John Thomas Perceval (1803 – 1876) founded the first ever user-led advocacy service, the Alleged Lunatics’ Friend Society, in 1845. Perceval’s beliefs about mental distress and recovery resonate with those of the service user/survivor and advocacy movements today.
Perceval was a very remarkable man and was author of a moving account of his own incarceration and (mis)treatment for mental ill health, A Narrative of the Treatment Experienced by a Gentleman, During a State of Mental Derangement: Designed to Explain the Causes and the Nature of Insanity and to Expose the Injudicious Conduct Pursued Towards Many Unfortunate Sufferers under that Calamity. The first volume of the Narrative appeared anonymously in 1838, and the second volume, under his name, in 1840.
His father was a politician who became prime minister, only to be assassinated in the Houses of Parliament in 1812, when John was only nine. His killer was John Bellingham, diagnosed as insane and hung shortly after. In his Narrative, Perceval describes an idyllic upbringing broken by the murder ‘I was born of parents powerful, honourable, and happy, till a cruel blow deprived my mother of a husband, and her family of a father.’ He was educated at Harrow, served briefly in the army, but left and went up to Oxford University. While there he heard of an evangelical group in Scotland and decided to leave to learn more of the so-called ‘Row miracles’. However he found the experience of seeing others having visions and speaking in tongues in church disturbing, and the group in turn considered him very odd.
Perceval left Scotland after three months and went to stay with friends in Dublin, and it was here, in December 1830, that he experienced his first breakdown. In January 1831, his oldest brother Spencer brought him in manacles
by coach from Ireland to the well-respected private madhouse establishment of Dr Edward Long Fox (1761–1835) at Brislington (Gloucestershire). Perceval was ‘treated’ with shockingly iced baths and forced dunkings, cold vapor baths, and medicines that he called ‘noxious fumigations’, and twice with bloodletting.
In May 1832, after continual protests, he was transferred to Ticehurst House in Sussex, owned and run by Dr Charles Newington and probably the most lavish asylum in the country – although luxury was most certainly not Perceval’s experience: ‘I met… with nothing but severe falls and blows on my face and arms from the door, and rough handling from my attendant; who threw me back violently on the seat, and when there struck me in the abdomen, and then pitched into my face.’
Perceval became deaf in his left ear as a direct consequence of the attacks he experienced from his ‘keeper’. After three long years in madhouses, Perceval finally got his freedom in 1834, moved to London, and married Anna Gardner. They had four daughters – the first born in 1836. He decided to write a book of his experiences and moved to Paris in 1835, where he met Dr Esquirol, soon to be a leading figure in the reform of asylum abuses, who advised him about the political actions needed for reforming the lunacy laws. Perceval wrote a great deal of his Narrative, published in two volumes in 1838 and 1840, during this period.
Journey out of madness Perceval’s Narrative is essentially a journey backwards into madness, in which he is trying to make some sense of what happened to him, five years on. He describes the barbarity of treatments beginning in Dublin, at Brislington and later at Ticehurst. Some were part of the so-called ‘heroic regime’ – based on attempts to shock the unwary lunatic into sanity – which included freezing baths. Other strategies were based on disrespect and devaluing, which Perceval found unusually abhorrent because of his aristocratic background: ‘The gross want of respect to situation, rank, character, or profession, manifested by these men on all occasions, is shocking to the imagination, and revolting to reflection…’
Other practices were simply ‘man’s inhumanity to man’ – the characteristic of mental health services for centuries – ranging from mocking and winding up through to unnecessary seclusion and manacling to kicks and punches. Things were done daily without the slightest attempt to consult or engage with him. The madhouse regime was aimed at breaking down his will and rendering him remonstrance; and impolitic, without a thorough knowledge of the temper and humour of the individual to whom it was applied.’ The Narrative reflects on what might help in healing. ‘The chief thing to be desired in the treatment of an insane person is quiet, peace, security; security from intrusion, observation, exposure. A lunatic appears insensible, but his is, perhaps the most alive of any mind to ridicule, and to the contemptibleness of his state… If indeed, he were in quiet, peaceful circumstances, if he were secure he might find his mind reflect to his conscience perfectly, what the trouble occasioned by internal and external alarm prevents him noting; but the opposite is his position.’
