Psychological Medicine, 1997, 27, 899–908.

Copyright # 1997 Cambridge University Press

Voices of the mad : patients’ letters from the Royal

Edinburgh Asylum, 1873–1908
A L L A N B E V E R I D GE"
From Queen Margaret Hospital, Dunfermline

ABSTRACT
Background. This paper is based on a rich archive of 1151 letters by patients, who were
admitted to the Royal Edinburgh Asylum during the reign of Thomas Clouston (1873–1908).
Methods. All letters were examined for evidence of psychopathology, and the material obtained
was organized under the various psychopathological categories, such as delusions or
hallucinations, as defined by Sims (1988).
Results. A descriptive account of patient symptomatology is given. It is found that nineteenth
century psychopathology is very similar to that of the modern day, and that most forms of morbid
mental phenomena can be found in the patients’ letters. More specifically, most of the cardinal
symptoms of schizophrenia were described in the patients’ correspondence. The letters also illus-
trate how mental symptoms reflect the cultural and scientific concerns of their time.
Conclusions. The evidence in the patients’ letters argues for the unchanging nature of mental
illness across time, at least for the last 120 years. It also demonstrates that patients admitted to
the Royal Edinburgh Asylum suffered from serious mental illness, and it undermines the view
that the Asylum was simply a dumping ground for society’s disaffected.

release from hospital, and there is, inevitably,

INTRODUCTION
As a result of recent clinical studies of Victorian
asylums (Renvoize & Beveridge, 1989 ; Turner,
1992, Beveridge, 1995 ; Doody et al 1996), we
now have a much greater knowledge as to the
types of mental illness that patients, admitted to
such institutions, suffered. These studies, how-
ever, were all based on documents written by
doctors : thus, the descriptions of patient symp-
tomatology relied on the information contained
in the medical casenotes, asylum reports and
registers. What has been missing, so far, has
been how the patients, themselves, described
their symptoms. It is true that we have auto-
biographies by individual patients, such as John
Perceval (Bateson, 1962), Clifford Beers (1923)
and Daniel Schreber (1955), and that Peterson
(1982) and Porter (1987, 1991) have collected
numerous first-hand accounts of mental illness,
but all these texts were written after recovery or
" Address for correspondence : Dr Allan Beveridge, Queen
Margaret Hospital, Whitefield Road, Dunfermline, Fife KY12 OSU
899
the danger of retrospective rationalization, dis-
tortion or dramatization. As Porter (1991) has
observed many of these accounts were literary
exercises, composed by the authors for a variety
of personal and polemical purposes, and thus,
they may not be truly representative of the
common experience of asylum inmates.
Attempts to find accounts by patients, which
were written during their illness rather than after
recovery, have proved difficult due to the paucity
of records available. Detailed studies of two
Morningside inmates, John Home and John
Willis Mason (Barfoot & Beveridge, 1990, 1993),
certainly unearthed written material, but here
the focus was on the patient response to asylum
life rather than on psychopathological analysis.
And, although collections of patients’ letters do
exist, for example, from the Glasgow Royal
Asylum (Andrews, 1992), the Utica and Willard
Asylums (Dwyer, 1987) and certain Australian
asylums (Garton, 1988), there has, until now,
been no detailed clinical examination of the
900 A. Beveridge
symptomatology that such letters yield. This
paper attempts to address this deficiency. In
particular, it examines over a thousand letters,
which were written by patients admitted to the
Royal Edinburgh Asylum during the period
1873 to 1908, when Thomas Clouston was
Superintendent. Completed while the patients
were still resident in the Asylum, these accounts
are less detached than retrospective reports and
give a more immediate and spontaneous record
of the experience of madness. In fact these letters
provide a comparatively rare resource, which
enables us to hear directly from the nineteenth
century patient in his or her own words, rather
than filtered through the physician’s casenote
description. This paper aims : (1) to allow the
voice of the nineteenth century patient to be
heard ; (2) to examine the form and content of
the psychopathological material contained in
the letters ; (3) to complement the previous case
note-based study of Royal Edinburgh Asylum
patients (Beveridge, 1995) ; and (4) to allow
comparisons to be made between nineteenth
century psychopathology and that of today.
PATIENTS’ LETTERS
During Clouston’s period of office, the Royal
Edinburgh Asylum admittted some 10 000
patients, of whom nearly 3 000 were re-
admissions. The institution catered for both
private and pauper patients, and this means that
a wide range of social classes is represented
among the Asylum correspondents. Background
details to the Royal Edinburgh Asylum under
Thomas Clouston can be found in Beveridge
(1991, 1995).
