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Method or Madness?

Research and planning folder

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Contents

The Public Lunatic Asylum: ‘Bedlam’

19th Century Treatments

A History of Schizophrenia

Character Research

Characterisation

Seminar & Workshop Material

Plot & Story

Bibliography

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- The Public Lunatic Asylum-

The Birth of the Asylum

Institutions for the insane can be traced back thousands of years as early as the 5th Century. These

buildings acted as prisons to house the mentally ill, where patients would be chained, beaten or killed

to remove them from society. It wasn’t until the 18th and 19th centuries that society became more

interested in the causes of mental illness, and special buildings called madhouses were constructed to

house the mentally insane. Despite these new institutions there was little change in the treatment of

patients, who continued to be beaten and treated like animals chained to walls and used as a form of

entertainment for the wealthier social classes.

During the turn of the nineteenth century, attitudes towards the mentally ill changed drastically.

The Enlightenment provided technological advancements in society, particularly in science and

medicine, which helped people to see lunacy as a condition that could be treated, and therefore began

the reformation of madhouses across the country. The Lunacy Reform Act 1845 enforced an

improvement in the treatment of insane patients, and transformed London’s madhouses into public

lunatic asylums. These new asylums provided slightly better living conditions and advancements in

treatments. An example of this development can be seen in Bethlem Royal Hospital in London, an

institution founded in 1247, one that is still serving as one of Europe’s oldest Mental Hospitals. I have

chosen Bethlem Asylum, or ‘Bedlam’ as the primary setting that Rebecca, my protagonist, finds herself

in my novel.

Bedlam (Bethlem Royal Hospital) London 1828.

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Map of Bethlem Hospital in London now (2016)

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Bethlem Hospital circa 1850

Below is a map of Bethlem Hospital in London in 1850. It first opened as a hospital in 1330,

to house the criminally insane. In 1828, it was moved to St George’s Fields where it became a

public lunatic asylum, specialising in the treatment of the mentally ill.

This small, circular building is Bethlem Royal Hospital after it had been

moved from its original location, to St. George’s Fields.

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Diagram of Bethlem Hospital circa 1850:

‘The whole building (the House of Occupations included) covers, it is said, an area of 14

acres.’

From this diagram, we can see that the male and female patients were situated on opposite sides

of the complex, probably to avoid contact with one another. There are a number of courtyards

available for the female patients, suggesting that they were allowed outside of their cells and

could interact freely with other patients.

The female patient airing ground is where Rebecca will meet Jane, and is one of the

places where the two characters will discuss their plot to escape the asylum. The key at the

bottom of the image indicates the different rooms available to the patients for example, the day

room which indicates that patients were moved from room to room, which is where Rebecca

will write her diary entries.

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Internal Layout of Bethlem Hospital in 1816:

Although this diagram was printed forty years prior to the setting of my novel in 1854, it

displays the names of some of the staff that worked within the asylum, as well as displaying a

‘friends room’ where patients were allowed to visit their friends. I will use this in my novel as

a place that Rebeeca and Jane will spend most of their free time together when they are not

working in the Laundry room, or receiveing treatment.

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Daily Life in the Asylum

Despite the implementation of the Lunacy Reform Act in 1845, there was no noticeable change

in the treatment of the mentally ill until the late nineteenth century. Many asylums continued

to restrain their patients as a form of treatment, where they would beat them into submission if

they were uncooperative. Patients were forced to live in unsanitary conditions, in cramped cells

which only enhanced the severity of their illnesses. It wasn’t until the end of the nineteenth

century that mental illness was taken more seriously.

https://www.youtube.com/watch?v=EtgzpAbxcRI

As a part of daily life in an asylum, patients were allowed outside for fresh air and exercise.