As Perceval gradually recovered, he considered the key issues in healing and understanding. He explores the meanings of literal and metaphoric communication as well as the spirit: ‘… you will hear one lunatic declare that he is made of iron, and that nothing can break him; ‘I resolved – I was necessitated – to put my strength and abilities against that system… in order to expose and unravel the wickedness and the folly that maintained it, and to unmask the plausible villainy that carried on totally passive and compliant. My silence, I suppose, gave consent. I mean, that I was never told, such and such things we are going to do; we think it advisable to administer such and such medicine, in this or that
manner; I was never asked, Do you want any thing? Do you wish for, prefer any thing? Have you any objection to this or to that?’
Perceval sums up his brutal experiences in Brislington: ‘For nearly eight months I may say that I was never out of a strait-waistcoat; I used to be tied up in it, in a recess the whole day, on a wooden seat, for months and months, with my feet manacled to the floor, and in the presence of fourteen other patients.’ In the eyes of Perceval, the mad doctors understood very little about insanity and its treatment: the 19th century mental health services offered almost the exact
opposite of what was needed for recovery: ‘I needed quiet, I needed tranquility; I needed security, I needed even at times seclusion – I could not obtain them. At the same time I needed cheerful scenes and lively images, to be relieved from the sad sights and distressing associations of a madhouse; I required my mind and my body to be braced, the one by honest, virtuous and correct conversation, the other by manly and free exercise; and above all, after the coarse and brutal fellowship I had been reduced to, I sighed for the delicacy and refinements of female society.’
In Perceval’s view, staff needed to comprehend the whole social context of their patients. This had to begin with understanding the meanings of the various ‘delusions’ expressed. Nothing was just nonsense; everything had some sort of meaning. Instead: ‘If the insulting and degrading treatment… was indeed designed to mortify and probe the feelings, it was preposterous, without explanation, expostulation, or another, that he is a china vessel, and that he runs in danger of being destroyed every minute.
The meaning of the spirit is, that this man is as strong as iron, the other as frail as an earthen vessel; but the lunatic takes the literal sense, and his imagination not being under his own control, he in a manner feels it.’ Later he becomes even more specific about methods and remedies. He starts to consider the central significance of breathing and the links between body and mind: ‘… a healthy state of mind is identical with a certain regulated system of respiration, according to the degree of bodily action; that the exercise of reflection or of conscience, in the control of passions or affections of the mind, is concomitant with, or effected by a proper control of the respiration – quiet when the mind is quiet,
accompanied with sobs and sighs when otherwise. That the mind and the blood being intimately connected, the health of the body depends also on this healthy regulation of respiration, promoting a proper circulation and purification of the blood; that, consequently, the effecting respiration by mechanical means, without the control of the muscles by thought, is profitable to the health of the body, and also to the mental faculties.’
Slowly Perceval’s distress and confusion turns to compassion for others, and on to advocacy. In chapter xxvii of the Narrative he comments extensively on ‘my wretched companions in confinement, and in affliction’. He writes about 12 individuals, one an elderly man, and feels for their pitiable circumstances. ‘The treatment I had endured was shameful, but yet I was a young man. The treatment of this old man was horrible. All day long he was confined as I had been, on a wooden seat, amidst noise, insult, flippancy, and confusion. After sitting a whole day, in the evening I heard him begging for one of the hair cushions of the chairs, to put under him; no one attended to him; I did: the servant desired me not to do it, but I gave it to him.’
Perceval became a warrior for better conditions and compassionate care. In the opening section of the first volume he cries out: ‘I open my mouth for the dumb… I entreat you to place yourself in the position of those whose suffering I describe, before you attempt to discuss what course is to be pursued toward them. Feel for them; try to defend them. Be their friends – argue not hostilely.’ In the second volume, it becomes a bold cry to arms. ‘I resolved – I was necessitated – to put my strength and abilities against that system, to fail in no duty to myself and to my country; but at the risk of my life, or my health, and even my understanding, to become thoroughly acquainted with its windings, in order to expose and unravel the wickedness and the folly that maintained it, and to unmask the plausible villainy that carried on.’