The bulk of the archival material relates to
patients’ letters which were appended to the
Table 1. Origin of letters from Royal
Edinburgh Asylum patients
Number
West House (pauper)
Males 406
Females 181
East House (private)
Males 173
Females 119
Unappended letters 272
Total 1151
casenotes by Dr Clouston and his medical staff.
From this 35 year period 879 such letters exist,
while there are also 272 loose letters from
Clouston’s own collection. A breakdown of who
sent the letters is shown in Table 1.
It is important to consider both, why the
medical staff kept the letters and why the letters
were written. Medical staff were permitted by
the 1866 Scottish Lunacy Act to open all
patients’ correspondence and prevent any letters
being sent that they deemed unsuitable. As well
as intercepting letters that were openly critical of
the Asylum, staff also held back ones they
judged to reveal mental aberration. Many such
letters were attached to the patient’s casenotes,
with written comments like ‘ a mad letter ’ or
‘ showing several delusions ’ ; they were kept as
an example of a patient’s disordered mind. In his
Clinical Lectures, Clouston (1896) quoted several
examples of patients’ letters to make clinical
points, and he also used them as illustrations in
his lectures.
In addition to the letters that staff kept back,
there were numerous letters that patients wrote
directly to the doctors and nurses. Many of
these were also filed in the case notes, either,
because they were thought to illustrate the
writer’s mental disorder, or simply because they
were items of information. Patients wrote for a
great variety of reasons : to describe their
torments, to make sense of their distress, to
complain or to plead their sanity. Patients ’
output ranged from a few lines to several dozen
pages.
The material that exists is, of course, selective.
First, it is only the letters that the staff retained
that are available. Secondly, the level of literacy
in the population affected who was actually
capable of writing and, not surprisingly, the
professional and the well-to-do are greatly over-
represented. Nevertheless, many of the poor
could read and write (Donaldson, 1986 ; Gifford,
1988), and a large number of letters from pauper
patients have survived. Another factor is that of
gender, with letters by men outnumbering those
by women by a factor of nearly two to one.
The diagnosis is also of relevance ; those who
were given a diagnosis of ‘ mania ’ typically
wrote the most letters. Those suffering from
organic brain conditions, such as general par-
alysis, wrote fewer and what they did write
was often incomprehensible. Despite these
 Voices of the mad
limitations, a wide spectrum of patients from
many different backgrounds is represented in
these letters and a great variety of psycho-
pathology is revealed. The selective nature of the
material does mean, however, that detailed
statistical analysis is inappropriate. Rather, the
paper gives a descriptive account of the patients’
correspondence.
All the letters were examined for evidence of
psychopathology, and here it is important to
emphasize that not all of them showed such
evidence ; indeed, a great many contained per-
fectly lucid, albeit, critical accounts of Asylum
life, and they will form the subject of a separate
article. This paper, however, is concerned with
those letters that did display symptomatology. It
is organized by considering excerpts from the
letters under the various psychopathological
categories, such as delusions or hallucinations,
as defined by Sims (1988). This categorization is
inevitably artificial as more than one type of
symptom may be present in a particular passage ;
for example, under the heading of ‘ delusions of
control ’, a patient’s description may also show
evidence of a somatic hallucination and a
persecutory delusion. However, given such a
large corpus of patient writing, some degree of
structure is necessary, and, by using modern
psychopathological terms, comparison with
present day symptomatology is readily
appparent. Finally, in the interests of auth-
enticity, no attempt has been made to ‘ correct ’
any apparent mistakes in punctuation, grammar
or syntax.
ABNORMALITIES OF LANGUAGE
While many letters showed no evidence of
linguistic dysfunction, those that did revealed a
variety of abnormalities. Some letters were
disjointed, some rambling, while others coined
new words. In his textbook, Clouston (1896)
provided several examples of language disturb-
ance, such as the syntactical and semantical
disintegration seen in cases of ‘ general paralysis ’,
the excessive underlining and use of capitals in
the letters of the morbidly suspicious, and the
exuberant rush of topics in patients with ‘ mania ’.
While many of the excerpts used in this paper
will demonstrate abnormalities in language, it is
worth giving some specific examples at the
outset.