This comment from a Lunacy Commission Inspector at Norfolk County Asylum in 1854,

shows the level of control that was enforced when they were let out of their cells. One of the

methods used to control the patients were the drills exercised by the nursing staff. These drills

were part of the patient’s daily routines and were crucial as they ensured order in an

otherwise chaotic and unpredictable environment:

"Great control is gained over the patients and the task of taking a vast number …for air and

exercise, becomes comparatively easy.”

(Female Patients Exercising in the Metropolitan Lunatic Asylum)

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Fresh air and exercise were part of a strict and organised routine for the patients in

asylums from the mid nineteenth century. In some institutions, female patients would be woken

up at a certain time where they would then be washed and have their hair brushed, before being

examined for medical purposes. There was also a specific time that the patients were put to bed

by the nursing staff. In the early 20th century, the beds were just as organised as the patients

themselves, being arranged in long lines exactly two feet and six inches apart.

Towards the end of the 19th century, patients had to work as part of their rehabilitation,

either in nearby workhouses, or if they were lucky, within the asylum itself. Domestic jobs

such as washing and drying laundry, cooking, and cleaning were all common tasks for patients,

which was believed to help with their condition.

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Extract from a report of Bethlem Hospital in 1844:

1844 Bethlem Hospital, St George's Fields, South London.

1.1.1844: 355 patients of whom 90 were criminals.

Bethlem was outside the Metropolitan Commission's investigative authority. For statistical

purposes:

"In the absence of any specific information ... we have entered the Criminal Lunatics ...

seventy Males and twenty Females, as Paupers. We have also assumed that the remainder

of the Patients ... generally, are of Private class, although we have reason to believe that

some of them are maintained, wholly or in part, at the charge of Unions or Parishes" (1844

Report p.186)"

This report indicates the number of patients

admitted to Bethlem during 1844, giving me an idea of how

many patients would have been housed within the asylum

at one time. The patients were divided up into categories to

keep the violent and dangerous patients from harming

themselves or others.

This particular report indicates that in 1844 the two

main categories of patients included Criminal Lunatics,

Paupers, and Private Class Lunatics. In my novel, both

characters, Rebecca and Jane, will be placed in the Private

Class category, the larger and less violent of the three listed

in the above report.

Harriet Jordan in her Bethlem

Royal Hospital portrait, newly

diagnosed with acute mania.

(1856)

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Payin

g fo

r Trea

tmen

t

‘The o

ne sig

nifica

nt d

evelopm

ent in

adm

issions

to B

ethlem

Hosp

ital in

the V

ictoria

n era

had

been

a m

id-cen

tury sh

ift aw

ay fro

m a

dm

itting

paupers (fo

r who

m th

e new

county lu

natic

asylu

ms w

ere thought to

cater) in

favo

ur o

f

patien

ts of th

e mid

dle a

nd skilled

labourin

g

classes’. (“

Presu

med

Cura

ble”

p.5

)

In

my

no

vel.

Reb

ecca’s w

ell ed

ucated

back

gro

und is b

ased o

n th

e assertion th

at durin

g

the 1

9th C

entu

ry, B

ethlem

Hosp

ital acted as m

ore

of a p

rivate in

stitutio

n fo

r upper class p

atients,

with

wealth

y fam

ilies. The ch

aracters of Jan

e and

Reb

ecca are exam

ples o

f patien

ts that co

me fro

m

wealth

y b

ackgro

unds an

d are w

ell educated

. This

is dem

onstrated

in th

e book P

resum

ed C

ura

ble

by

Colin

G

ale an

d

Robert

How

ard,

that

discu

ss

Beth

lem A

sylu

m d

urin

g th

e 19

th Cen

tury

.

