A biography of William Tuke (1732–1822): Founder of the modern mental asylum

Early and family life

William Tuke (Figure 1) was born in York on 24 March 1732, the only child of Samuel and Ann Ward, members of the prominent Tuke family of Quakers. He was educated in York before continuing his studies under the guidance of clergymen. At a young age he became involved in the family-run coffee and tea business and remained in it until his old age. As a Quaker he was heavily involved with the Society of Friends in York which further paved his way into his works with the mentally ill. ¹ OPEN IN VIEWER

In 1754 he married Elizabeth Hoyland (1729–1760), his first wife, and fathered four children. Their eldest child, Henry (1755–1814), later took a role within his father's Retreat. After Elizabeth's death he married Esther Maud in 1765 with whom he had three further children. ¹

Treatment of lunatics in the 18th century: Mental asylums

During the 18th century there was a shift in the theories of madness from a spiritual disease, instigated by the possession of the sufferer by the devil, to a more secular condition. It was thought of as a loss of rationality that degraded the humanity of a person to a level not dissimilar to an animal. Thus the emphasis on responsibility to lunatics changed from that of the Church, workhouses and prisons to asylums. However, this evolution was only in location and much of the traditional treatments remained. Patients of such asylums were subjected to archaic remedies based on Galenic ideas of the four humours which included blood, phlegm, black and yellow bile. This was undertaken to the extent that patients were regularly bled or coerced into swallowing purgatives and emetics. These were often combined with actions to suppurate the body by trepanning or creating artificial blisters. In addition to this, some patients were restrained using chains, manacles and the techniques of fear, which were used to ‘jolt apart’ the misconceptions that troubled them. Tuke believed these methods to be inhumane and so the idea of a modern institution was realised. ²

The Retreat

In 1791 a member of the Society of Friends, Hannah Mills, was admitted to York asylum with the diagnosis of melancholy ³ and soon died. It was suspected that she had been maltreated due to the refusal of the managers to allow Friends and family to visit her during her stay. This incident was brought to Tuke's attention upon which he decided to act. It was in fact his daughter Ann Tuke who instigated the idea for a new institution run by Quakers for Quakers. ¹ Tuke proposed this idea as ‘an institution for the care and treatment of those who laboured under that most afflictive dispensation – the loss of reason’ ⁴ to the Society of Friends at the March 1782 meeting. Although first faced with some discord, Tuke argued his proposal forcefully and eventually it was approved. ³ It was then decided that a building capable of housing 30 patients was to be erected in spacious and attractive grounds. ⁴

In the hope of further understanding the requirements of such an endeavour, Tuke visited St Luke's Hospital for lunatics in London, contemporaneously felt to be second in reputation only to Bethlem. Here he witnessed a young woman, naked and filthy, chained to a wall. This experience had a profound effect on him and he realised the managers did not intentionally endow cruelty on their wards; it was, in their eyes, a necessity in order to treat the mad. ⁴

In June 1795 funding for the project was still modest and the lack of support from the Friends was becoming more apparent. However, one enthusiast, a fellow friend, Lindley Murray, came forward. Immediately he set his thoughts to raising funds and developed the idea of using annuities, a method most attractive to the Friends. Once these promises had been settled, Tuke was given permission to search for a suitable location, which he found half a mile from the city. The 20-acre site had elevated and airy grounds and cost £2,325 but was, at once, reduced by eight acres and sold for £938. ³ A London architect, John Bevans, was then hired to construct the building. Tuke was much involved in the design process and his ideas were most unlike those for other asylums in that they were imaginative, lavish and supportive of their principle of compassion (Figure 2). One feature of note was the long wide corridors or galleries as they were named to enable patients to take longer walks when they were unfit for outdoor stimulation (Figure 3). ³ OPEN IN VIEWER

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Figure 3.

Ground plan of The Retreat, York, reproduced with the kind permission of the Wellcome Library, London.