901
William W., with a diagnosis of ‘ mania ’,
wrote a letter that revealed the excited and
barely contained flow of his thoughts :
My own name is to be changed to the Holy and sacred
one of Israel Jesu Christ, the Second son of God the
Father to reign for thousands of years in the new
World that will appear out of the debris of the Earth
when after 115 years more or less shall have expired
after it has been burned up & purified from all filth &
uncleaness by a fervent fiery heart & by deluges of the
boundless & mighty waters of the Oceans that occupy
so large a portion of this fair earth.
In a letter which revealed both syntactical
disturbance and the use of a neologism, David
B., a 50-year-old labourer, suffering from
‘ mania ’, wrote :
The Mesmeric Operator (REA) still continues from
time to time to speak aloud transgrammar with the
Medicines tongue. This is called the transgrammar
nuisance.
William W., a 35-year-old stockbroker, with
‘ general paralysis ’, revealed syntactical and
semantical collapse in his letter :
That ugly red mark.Crash – down tumbled Baby and
Cradle and all.
The above is called chain-sticked cocoa ribs
Into where else said this
North – North by East – East …
DELUSIONS
Slightly over half of patients admitted to the
Royal Edinburgh Asylum suffered from
delusions (Beveridge,1995), and, therefore, it is
not surprising that delusions figure prominently
in the patients ’ correspondence. In the letters,
we encounter strange worlds, peopled by kings
and queens, by divinities and devils, and by
secret agents and assassins. Mysterious
influences prey upon their victims, and people
are not who they seem. Bodily tortures are
endured and mental processes are derailed. Great
fortunes await the chosen, while scientific break-
throughs are confidently announced.
Patients tried to understand and explain their
experiences in terms of contemporary cultural
and scientific developments. Thus, gas, elec-
tricity, railway tunnels, telegrams and the tele-
phone all appeared in patients ’ delusions.
Patients quickly absorbed the latest scientific
advances, and, for example, within a year of the
902 A. Beveridge
discovery of Ro$ ntgen rays, several patients were
attributing their troubles to this new technique.
The tendency of the mad to reflect contemporary
aspects of their society has frequently been
noted, and, indeed, Clouston (1896) had high-
lighted this in his account of his patients ’
delusions.
Delusional mood
Some patients described the early stages in the
formation of their delusions, a stage that would
now be termed delusional mood. For example,
Alex H., a 24-year-old draper with ‘ mania ’,
observed, ‘ As far as I can see there is something
very mysterious going on ’. William B., a 42-
year-old man with ‘ mania ’, wrote : ‘ I had an
idea that there was a danger of some sort
hanging over our family … but I was quite at sea
as to the reason for it ’.
Delusions of persecution
Delusions of persecution were the commonest
type of delusion in patients admitted to the
Asylum (Beveridge, 1995). In the letters, patients
complained that they were the victims of
conspiracy or injustice, reported that they were
being followed or poisoned, and warned that
they were in mortal danger. Many claimed that
they were persecuted by their own family, while
others blamed their employers, the government
or the Asylum staff. Still others blamed the
Russians, the Freemasons or the Orange Lodge.
John R., a 38-year-old doctor, wrote that he
was to be ‘ taken tonight and murdered by a man
named J. MacPherson. ’ George M., a 37-year-
old Roman Catholic with a diagnosis of ‘ mania ’,
complained that : ‘ There are a lot of Belfast
Protestants here and I shrewdly suspect that the
Orange Lodge has a good deal to do with my
being kept here as well as my dear mother’s
death ’. Peter C., a 22-year-old clerk with
‘ melancholia ’, was hounded by ‘ Secret Russian
Societies ’, who used ‘ very subtle drugs ’. Stewart
M. wished to change his nationality to Italian
because : ‘ The hideous injustice to which I have
been subjected in England, has so given me such
a thorough distaste for everything English that I
desire nothing so ardently as a total severance
from the land of my nativity ’. Susan T., a 49-
year-old servant suffering from ‘ mania ’, wrote :
The Torturer of Spiritualism … has been continuously
torturing me every minute and no sympathy given me
indeed scarcely food to keep me in life … If I am not
taken out soon I will be found dead with the Tortures
of Spiritualism … God help Me I am a Poor Persecuted
Woman by Brutes of Men …
Mary C., a 46-year-old woman suffering from
‘ melancholia ’, complained : ‘ i am a power loome
worker and my health is fearfull empaired by the
partys … al combining and conspiring my life
away … scoudrells & cowrds ’.
George R., who maintained that some of his
children lived in the Asylum, ‘ on the first floor
in a room by themselves ’, appealed to his
solicitors : ‘ I and my children are confined here
under viscious false pretences and our lives are
in danger as those who have us in their custody
threaten daily that they will murder us unless
their wishes are complied with ’.
