notions of insanity within the lunatic asylum.Footnote ⁵⁶

Legge's Observations on Music and Insanity

Richard Legge served as an Assistant Medical Officer at the Derbyshire County Asylum, later succeeding to the post of Medical Superintendent. Legge had a special interest in patient responses to music, and he drew on a series of observations in his article, most notably linking different forms of insanity with reactions to, and relationships with, music, both in terms of listening and performing. Like many asylums, by the 1890s Derby provided a number of opportunities for musical experience; and Legge's account suggests patients had regular access to pianos, music in the chapel, and more formal performances. Legge also refers to patients playing in asylum bands, which was more unusual even during the later period.Footnote ⁵⁷

In common with some of the approaches taken by Medical Superintendents elsewhere, Legge largely considered musical experience in terms of an intellectual appreciation: his report focuses on the ‘Musical Faculty’, including both the evidence of a ‘Musical Ear’ and emotional responses to music. Alongside these he considered the more advanced skills of execution and composition.Footnote ⁵⁸ Assessing a musical ear was not without its difficulties, however: Legge recounted that ‘it is not easy to determine accurately the amount of ear for music which a person may possess, and with the insane the difficulty is increased; in the case of idiots, often, all that we can do is to form a rough judgement, by listening to their singing and noting if it be in tune’.Footnote ⁵⁹ Nevertheless, Legge attempted to formulate a potential link between mental illness and musical ‘ear’ by observing patients’ appreciation of musical intervals, tuning and rhythm.

Many of the patients Legge chose to observe were active in producing music – playing the piano or singing hymns were the most common manifestations of a musical interest. Yet listening does play an important part in his assessment of musical ability, although recorded with less detail than performance. In most cases Legge suggested that musical appreciation was significantly reduced by a patient's afflictions. Among patients suffering from mania this was most acute. Among those experiencing acute mania, for example, he noted that ‘music heard by him has little effect; at most it arrests his attention for a moment, or turns the current of his thoughts into a different channel’.Footnote ⁶⁰ A similar effect is recorded among patients suffering chronic mania, although here Legge also makes reference to the specific impact of musical listening: ‘Excitable patients occasionally become excited on hearing lively music; but on the whole, I think that susceptibility to musical influence is less marked among chronic maniacs than among the sane.’Footnote ⁶¹

Regarding melancholic patients, Legge had little more positive to record. Patients with melancholia, he reported, ‘seldom play, and are seldom pleased on hearing music’.Footnote ⁶² He refers to an observation made by Florence Nightingale, noting the effective use of music with a sustained character (such as a harmonium) in treating the sick. While this might apply to those with mild depression, Legge argues, in the case of severely depressed patients ‘music of a sad character deepens the patient's gloom, while lively music often irritates him as out of keeping with his feelings’.Footnote ⁶³ Furthermore, music of a ‘high class’ required an effort to appreciate, beyond the capabilities of melancholic patients. While musical entertainment could act as an effective boost for those already recovering, or to brighten the lives of ‘permanent residents’, it was ineffective as a means for beginning to cure such patients.

Legge's pessimism continues throughout his account of other types of mental affliction. Among patients suffering from general paralysis, he noted a ‘loss of ear for music’; among dementia patients he recorded that ‘after the capacity for appreciating music has been lost, the power of performing upon an instrument remains’.Footnote ⁶⁴ One patient is recorded as retaining her ability to play complex piano pieces, though without musical feeling or intelligent understanding, although ‘she takes no notice of music played in her hearing’.Footnote ⁶⁵ It was only among ‘idiotic’ patients that the musical ear played a particular part in the patient's remaining abilities; Legge notes that ‘in idiocy we find that a rudimentary aesthetic sense frequently exists in cases where other common mental attributes are nearly, or quite, absent’.Footnote ⁶⁶ The musical capacity of ‘idiotic’ patients, he found, was on a par with ‘musically-uncultivated sane persons’: while general enjoyment of music might remain, the reduced intellectual faculties meant that appreciation of complex musical forms or emotional expression was impossible.Footnote ⁶⁷ Among the fifty ‘idiots’ he examined, thirty were found ‘to be pleased when they hear music’.Footnote ⁶⁸ One of Legge's ‘idiotic’ patients further demonstrated the power of music to penetrate intellectual incapacitation. This particular patient ‘had never been heard to speak, and was supposed to be deaf and dumb, until she was heard singing a tune picked up from another patient; she took little notice of unmusical noises, even when loud, but usually showed pleasure on hearing musical sounds; she was almost devoid of intelligence, could not walk, and did not recognise her nurse’.Footnote ⁶⁹

Legge's experiments show that, even in the absence of other intellectual abilities, patients continued to demonstrate a mental engagement with music. Here, the pleasurable and the intellectual are entwined. Legge's work explored the different ways in which music could be engaged with and appreciated – whether in performance or in listening. Legge's interest in the aesthetic also extended the work of earlier Medical Officers from the general to the specific, investigating mismatches between physicality, intellectual and emotional engagement (such as the pianist who played with no musical feeling).

Legge's consideration of musical listening, intellect and appreciation speaks to some of the contemporary debates about the aesthetics of listening. In particular, papers read at the Musical Association had responded to John Stainer's influential book on Music in its Relation to the Intellect and the Emotions, first published in 1892.Footnote ⁷⁰ Stainer argued that intellectual engagement with musical form was a necessary pre-requisite for a true emotional response; advanced musical training, resulting in a more detailed intellectual understanding, would result in a deeper emotional experience. Given the choice between intelligence and emotion, Stainer is unashamed about his preference for the ‘intelligent non-emotionalist’ over the ‘untrained emotionalist’; while the judgement of the former is limited, the experience of the latter is of no value at all.Footnote ⁷¹ It is clear from the evidence we have about musical listening in asylums that direct, emotional engagement with music was certainly part of the way in which music was received, but that it was the use of music to move patients towards self-control and an intellectual engagement with both music and the world at large that meant it took on further prominence as part of the therapeutic package. Some of this approach was also to be found in Legge's summaries, but applied to the ‘higher’ skills of performance and composition. He suggested that, while mechanical ability might not be impaired, ‘as the higher expressions of the aesthetic sense involve not only emotions of great complexity, but much pure intellect, so, in the power of employing music as a means of appealing to the higher feelings, the capacity of the imbecile diminishes pari paneu with his mental power’.Footnote ⁷² It is Legge's work, rather than the generalized musical events of the earlier asylum regimes, that speak more closely to modern-day, personal approaches to music therapy.

Legge's article doesn't carry his observations through to any suggestions about using music to treat insanity; by the end of the nineteenth century medical advances meant that, while music and other aspects of moral management remained important parts of asylum life, ‘treatment’ had taken on a more systematized and medicalized form. Yet in parallel to Legge's interest, the work of Frederick Kill Harford aimed to use these kinds of observations to introduce music as a regular part of treatment. Legge's observation about excitable patients, in particular, was echoed in Harford's work in his attempts to provide a style of music appropriate to each patient's ailments.