The Retreat was arranged under a set of four basic guidelines. ⁵ The first was that there was to be complete separation of males and females although some interaction was permitted when it benefited the patient. Second, patients were categorised on the basis of their states of mind and then organised into an appropriate number in which they could be housed. This was revolutionary since common practice at the time was to keep patients in large numbers on the basis that the turbulence and confusion they would face in such a large group would bring them to refocus their attention on themselves and ergo return to normality. However, Tuke noticed that patients in smaller groups were able to form close bonds with other patients with similar maladies and often would support each other through their eccentricities and essentially form a small supportive society. ⁵ Tuke saw this to be a more beneficial and healing environment to the patient as was demonstrated by the woman he observed at St Luke's who was transferred to The Retreat and made a more satisfying recovery. ⁴ Individual seclusion, however, was not deemed appropriate at The Retreat and was reserved for the most difficult and violent patients. ⁵

Third, in terms of the atmosphere and environment Tuke encouraged the idea of comfortable and free surroundings. Accommodation for patients was required to be ‘cheerful’ and to allow them every opportunity to vary their daily scenery. They were allowed visits to their places of worship with an attendant as well as being given routine jobs such as sewing. ⁵ Nevertheless, these circumstances would also have to adhere to the basic security of the patients. Finally, in order to ensure safety and protection of his patients, Tuke compiled a system in which attendants to the patients would have to be presided over by their superior officers, thus guaranteeing that patients would not be abused by subordinate members of staff as had been known to have occurred at other institutions. ⁵

Medical and moral treatment

Despite the large number of administrative duties, Tuke played an active role in managing The Retreat. He took particular interest in the treatment of the patients and was very supportive of an empirical practice of medicine. His appointed doctors were given the freedom to make observations and subsequently use their findings in their daily practice. Thus The Retreat became unique in administering treatments that were not deemed appropriate at the time. The philosophy behind this was that

‘any medicine …  should not be administered when the aversion of the patient was great, unless the general health strongly indicated its necessity; well aware, that otherwise, the probable good would not be equal to certain injury’. ⁶

This meant certain traditional treatments such as bleeding were deserted in favour of newer, more benevolent approaches. The warm bath was one that was persevered with and was found to be very effective for those afflicted with melancholia. Another empirical finding was the sympathetic existence between the body and the mind. Tuke, having understood this connection, often had the patients’ physical needs attended to and often sought to tend to their general health first; diet and exercise were also considered of paramount importance and were monitored. ⁶ In his personal letters he often described to one of his correspondents the separate ailments of each patient. ⁷

The Retreat was known at the time as a pioneer in the moral treatment of the mentally ill. Tuke worked under strict principles based on his Quaker values and applied these to the running of his hospital. He had observed that many of the patients on admission showed no signs of insanity to such an extent that they could not be diagnosed as having a mental disorder at all. This he deduced was through the retention of their own self-restraint and command, pertaining to their fear of an increased duration of stay and a harsh mode of management had they exhibited any of the traits. Therefore Tuke found treating the patient in a manner that appealed to this, through kind and mild persuasion and encouraging a sense of reason, made for better progress in terms of fewer instances of violence and manic excitement and even suicidal thoughts. However, he also discovered that fear played an important part in maintaining the patient's behaviour. Nevertheless Tuke decreed that fear was not to be excited in any patient more than was necessary for daily tasks; too much fear caused all reason to exit the patient and allowed him to tumble into even worse states. ⁶

Despite this, in certain rare situations stronger methods of coercion were needed. In these cases patients were not shackled to chains and corporal punishment was forbidden, and instead, straps were used to restrain patients and, in the most severe circumstances, a straitjacket was used. This was seldom the practice as patients at The Retreat were very well behaved and as a result the superintendents were allowed to host tea parties where patients would be treated as normal persons. ⁶

These methods were at the time a novel way of dealing with the insane and often were met with doubts and resentment but Tuke persevered and enjoyed a higher success rate than all of the other institutions for the insane.

Other work and later life

Tuke's work was not confined to that of the mental asylum. He was instrumental in founding three Quaker schools in the York region and he appointed his wife to run one of them. He was an activist against the slave trade and demonstrated this in his support for William Wilberforce (1759–1833) who was campaigning in a Yorkshire parliamentary election for the abolition of the slave trade. ⁸

He was known as an ‘active and infatiguable labourer’ ⁸ and consistently sought to improve the standards of his own life and that of others whom he would sometimes reprimand if they did not meet his standards. ⁸ Even in his old age Tuke gave evidence to the Select Committee on Madhouses ⁹ which was appointed in 1815. This led to further inquiries that resulted eventually in the County Asylums Act of 1828, detailing a higher standard of care required by proprietors of madhouses to hold a licence. ³

Throughout his whole life Tuke was a devout Quaker and spread the Holy Scriptures both at home and abroad. His moral sense of duty was unquestionable and he proved this time and time again. He maintained his role within The Retreat until only the onset of blindness stopped him at the age of 82. He died on 6 December 1822 following a paralytic attack. He is buried in the Friends’ Ground, Bishophill, York. His name lives on in the work he achieved for humanity. ⁸