Delusions of control
Delusions of control featured frequently in
patients ’ letters, and, in fact, Clouston had
described this type of delusion at length in his
textbook under the heading of ‘ delusions of
unseen agency ’. Patients complained that their
thoughts, emotions, sexual impulses and physi-
cal actions were at the mercy of outside
influences. Morningside’s residents described a
terrifying catalogue of contraptions, responsible
for bodily and mental misery, such as air pumps,
gas pipes, and machines strapped to the back.
Patients commonly explained their passivity
experiences in terms of electricity, hypnotism or
mesmerism.
Henry B., a 36-year-old commercial traveller
with a diagnosis of ‘ mania ’, complained about a
sea trip he had taken :
A ship full of passengers who were principally thought
readers, Animal Magnetists and Hypnotists so
tortured me during the whole voyage that previous to
arriving in London my head became slightly affected
by the constant use of the Rontgen Ray. These same
thought readers trace me here and combine to make
it appear as if my mental equilibrium was affected.
These thought readers I believe to be a gang of
blackmailers and one of the name of Mr. Pendergast
late of Auckland.
Catherine F., a 35-year-old servant, com-
plained of ‘ ruffian monsters … keeping their
horrible influence on me that I can neither sit in
a chair or stand or lie in bed ’. Thomas M., who
was diagnosed as suffering from ‘ monomania of
 Voices of the mad
unseen agency ’, complained of : ‘ Forced dream-
ing ‥ cold shivering by the forced thinking …
pains in the stomach by any way that the
thinkers can think. ’
Jessie H., a 43-year-old governor, suffering
from ‘ melancholia ’, recorded : ‘ Every four hours
the hypnotist and telepathist go and two others
come. There is no doubt they have a school for
teaching hypnotism and I am the hypnotic
subject ’. William O., a 28-year-old coalman
with ‘ melancholia ’, complained that he was
‘ mesmerised ’ by ‘ a mesmerist with chloroform. ’
Alex. B. confessed that he was being immersed
in unwelcome sexual matters : ‘ I have found
myself by mesmeric influence … tempted to think
too much of things that were inclined to
sensuality and to do things in an unnatural way
… (I am) being made a complete slave to the
habit ’.
Other sufferers invented new terms to explain
their predicament. Zerul B., a 33-year-old
brushmaker, wrote directly to the Chief Con-
stable to protest against what he called ‘ psycho-
quotism ’ :
There is a number of persons located in No 2.
Drummond St. who by the aid of psychoquotism
have the power to cause illness and death, the
symptoms being loss of flesh by depriving one of the
benefit of their food, by a drawing or a suction of the
body, also a feeling, as if a vibration at the lungs and
heart, the lungs feel as if they were paralized or
emptied of blood also an extreme weakness of the
heart for the time being, and if continued a fatal issue
could be the result. Now as psychoquotism is said to
have as much effect on the body as hypnotism has on
the mind I think it would cause all the symptoms I
have described.
Alex. D. wrote bitterly of being ‘ an invol-
untary sodomised pimp ’, who was the victim of
‘ the incredible nightly foul use – natural vile
abuse – of this my vile body by means of some
gaseous substance calculated to induce tem-
porary insensibility in my sleep ’. William P., a
24-year-old barrister, suffering from ‘ melan-
cholia ’, told his father :
The bedroom in which I sleep is very badly ventilated
and it seems to me that there are fumes of some sort
pumped down the chimney … I can feel perceptible
particles falling over me … For a couple of nights it
was of pipes laid on with a gas cylinder in the room
above … I have been made a mechanical experiment
of.
903
Catherine M., a 33-year-old servant, suffering
from ‘ mania ’, complained of being ‘ followed by
two torturers with some awful machine attached
to me which is drawing the soul out of me ’.
Delusions of the control of thought
Thomas W., a 38-year-old labourer with a
diagnosis of ‘ melancholia ’, appeared to describe
thought insertion when he complained he was :
‘ getting too much of this forced thinking – the
thinkers are sweating on my back and putting
other thinking on in its place ’.