‘Fro

m 1

882 o

nw

ard

s, patien

ts’ relatives w

ho w

ere

willin

g to

pay to

secure a

pla

ce at B

ethlem

contrib

uted

two g

uin

eas a

week to

ward

s the co

st of

care’. (“

Presu

med

Cura

ble”

p.5

)

In m

y research

I disco

vered

that a p

atient’s fam

ily

had

to p

ay fo

r care in th

e asylu

m. A

s a result,

Reb

ecca’s husb

and, Jam

es Rusw

ick, w

ill be sh

ow

n

to p

ay th

is two g

uin

ea contrib

utio

n to

keep

Reb

ecca

in th

e asylu

m after h

e reports h

er as bein

g m

entally

unstab

le. The n

ovel b

egin

s with

a signed

letter to th

e

asylu

m fro

m M

r Rusw

ick, to

confirm

the p

aym

ent

for R

ebecca’s co

ntin

ued

treatmen

t in th

e asylu

m,

illustratin

g th

at

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-Treatments-

Psychiatric treatment undertook a dramatic change during the nineteenth century. It was believed that

mental illness was a kind of state of the soul, at a time when religion had a ruling influence on the

common people. Towards the mid nineteenth century, scientists began to take a deeper interest into the

human mind, and through the technological advancements of the industrial revolution between 1820-

1840, treatment of the mentally ill became the primary focus for psychologists in the field of psychiatry.

Up until the 1870’s, treatment of the mentally ill can be described as barbaric and inhumane.

Asylum staff treated patients like animals, often confining them in cages, or animal pens where they

would be abused by staff, or viewed by visiting citizens for entertainment as seen in the picture below.

(Patients being viewed by paying citizens as a form of entertainment)

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Restraint

These pre 1850 images shows patients being chained to the walls whilst being observed by

visitors to the asylum as they suffer for profit. It was seen as a common spectacle for the wealthy

to watch the inmates as a form of entertainment.

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The primary method for maintaining control within asylums up until the 1850’s was restraint. Prior to

the Lunacy Reform act, patients were most commonly chained to the wall, or to their beds with very

little freedom to move around. Solitary confinement, straight-jackets, ice baths, and machinery such

as the restraint chair were all methods that restrained the patient to keep them calm, quiet and away

from society.

(Restraint Chair Circa 1850)

The Restraint chair was used as a ‘humane’

alternative to the straight jacket.

Chaining patients to objects was another

method of restraint used prior to 1850. In the

picture below the patient’s hands, feet and

neck are chained to the pole, restricting any

freedom of movement.

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(The Ice Bath or ‘Surprise’ Bath)

Patients would be stripped of all their clothes and told to lay in a bath, where freezing buckets of water

would be dropped onto them from above and when full, would be left to sit in it for hours. It was thought

that this would shock the patient and cause any confusion or illness to be shaken away. This of course

didn’t work, and instead caused many of the patients to die of hyperthermia.

(Straight Jacket)

Invented in 1790, the straight jacket was the

most common method of restraint within

asylums and mental institutions. These

jackets were often used on patients who

could not control themselves and were either

a danger to themselves or others. The

patient’s arms would be inserted into the

sleeves which were then crossed across the

chest. The ends of the sleeves are then tied to

the back of the wearer, ensuring that the arms

are kept close to the chest with as little

movement as possible, preventing the patient

from moving their upper body.

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(Straight Jacket)

(Restraining Belt)

(Hand mitts - used in

asylums to prevent from

patients who would tear

their clothes off, or self-

abuse)

(Neck Restraint)

(Belly Chains)

(Cuffs)

(Restraint Harness)

Below are some images of the various types of

physical restraints used in insane asylums:

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Lobotomy

"It seems possible that with additional experience and a minute study of the pathologic changes seen

in the brain, the knife may be the means of restoring to reason many cases now considered

incurable"

--Emory Lamphear (1895)

Following technological advancements of the enlightenment, the understanding of mental illness

started to improve, with a rapid growth of interest from a scientific perspective and an increase of

available treatments. These included lobotomy, which involved drilling two holes into either side of

the skull where the patients, in earlier treatments, remained conscious during the procedure.

