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December 22, 1993

The Most Solitary of Afflictions: Madness and Society in Britain 1700-1900

JAMA. 1993;270(24):2982. doi:10.1001/jama.1993.03510240098041

This text seeks to document the historical reasons for the shift from the medieval British societal response of not segregating the mentally ill to the 19th-century practice of patients being "incarcerated in a specialized, bureaucratically organized, state-supported asylum system which isolated them both physically and symbolically from the larger society." The author notes that medieval England had an unsystematic approach to the care of the mentally ill, and the state had to take more control. In the 18th century these individuals were isolated from society in workhouses, prisons, and hospitals. Since the mentally ill did not fit into these settings, the desire to separate them out began to be a priority, and they became identified as a market.

In 1815 a parliamentary inquiry began, and the bad conditions in asylums were exposed. The first attempt at passing reform bills failed owing to their threat to the "mad" business. Since local