Catherine F., another servant, described
thought broadcasting, when she protested that
Clouston had a machine which made her
‘ breathe thoughts ’, and asked him, ‘ Are you not
afraid when you hear my breathing thoughts
amongst you when I am not present ? ’
Delusions of grandeur
Delusions of grandeur were the second most
frequent type of delusion, recorded in the
Edinburgh casenotes (Beveridge, 1995). Typical
delusions in the letters involved the possession
of immense wealth, having great abilities or
being an exalted person. The role call of the
eminent among the Asylum correspondents
included : Marshall Commander-in-Chief of all
Her Majesty’s troops, the Earl of Kirkcud-
bright, the King of Spain, the Consort for
Peace & Prosperity in Israel, Jesus Christ, the
Goddess of Heaven, the Universal Empress,
the Divine Holy Trinity, the Prophet Elias, the
Prince of Wales, the King Regent of the United
Kingdom, the Prince of Alland, Lord Salisbury,
the President of the United States of America
and Queen Victoria.
James W. offered to cure the ailing Archbishop
of Canterbury and put forward his credentials as
follows :
The writer of this note happens to be one of the most
important medical discoverers of this or any other
century. For example he was the earliest discoverer of
the cure of rheumatism … the first curer of cancer
without the knife by means of the air pump …
Robert W., claimed to be able to find the
Phoenix Park murderers. Charles C., a 44-year-
old clerk with ‘ general paralysis ’, claimed that
Tennyson was inspired by him and further that
‘ everything which has been published up to the
present time from time immorial is my com-
904 A. Beveridge
position ’. Cecilia O ’ L., a 41-year-old print
worker, suffering from ‘ mania ’, wanted her
employers ‘ to circulate Swedenborg’s Works
throughout the world ’. Isaac MacK. a 30-year-
old clerk, suffering from ‘ mania ’, claimed that
he ‘ could work at almost anything, besides
being endowed with sound scholarship, being
the greatest statesman of modern times, besides
having knowledge of science ’. William W.
claimed he was, ‘ God’s Vice Regent on Earth ’
and that he would be ‘ the means of raising
Jerusalem to a pitch of greatness that it never
attained during its most palmy days ’. Thomas
M., a 36-year-old printer, suffering from
‘ melancholia ’, stated that ‘ the whole supernatu-
ral powers of Heaven & Hell are in my belly ’.
William M. wrote to Clouston to advise him
about ‘ the New Elixir of Life ’ :
A short period before I was brought here I wrote to
Sir James Coxe M. D., late Commisioner for Scotland,
after reading his report on Lunacy, suggesting to him
to try the New Elixir of Life in the care of lunatic
patients … I could make up and supply a Medicine
grounded on the same principle as the New Elixir of
Life, which effect a complete cure in a large number
of cases. I could supply it at 6}6 per bottle containing
one month’s supply.
Mary J., a 28-year-old woman, wrote to the
‘ Marquis of Hamilton, Commander in-Chief
pro tem ’ : ‘ I command you to furnish a Guard
of Honour composed of the Queen’s Royal
Archer Guard to convey me as befits my rank to
the Castle & Palace of Holyrood by the hand of
Dr. Clouston, my ambassador ’. She signed the
letter ‘ Victoria 1st. ’ Helena H. wrote to the
Queen, requesting that, ‘ Her Most Gracious
Majesty be pleased to command Dr. Clouston to
order Helena Augusta H- out of the Royal
Edinburgh Asylum to a place of safety. Upon
Helena A. H-’s deliverance depends fifty thou-
sand lives … ’ Janet R., a 33-year-old domestic
servant, suffering from ‘ mania ’ announced, ‘ I
am the Goddess of Heaven in my own right
made into a woman to atone for sin … God says
he has to obey me in heaven ’.
Thomas P., a 35-year-old joiner with a
diagnosis of ‘ mania ’, declared :
… (God) is raising me up above all others and intends
to set me up on the earth the wisest Philosopher in the
world as i am a burning & a shining light upon the
earth this World is in Darkness until i come to its
assistance …
Delusions of guilt
Whereas delusions of control typically involved
scientific themes, delusions of guilt more often
had a religious content. Many patients felt
themselves to be sinners and believed they were
damned in the eyes of God. A 56-year-old
minister, James McK., suffering from ‘ melan-
cholia ’, was typical :
I gather my life has ended in disaster … and that I am
doomed to some dreadful end, the exact form of
which I cannot apprehend … God has manifestly
shown his displeasure of me and my life. The awful
degradation of the life I have lived during the past
fifty years. I have destroyed human nature to the level
and below the level of the brute. I have destroyed
vegetable and plant and flower. My destruction I
believe to be necessary for the preservation of the
world.
Henry S., a 33-year-old cooper, suffering from
‘ mania ’, declared :
In case I do not be spared to see another day I desire
to put in writing the chief sins that this body was
guilty of, first – disobedience, then lies, a thief, a
fornicator, a profligate, an adultress, a perjuer and
swindler.
