“Better…at the Bottom of the Sea”?: Affect, Agency, and the Archive at Holloway Sanatorium

In August 1889, an English woman named Charlotte S. experienced a depressive episode marked by religious delusions. Convinced there “was no hope for her in Eternity,” the once “strong, healthy [and] active” fifty-five year old was certified insane^[1] and institutionalized at Holloway Sanatorium.^[2] When patients were admitted to Holloway, staff recorded their personal details in hefty leather casebooks. As treatment progressed, staff noted updates and, in about one third of all cases, affixed a photograph of the patient to their chart.^[3] The casebooks are now fully digitized and available online through the Wellcome Trust. Although some patients recovered, the casebooks contain many tragic accounts of those who did not, and whose struggles surface in an archive that renders them “dirty” and “incoherent.”^[4] One patient, a twenty-eight year old schoolteacher named Emily E., told doctors that it “would be better to her if she were at the bottom of the sea.”^[5] She is long deceased, but the Holloway archive remains. Who should have access to the record of private pain? Ought we to consign the Holloway archive, and the suffering it contains, to oblivion?

When Holloway Sanatorium was founded in 1885, the co-ed institution positioned itself as a humane and modern asylum – an alternative to the madhouse for those who could afford it. Situated on twenty-two acres of lawns and gardens in Virginia Water, the sanatorium’s Gothic Revival campus was equipped with amenities like a bathhouse and chapel. Patients engaged in activities appropriate to their bourgeois social class, such as strolls on the grounds, dances, concerts, and excursions to stores in London.^[6] The medical superintendent even hired a few same-gender companions for patients with the aim of encouraging “normality and socially acceptable behavior.”^[7] While doctors at Holloway provided care based on their best abilities and the science of the time, 19th century understandings of mental illness were different from our own. There was little agreement about the causes of, much less cures for, mental illness.^[8] Accordingly, etiologies in the casebooks are often circuitous (e.g. “the supposed cause of…attack is previous attack”)^[9] or barely attempted (e.g. “the supposed cause being absolutely unknown”).^[10]

Unlike the frontal, mug-shot style photographs taken directly upon admission at most asylums, photographs at Holloway were not systematized and presented subjects in a range of poses. Often borrowing from the dialect of Victorian family photo albums, staff cut the photos into shapes (an oval, or perhaps a square with trimmed edges) before pasting them into the patient’s file (below).^[11] Their distinct visual register, which slips between the aberrant and the normative, has generated new scholarship examining these images more closely.^[12] However, the photographs also surface key issues related to consent, privacy, and the potential for voyeurism in terms of both their original production and our current access to them. This concern is not just a modern ethical hang-up. At the 1901 meeting of the Medico-Psychological Association of Great Britain, one doctor asserted that “he did not think that anyone had a right to photograph insane patients.”^[13] Yet the photos also present an opportunity to bear witness to how, even at a reform minded institution for the upper middle class like Holloway, attempts to cure the mentally ill involved control and coercion.

For example, the first page of the entry for Constance C., a nineteen year old from Winchester, shows her being held by two nurses to be photographed – much like a butterfly pinned for display in a glass case (below). Although the nurses are sliced out of the photo, the book’s spine and the margin of the page do the same work of keeping Constance in line. The notes reveal that she “had to be subjected to slight restraint” and was confined to sleep in a padded cell rather than a general dormitory.^[14] She was also given what were called “continuous baths,” in which the patient would sit for hours in a tub of hot water and have cold water poured over their head.^[15] Physically restraining patients within the bath was not an uncommon practice, and the casebooks report that Constance C. had a “strong aversion” to this treatment. Considering this evidence, the camera can be seen – to borrow the words of the casebook chronicler – as a “slight restraint.” The “slight restraint” of photography was used at Holloway alongside forms of physical restraint such as sleeve jackets, locked gloves or leather mitts, padded rooms, hypnotic/sedative drugs like chloral and sulfonal, central nervous system depressants like paraldehyde, and electrotherapy.^[16]

Evidence of coercion can also be located in images that, at a quick glance, appear to eschew such forms of control. These photos show patients posing outdoors in fashionable clothes. In one such image, a woman named Elizabeth M. dons a fur trimmed coat and glances away from the camera (below).^[17] It is tempting to read her stylish appearance as an expression of individual agency and identity. However, the casebooks suggest the opposite. They observe that Elizabeth M. was “incapable of saying how long she has been here or where she lives”^[18] while another patient, Hélène P., “invariably required about 10 nurses to dress + undress her.” ^[19] It is thus likely that many patients were dressed by staff. The effort to dress and photograph patients is consonant with the “moral treatment” favored by 19^th-century asylums.