Although the term ‘Lobotomy’ wasn’t introduced until the 20th century, surgical manipulation

of the brain was being used in asylums as early as the 1880’s. A Lobotomy was a surgical procedure

in which the nerve pathways in a lobe or lobes of the brain were severed from those in other areas.

The procedure was formerly used as a radical therapeutic measure to help grossly disturbed patients

with schizophrenia, manic depression and mania. The practice gradually fell out of favour beginning

in the mid-1950s, when medication such as antipsychotics and antidepressants came into use which,

were much more effective in treating and alleviating the distress of mentally disturbed patients.

This diagram illustrates a

frontal lobotomy. The surgeon

would drill into the skull, or

pierce the brain through the

nasal passage or from behind

the eye.

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Trepanning

As a predecessor to a Lobotomy, Trepanation was a method used before and during the 19th century.

This is an ancient procedure in which a hole is drilled or scraped into the human skull, exposing

the dura mater, to treat health problems related to intracranial diseases.

The instrument used for

trepanning was called

a trephine. It is a screw-like

device that the surgeon would

turn, rotating a sharp metal

point at the end of the device.

This action would cause the

point to pierce the skin and cut

out a round piece of skull bone,

as demonstrated in the above

diagram.

Trepanation is still used

in practises of modern day

medicine as a method of

accessing other parts of the

body that are otherwise

unreachable. However, it is no

longer used to treat mental

illness, and is a procedure that

is much more humanely

performed.

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Insulin Shock Therapy

During my research into this treatment, I discovered that the introduction of Insulin Shock

Therapy didn’t start until the 1920’s, much later than I had first anticipated when planning

my novel. As Rebecca’s Insulin treatment is a vital to the plot, I have decided to change the

date in which the novel was set from 1854 to 1884. Although this is still some years behind its

introduction, I aim to present this treatment in my novel as a one of the first private

experiments of a new, unknown drug, which would later (in the 1920’s) become known as

Insulin. As a result, the effects of the drug will be unknown to science at the time and

therefore no guideline will exist as to how it should be administered to a patient. Rebecca,

therefore, will experience a similar treatment to what we now understand to be Insulin Shock

Therapy, but with methods that differ from how it was administered in the 1940’s.

Insulin Shock Therapy, or Insulin Coma Therapy as it was more commonly known

(ICT), was a psychiatric treatment that was introduced in the 1920’s. It was used extensively

in the 1940’s as a treatment for schizophrenia and other mental illnesses. The patient would

be repeatedly injected with large doses of insulin in order to produce daily coma’s lasting up

to several weeks. This form of treatment fell out of favour in the 1960’s when neuroleptic

drugs were introduced, which calmed the patient much more effectively.

During the 1950’s, patients suffering from Schizophrenia required great physical

strength and good prognosis in order to be selected for the treatment. The procedure required

specialist staff as it was a labour intensive treatment, and there were no standard guidelines

for them to follow; different hospitals and psychiatrists developed their own protocols. In my

novel, Rebecca is the first person to be administered this treatment as a form of private

experimentation by one of the doctors in the asylum, Victor Porter. He performs the

injections himself, without any specialist unit, using the restraint chair and other restraint

devices which prevent her from moving, especially during the first few days of her treatment

where she attempts to resist. The low glucose levels that resulted from ICT made patients

extremely restless, sweaty, and liable to after-shocks. In the most severe cases, some patients

were known to suffer from brain damage, and others died from their induced comas.

Brass Ear Syringe (1880)

(Lapinlahti Psychiatric Hospital, Helsinki, 1950)

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-Schizophrenia-

In this section I will talk about the condition of Schizophrenia. Schizophrenia is a condition

that was not officially named as an illness until 1913 by German physician, Eugen Bleuler.

Early 20th century patients who were associated with abnormal social behaviour and the

failure to understand reality were diagnosed with schizophrenia.