Self-accusation was common. John H., a 50-
year-old banker, suffering from ‘ melancholia ’,
stated that ‘ Everybody here is disgusted with
having me near them ’. Henry A., a 35-year-old
butler with ‘ melancholia ’, was convinced
that he had contracted venereal disease and
exclaimed, ‘ What a disgrace I have brought
upon myself ’. As well as the sins of the flesh,
patients berated themselves for financial wrong-
doings. Dr Daniel W. wished to give himself up
to the police because of ‘ fraudelent bankruptcy ’,
and, in similar vein, Miss Helen F. confessed to
‘ the terrible life of fraud … I have been leading
since 1876 ’, which was ‘ known not only in
Edinburgh but far beyond it ’.
Delusions of ill-health
Delusions of ill-health most commonly focused
on the bowels. Catherine H. wrote, ‘ I am dying
of a closing and contracting of every part of my
insides which has taken four years of suffering ’.
Emma H., a 57 year old woman, suffering from
‘ melancholia ’, complained : ‘ The frightful agony
I suffer from my bowels not working has made
me feel I can live no longer and it is impossible
 Voices of the mad
to go out in the world again ’. Alexander C., a
46-year-old bookbinder with ‘ general paralysis ’,
observed, ‘ No doctor can do anything here for
us as our insides are quite dried ’.
Delusions of misidentification
These delusions commonly centred on the
patient’s family or the Asylum staff. Peter C., a
24-year-old compositor with a diagnosis of
‘ mania ’, wrote to Clouston, describing him as
‘ my dear uncle ’, while James C., a 34-year-old
jeweller, claimed that the Superintendent was his
brother. James B., a 23-year-old law student
with a diagnosis of ‘ adolescent insanity ’, wrote
to his mother : ‘ I have had a lot of queer
experiences both mental and otherwise. The
most inveterate has been that you are old
mother Eve and I am Abel ’.
Emily T., a 32-year-old house wife, enquired
of staff if her family was still living, adding : ‘ I get
letters in their handwriting but all has been so
strange I fancy someone imitates their hand ’.
Delusions of love
These delusions frequently involved members of
staff. Mary S. informed her sister : ‘ … Dr.
Thomas Smith Clouston has been found as
claiming me for his wife … I have, I think,
witnesses now to prove that he sleeps with me as
his wife … ’ Whilhelmina B., a 45-year-old single
woman, told one of the medical assistants :
‘ Doctor I do not wish to go away if you love me.
I will live hear or any whear, alas to be near
you ’.
Alfred C, a 21-year-old music student with a
diagnosis of ‘ mania ’, declared his love for one
of the medical assistants :
My dear beloved Husband :– Don Alfonzo.
I hope I have not insulted you in calling you my dear
beloved Husband. I do love you better than the three
persons in one God, also better than the Blessed
Virgin Mary … I hope that you might accept me
through pity as I am longing to sleep in Bed with you,
and I have good seed, but as I am a male and you a
Royal Male we cannot multiply or in other terms get
Bairns – children.
HALLUCINATIONS
About a fifth of patients were recorded as
suffering from hallucinations, with those of
hearing being the commonest (Beveridge, 1995).
905
Auditory hallucinations
In the letters, patients described hearing spoken
words, musical notes, loud hissings and indistinct
mumblings. Voices frequently screamed abuse
at their victims or whispered of conspiracies
afoot. Sexual topics figured prominently, with
patients called ‘ whore ’ or ‘ self-abuser ’. Some
people described a cacophony of voices which
harangued them constantly, while others rather
enjoyed their communion with imaginary
worlds.
John O., a 36-year-old man with a diagnosis
of ‘ melancholia ’, gave a particularly clear
account of his problems in a letter to Clouston :
Before I entered your Institution I was troubled
with noises and hissing sounds in the ears and the
sounds (voices) I can quite clearly distinguish and
could name the parties by the sound. It is the same
day after day and night after night as if they had some
undue power over me in making my life unbearable …
I am not in bed three minutes before a perfect hissing
is kept up for hours till I fall asleep. Turn as I like or
make a move one way or another a perfect hurricane
of voices are forced in my ears.