The prominence of photography in the Holloway casebooks might be viewed as part of a wider effort to cure patients by assimilating them to the very image of bourgeois normalcy. This interpretation is supported by the fact that the casebooks often associate the recovery of female patients with their resumption of gender-appropriate behavior. For instance, notes marking an improved mental condition comment that Eva M. “begins to take an interest in her appearance, keeps her dress and hair tidy.”^[20] Some patients thoroughly resisted being dressed. For instance, forty-five year old Mary J. repeatedly destroyed the dresses she was given, and instead accessorized herself with “pieces of wool + odd scarfs [sic] of paper.”^[21] There is poetry in how her casebook portrait has slowly curled in on itself, disdaining to represent her in an outfit she did not want to wear (below).

Forty-five year old Mary J., MS 5158 322. (Courtesy Wellcome Trust)

Back of photograph of Mary J., MS 5158 322. (Courtesy Wellcome Trust)

Although the camera was used as a tool of restraint and conformity, it also often reveals what the written treatment histories cannot: the patients as distinct people. For example, in a photo of Henriette C., the patient at first appears to be sleeping (below). However, upon closer examination, she is looking directly at the viewer. The thirty-one-year-old mother was subjected to electrotherapy and either force fed or fed with a tube up to three or four times daily. She figures in the casebook as “very troublesome” for her physical resistance (“struggling, kicking + shouting”) to these forms of treatment.^[22] Yet here we can glimpse an aspect of her personality – her particular, wakeful attention. She is laid out in bed like a supine Christ on his tomb, but she is not dead. Nor will she be surveilled passively; instead, she attends to us looking at her and even orchestrates our gaze with the raised placement of her hands. In contrast, the casebooks often fail to link Henriette C.’s affect with any deeper significance. For instance, they observe that she “is emotional, will burst into tears for no obvious reason.”^[23] Yet as modern viewers, we can assume that every facial expression and bodily gesture has meaning, even when we cannot read the emotional iconography. Our task, in viewing these photos today, is to restore the coherence and integrity of the patients they depict.

The stakes for doing so are all the higher given that these images are easily accessible online. The risk of voyeurism is exemplified by a recent incident, in which two historians of medicine found psychiatric records offered for sale on eBay. This, they write, is part of a wider, “stigmatizing subculture around madness and disability, intended to evoke prurient curiosity, fear, and disgust.” Their concern is duly noted. Indeed, some of the Holloway images have already found their way onto Pinterest boards. At the same time, perhaps we can see the internet not just as a liability, but as an asset too, making it possible to share debates about sensitive images and histories with the broad public – something historians of medicine have called for.^[24] After all, we are the heirs of Charlotte S., Emily E., Constance C., Elizabeth M., Mary J., and Henriette C. What they lived through is ours to contend with now, in a society in which ‘mental health’ has become an omnipresent buzzword, but the crisis of mental illness only continues to worsen. Furthermore, the language of psychology has increasingly entered the mainstream, with the dubious effect of pathologizing normal behavior and diagnosing relational conflict as toxic. While the Holloway photographs present neither easy solutions nor tidy narratives of recovery, they do offer an opportunity to nuance contemporary discourse around mental health. They ask: how do we attend to our vulnerable past? In looking closely at these photos, we do perhaps run the risk of disturbing the dead but for good reason. Through our attention, we wish to do them justice.

Adriana C. van Manen

Adriana C. van Manen is an Ada Comstock Scholar at Smith College, where she is on the editorial staff of the journal Dies Legibiles. Her interests range from 20th c. female surrealists to late medieval manuscripts. Her work has been published in NYU’s undergraduate journal of art history and she has presented at the SUNY New Paltz undergraduate symposium.

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