He saw the law and the English desire for justice as the primary route for radical change. He struggled to use the legal process for better conditions and his own release, with disappointing results. ‘In order to succeed I desired first legal assistance to set forth my case and to save my rights; secondly to be taken to London to be for a short time under the care of a surgeon who had known me from a child, that he witnessing my state of mind and body, and hearing my complaints, might be able to argue and to give evidence concerning the necessity of requiring me to use the cold bath, at that inclement season… These requests were denied.’
Soon after the publication of the books, Perceval began advocating for people in poverty, detained lunatics and against the new Poor Law. He gained an appointment as Guardian of the parish of Kensington. During his statutory visits, he learned about Richard Paternoster being confined at Dr French’s madhouse in Kensington, and campaigned for his release. When he was freed, Paternoster wrote a letter to The Times ‘for fellow sufferers to join him in a campaign to redress abuses in the madhouse system’. Perceval soon joined him, and they petitioned the city magistrates for an investigation into asylum treatment.
Perceval gathered together a group of supporters. This group expanded, and in 1845 became the Alleged Lunatics’ Friend Society (ALFS). Most were either ex-patients or had relatives in the psychiatric system; some were Perceval’s relatives. The ALFS pressurised successive Home Secretaries for radical changes in the asylums, including Northampton County Asylum where the famous ‘lunatic pauper poet’ John Clare was incarcerated from 1841 until his death in 1864, and took up the cases of more than 70 patients.
The Alleged Lunatics’ Friend Society became a major influence in highlighting the whole issue of improper confinement in the asylums with the very resistant Lunacy Commission. Differences that arose between Perceval and other founder members – not least, over his continued religious zeal – perhaps suggest that he remained a difficult person, but there is no evidence of any relapse into mental disturbance. The society advocated boarding out schemes rather than asylums for distressed people, based on the well- known Geel system in Flanders. John Bucknill, the leading 19th century alienist (psychiatrist), also recommended the Geel system. He also argued for non- restraint, with some few exceptions – an emerging characteristic of ‘progressive asylum practice.’
Perceval noted: ‘I am convinced that the collecting of lunatic patients together is a necessity to be deprecated, rather than a principle to be admitted.’ The society advocated traditional treatment systems before involuntary
admission and for after-care following discharge. Perceval gave evidence to a Select Parliamentary Committee in 1859. When asked why he was so single- minded about ensuring the delivery of patients’ letters, he responded: ‘I consider myself the attorney-general of all Her Majesty’s madmen.’
After 20 years of vigorous activity with Perceval at the helm, the society seems to have come to a natural end in the mid-1860s. ‘One suspects that the appointment of his nephew Charles Spencer Perceval as Lord Chancellor’s secretary in 1866, and later as secretary of the Lunacy Commission, finally gave him some peace of mind.’ Perceval helped us to understand in a profound way so many dimensions in madness, recovery and advocacy. He promulgated a very modern concept of advocacy – both peer, individual and collective – that flourishes robustly today. He made the valuable connection between spiritual exploration and breakdown; outlined some vital principles for healing and recovery, and linked embryonic advocacy with radical changes in the law and regulation to outlaw injuriously oppressive treatments.
His favourite offspring, the Alleged Lunatics’ Friend Society, was the first formal body to collectively advocate for the needs of users and relatives. Most importantly, he gave us the two volumes of his vibrant Narrative.
These wonderful volumes graphically describe the torments of an alleged lunatic, his ‘injurious treatment’ and his recovery. For which we owe Perceval an enormous debt.
Perceval J. A narrative of the treatment experienced by a gentleman, during a state of mental derangement: designed to
explain the causes and the nature of insanity and to expose the injudicious conduct pursued towards many unfortunate sufferers under that calamity.
Volumes I and II. London: Effingham Wilson, 1838; 1840.
Also see Patient and Reformer