Mary S. also described a multitude of voices :
‘ The sound of voices around me, both above
ground but particularly below, from the caverns
through which the North British railway and the
Caledonian pass make it almost an impossibility
to think or speak coherently ’. Mary C., a 25-
year-old domestic, heard music : ‘ My head is
always fule of strange musical noises to which
my body seems to keep in time ’. Major Ernest
B., a 50-year-old man with ‘ melancholia ’, was
also troubled by music and complained that his
tormentors ‘ interfered with my Ears by putting
A flat in one and G flat in another ’.
Alex H., a 24-year-old draper with a diagnosis
of ‘ mania ’, described thought echo : ‘ I must
have been treated with medicine to make me a
thought speaker and hearer … if I just think a
question I receive an answer in words from all
parts of the room ’.
The content of hallucinations was often
unpleasant. Thomas I. complained of what he
called ‘ audible communication ’, which was
‘ constant ’ and which consisted of ‘ abusive,
filthy and blasphemous language ’. Henry B.
complained to Clouston about a fellow-resident :
‘ You have a man upstairs who has mentally
connected himself to me and has asked me
906 A. Beveridge
continually now for 5 months if I am going to
commit Buggery ’. Similarly distressed by sexual
suggestions, Alfred R., a 27-year-old lawyer’s
clerk, suffering from ‘ melancholia ’, penned an
officious note before his admission to the
Asylum :
On Wednesday 17 ult. a man occupying a bedroom
next to mine in lodgings kept by Mr. Jones 16
Marchmont Crescent, Edinburgh did threaten ‘ to cut
off my balls ’, ‘ seduce my sister ’, ‘ particularising the
younger and go for any wife I might have. ’
Patients tried to explain the origin of their
unwanted voices. Andrew H., a 34-year-old
chemist with ‘ mania ’, concluded : … ‘ I have
been the victim of a practical joke of some kind
of hypnotic transport or other form of
mediumism … The phenomenon consists … of
continual conversations of course entirely men-
tal ’.
The telephone became a common mode of
explanation for uninvited conversations.
Catherine F., was plagued by ‘ ruffian monsters
in the cellar below ’, who continually abused her
by means of ‘ this telephone work ’. Annie C., a
cook, suffering from ‘ mania ’, was haunted by a
‘ speaking Telephane ’. Robert M., a 38-year-old
alcoholic draper, gave a vivid account of being,
what he termed, ‘ Telephonated ’.
On the Monday following, about 10 o’clock at night
sitting in the same public house, I heard the voices for
the first time, they threatened violence, I looked about
the front shop to see where the parties were. Could see
no likely persons … I took the train to Edinburgh
trying to get rid of the voices. When in the South
Bridge about midday on Tuesday, … a very strong
voice, as some one giving a recitation seemed to come
from the clouds, read a verse or two of Scripture …
Other hallucinations
There were several accounts of visual
hallucinations. Duncan McG. reported : ‘ This
forenoon at about 11.30 am I saw a yellow
indefinite phantom about three quarters above
the southern horizon ’. Alex H. wrote : ‘ By
looking steadily at a person’s face and imagining
that of another, I could see that person’s face
change into that of the person I imagined ’.
Robert Y. described numerous abnormal per-
ceptual experiences in his ‘ Record of Miracles ’.
He claimed that people’s faces changed to that
of others, that his height increased temporarily
to seven feet, that he saw a man in the sky who
later descended to earth and that while watching
a group of female patients he witnessed all their
clothes fly off, leaving them naked.
Several examples of somatic hallucinations
occurred in the context of passivity experiences.
Thomas I., a 40-year-old Minister, catalogued a
desperate series of woes in a letter to Clouston :
… the feet (and especially the left foot) is compressed
and acute pain is caused : the hand is violently shaken
at times and the jaws are violently compressed :
great heat in face and severe headache : the eyes are
enlarged and contracted, and sight is distorted
occasionally : impure suggestions are stirred up by
keeping the brain fixed on imaginary scenes and
objects presented to it … penis is painfully erected and
suppressed, involuntary emissions violently caused,
irritation in scrotum and anus … these forms of
suffering have been needlessly caused by irregular use
of electric action …
DISORDERS OF MOOD
At least a third of patients admitted to the
Royal Edinburgh Asylum had a diagnosis of
‘ melancholia ’ (Beveridge, 1995). Richard A., a
45-year-old barrister, wrote ‘ a heavy depression
hung over me ’, while William C., a 54-year-old
merchant, reported, ‘ I was in a low desponding
state ’. Margaret M. lamented ‘ I am ill and my
nerves is shattered ’. John M., a 68-year-old
clergyman, wrote that, ‘ God has advised me
that I cannot recover ’. Catherine H., wrote :
I am a crooked, twisted piece of humanity. The
sooner I die the better. I hope God will relieve me
from my sufferings as I really cannot stand it.