In my novel, set in 1884, Rebecca begins to develop Paranoid Schizophrenia, a condition

which, at the time, had not yet been named as its own illness. As a result, the condition of

Schizophrenia that Rebecca develops will not be named as such at any point in the novel, and

the staff within the asylum will lack any understanding of the condition.

In my research into Schizophrenia, I found that five types of the condition were delineated in

the Diagnostics and Statistics Manual III in 1952:

• Disorganized: ‘These reactions are characterized by conspicuous motor behaviour,

exhibiting either marked generalized inhibition (stupor, mutism, negativism and waxy

flexibility) or excessive motor activity and excitement. The individual may regress to

a state of vegetation.’

• Catatonic: ‘The subject may be almost immobile or exhibit agitated, purposeless

movement.’

• Paranoid: ‘This type of reaction is characterized by autistic, unrealistic thinking, with

mental content composed chiefly of delusions of persecution, and/or of grandeur,

ideas of reference, and often hallucinations.’

• Residual: ‘This term is to be applied to those patients who, after a definite psychotic,

schizophrenic reaction, have improved sufficiently to be able to get along in the

community, but who continue to show recognizable residual disturbance of thinking.’

• Undifferentiated: ‘The chronic schizophrenic reactions exhibit a mixed

symptomatology, and when the reaction cannot be classified in any of the more

clearly defined types, it will be placed in this group. Patients presenting definite

schizophrenic thought, affect and behaviour beyond that of the schizoid personality,

but not classifiable as any other type of schizophrenic reaction, will also be placed in

this group.’

As Rebecca has vivid hallucinations, she falls into the category of Paranoid

Schizophrenia. I will use the above definition of paranoid schizophrenia as a baseline, when

trying to convey Rebecca’s hallucinations in the asylum and her deteriorating mental state.

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Below are a collection of drawings from various patients suffering with Schizophrenia:

A series of paintings of cats by Louis Wain from the early 1900's. They capture a slow descent into varying levels of schizophrenic

episodes.

Drawn by Edmund Monsiel, an artist

in the early 1900's believed to have

been a schizophrenic.

‘A depiction of the affliction’ of

Schizophrenia by Erik Baumann.

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Paranoid Schizophrenia

Paranoid Schizophrenia is the most common type of Schizophrenia, and people who are diagnosed with

this sub-type often seem more ‘normal’ than other schizophrenics. Some of the symptoms associated

with a paranoid schizophrenic are delusions and hallucinations, or an in-ability to distinguish between

fantasy and reality. Rebecca experiences visual and auditory hallucinations from her time within the

asylum which develop from her exposure from her insulin treatment. Despite the advancements in

modern day science and medicine, phycologists have yet to determine the cause of schizophrenia; it is a

completely unpreventable illness.

(This drawing was found in an old asylum; the artist was a paranoid

schizophrenic)

Here is a list of reasons for admission into an

asylum in the 19th century:

There is no classification that fits Schizophrenia,

and as a result shows that the condition didn’t

exist.

Although Rebecca develops the symptoms of a

paranoid schizophrenic, she is not diagnosed with

the condition. Instead she is experimented on with

various types of treatments that have never before

been practised by science. In my novel, Rebecca

will act as one of the first patients to be

experimented on, which will, eventually, lead to

the discovery of Schizophrenia and Insulin

Therapy as a form of treatment for the condition.

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-Character Research-

Nineteenth Century Clothing

Women:

19th Century clothing changed dramatically throughout the period. This change was

influenced by shifts in taste and by the introduction of machines used in the construction of

clothing. Sewing and weaving machines, steam power, electricity, new dye formulas, and

other inventions increased the speed and ease of clothing manufacture. These inventions were

used to add embellishments to women's clothing and allowed more illustrious styles of dress.