Mary K. gave an evocative account of mental
anguish :
… all my senses have become painfully acute since I
found God had given me up and I knew there were no
limits to the horrors before me. I never read the
newspaper without being reminded of some horror
which makes me think with shuddering dread of
going to the place where these horrors come from. I
never feel too hot or take a hot bath without thinking
of that lake which burneth with fire and brimstone.
My torment of mind seems to increase every day …
James Mc C., a 20-year-old divinity student
with a diagnosis of ‘ acute mania ’, described his
low spirits in verse :
 Voices of the mad
Late falls the evening – woe is me !
So sadly falls the autumn leaves ;
For all the griefs in the world that be,
Have come to me that nothing grieves.
In contrast to reports of depressed mood, there
are very few letters in which patients commented
directly on their elevated spirits. An exception is
a letter by Margaret R., a 19-year-old servant
with ‘ acute mania ’, who announced that she
was going to host a party in the ward, and
declared :
… I am very well liked by all I keep them all laughing
they say they never seen such a girl to speak they say
if I am week my toung is not they say it is a wonder
I am not tired speaking … I cant sleep at night at all.
INSIGHT
Some of the letters show the patients developing
insight and struggling to come to terms with
their abnormal experiences. In a quaintly mis-
spelt note John G., a 43-year-old piano maker
with ‘ melancholia ’, stated simply, ‘ I new I was
not write in my mind ’. Patients often took on
the language of their clinicians to account for
their breakdown. James B., a 23-year-old law
student, wrote :
What has been wrong with me. Brain fever or What ?
To me it has been a mental struggle to make my
ideas of my surroudings understood. One delusion
I have suffered from almost incessantly viz. that it is
my duty to find Papa in the Land of the Leal.
James C., a 34-year-old jeweller with a
diagnosis of ‘ melancholia ’, apologized to one
of the female attendants :
I am sorry that I mentioned in my letter to you that
Dr. Clouston was my brother. It was a delusion …
Excuse the freedom I took in promising to marry you,
as it was a delusion.
William W., a 30-year-old teacher suffering
from ‘ melancholia ’, wrote to his wife : ‘ I have
given up a great many of the delusions under
which I laboured and it may please God to make
me a sane man again ’.
DISCUSSION
This paper has examined the psychopathology
displayed in letters from a wide range of patients
admitted to the Royal Edinburgh Asylum, under
907
Thomas Clouston. The symptoms described by
these nineteenth century inmates will be familiar
to the modern clinician, and what is most readily
apparent are the similarities, rather than the
differences, with present day psychopathology.
Most forms of morbid mental phenomena can
be found in these letters. Such a finding argues
for the unchanging nature of mental illness
across time, at least during the last 120 years.
More specifically, in the case of schizophrenia,
which had yet to be delineated when the majority
of these letters were written, we find that most of
the cardinal symptoms were described in the
patients’ correspondence. Thus, we have good
accounts of bizarre delusions, auditory hallucin-
ations, thought alienation, passivity experiences,
and disturbed speech. With regard to the content
of psychopathology, the patients’ letters vividly
illustrate how mental symptoms reflect the
scientific and cultural concerns of their time.
These letters add an important dimension to a
‘ mad people’s history of madness. ’ Unlike the
accounts by Perceval, Beers or Schreber, which
Porter (1991) has described as ‘ literary
artefacts ’, the letters from Morningside are
bulletins from the front-line, composed while
the writer was still in the midst of mental
turmoil. As a result they are less tidy, less
polished productions than published works, but
arguably, because of this, they give a more
authentic picture of the nature of mental illness
a hundred years ago. Further, because a large
number of letters have been examined, this
study is less vulnerable than individual accounts,
to the charge of being unrepresentative of the
common experience.
Clifford Beers (Dain, 1980) observed that
writing about his breakdown helped him to
come to terms with his ordeal ; it was a lifeline to
sanity. Likewise, in the letters from the Royal
Edinburgh Asylum, we sense that the act of
writing was for many patients, a means of trying
to make sense of their abnormal experiences.
The florid psychopathology evident in these
letters, once again, confirms that patients ad-
mitted to Morningside suffered from serious
mental illness, and it undermines the view that
the asylum was simply a dumping-ground for
society’s disaffected and discontented.
I should like to thank Michael Barfoot for his help
with this project.
908 A. Beveridge
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The many quotations are taken from patients’ letters, kept at the
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