The pictures below demonstrate the types of clothing women used to wear during the 19th

Century, either for domestic or social purposes:

At the beginning of the century, women wore dresses that were much slimmer and more tightly

fitted. By the 1850’s it was fashionable for women to have very small waists, and so they wore

corsets to hold the shape of the dress and seem slimmer than they actually were. By this time,

dresses had become larger, and more elaborate, with several different sleeve styles for different

parts of the day. Short puffed sleeves were generally worn during the evenings, and longer

sleeves for casual wear during the day. During the late 1890’s the bulky style of dress fell out

of fashion, in favour of a more loosely cut finish. This artistic style gave more freedom of

movement, and as a result did not require corsetry to be worn.

(1850)

Mid- 19th Century dresses

included whale bone or steel

wire frames, giving the dress a

bell-like shape, defining the

waistline.

(1850)

(1885)

Late 19th Century dresses

included a bustle instead of a

frame. This caused the dress

to bulge outwards at the back.

(1825)

Early 19th Century dresses were

longer and slimmer. Corsets were

worn underneath the dress that were

tightened in order to define the

waistline, making women appear very

slim.

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Below is a timeline of diagrams that show the transformation in women’s fashion during the

19th Century:

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Men:

By the early 19th Century men's fashion had also changed. Men generally wore an undershirt

with a waistcoat, and a coat finished in long tails at the back. Throughout the period, it was

uncommon for a man to go out in public without wearing a hat. In the early 1800’s, men wore

a variety of hats to match the fanciful designs of their shirts and jackets. However, in the later

years, the low black hats that were worn at the beginning of the century would evolve into

top-hats that continued to be worn right through into the early 20th Century.

In the early 19th Century some men wore boned corsets to give them a small waist,

but in later years they wore less layers of clothing and longer jackets to give a looser fit.

Alongside their tight waistcoats and jackets, men wore breeches, although these gradually fell

out of fashion when they were all but replaced by trousers. At first, trousers were only worn

during the day and for informal dress, however, by the 1820s they were acceptable for

evening wear as well. During the second half of the century, waistcoats and jackets were still

in fashion, though men’s jackets had become longer and less styled. In the late 19th Century,

men wore plain dark jackets with high-collared shirts and vests. The colour black was

becoming increasingly fashionable, giving a smarter, cleaner look to a man’s appearance,

with less fanciful designs.

(1840)

Mid- 19th Century clothing had

changed slightly from men’s

earlier fashion. The outfit was less

fanciful and men wore trousers

rather than breeches, which were

only worn in court.

(1890)

At the end of the 19th, early 20th

Centuries, every aspect of a man’s

appearance was much plainer, with

black top-hats and longer coats. This

new suit-like appearance made men

look cleaner and smarter in

comparison to early 19th Century

clothing, with a more loosely fitted

outfit.

(1805)

Early 19th Century clothing for

men, consisted of frilly, open-

neck shirts and tight breeches.

This fancy style of clothing was

also introduced into a man’s

jacket, which was cut-off at the

front and separated at the back.

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Character Inspirations

In order to widen my understanding of the behaviourisms of patients with mental illness, and

the ways in which doctors diagnosed conditions during the 19th Century, I have based Jane

and Rebecca’s behaviours around actual patients that were admitted to Bethlem Hospital in

the late 19th Century (available from book: “Presumed Curable” by Colin Gale and Robert

Howard).

Mary Robertson

‘Mary Robertson’ was admitted to Bethlem on 28th April 1895.

(Doctor’s report for Mary Robertson)

Rebecca’s character, based on Georgina Hewett (1892). Inspired character traits:

• Hallucinations (both auditory, and visually)

• Restlessness

• Inability to sleep properly

‘Patient imagines herself to have been

hypnotised. She declares she hears

voices, and instances one as saying that

her brother has been shot and also calling

her by name. I am informed by Miss Mary

Sturge that patient describes herself as

imagining she was followed and

persecuted in the streets last autumn. Also

that she is alternately apathetic (with head

on bed or hands over her eyes) and

restless. Also that she gets out of bed

continually at night declaring that voices

are saying in the street that her brother is

dead.’

Dr Jane Harriet Walker

(p.106)

‘She confessed to hearing voices

which order her to do various acts. To

seeing forms and faces, some pleasant

and some horrible. To believing in

these voices and faces as facts. She is

greatly altered in expression of face, in

manner and in type of conversation.

Miss Mary Darby Sturge MB, house

surgeon, New Hospital for Women,

says that Mary H. Robertson is unable

to concentrate her thoughts or to read

because of the voices which constantly

haunt her. Also she declares she has

been hypnotised (which is not the

case). She says that there must be

electricity in the ward which acts in

her.’

Dr Mary Ann Dacomb Scharlieb

(p.106)

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Georgina Hewett

‘Georgina Hewett’ was another patient admitted to Bethlem Hospital on 3rd November 1892.

(Doctor’s report for Georgina Hewett)

The character of Jane Harrington, based on Georgina Hewett (1892). Inspired character traits:

• Bad language

• Incoherent rambling

• The way in which she starves herself

‘She cannot converse in a rational

manner. She will not answer questions.

She chatters continuously in an

incoherent rambling and garrulous way.

Spoke of her mother as a devil. She seems

quite unable to take care of herself. Her

mother, Mrs Jane Hewett (widow),

informs me that yesterday the patient

exposed herself at the window in a state

of nudity and that she has been for some

time unable to manage herself and her

affairs.’

Dr Francis John Roberts Russell

(p.72)

‘Her manner was excited; she keeps

talking nonsense. She made grimaces

at me and said that I had been

‘Kodaked’ by her. She also said that

she had been starved. Alice Hewett,

sister, says that she dresses up in

fantastic dresses, that she exposes

herself at the window in scanty dress,

that she uses bad language.’

Dr Edward Rosser Mansell

(p.72)

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Novel Summary

The novel is focused around one character, Rebecca Ruswick and her experience of Bethlem

Asylum in 1884. Following a tragic accident on the family estate involving her young daughter, Eve,

Rebecca is condemned by her husband to live out her days in the asylum. It is here that Rebecca

begins treatment to cure her condition, though for much of her time in the asylum she is experimented

on and she begins to lose her mind.

She meets an anorexic, upper class woman called Jane Harrington and the pair have a lot in

common and become close very quickly. Rebecca is treated for, what is diagnosed as, Chronic Mania

and records her thoughts and experiences in a series of diary entries, which gradually become more

and more irrational. With the thought of her daughter constant on her mind, she becomes desperate to

see her daughter before she passes away and attempts to escape the asylum with Jane. Upon the day of

the escape Rebecca experiences various forms of hallucinations and it becomes almost impossible for

the reader to distinguish if what Rebecca is seeing is in fact reality; revealing symptoms of developing

schizophrenia.

With Jane’s help she manages to escape the asylum and begins her journey to the Ruswick

Estate. Once inside the house Rebecca moves upstairs and sees her husband watching over their

daughter. Determined that nothing will stop her seeing her daughter again, she sneaks up behind him

and, unware she is in the house, vengefully kills him. She enters the bedroom and is re-united with her

daughter, discovering she wasn’t too late after all.

The Accident

The accident involving Eve happened one day in February 1884. Rebecca and Eve were waking down

by the lake on the estate, as they did every morning. There was a swing that hung from one of the

ancient willow trees that loomed over the lake. On that particular morning, whilst Eve was playing on

her swing, the branch of the willow tree snapped, sending her tumbling into the icy water. Rebecca

remembers how helpless she was, trying to pull her daughter from beneath the heavy branch and

thickening mud, which was pushing her further under as she struggled to get free. Rebecca shouted

for help to free her, and eventually they carried Eve to the house. The branch had fallen on her head,

putting her in a temporary coma, but due to the freezing temperature of the water and

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- Characterisation -

Character Profiles

Name: Rebecca Jade Ruswick (Protagonist)

Age: 28 Gender: Female

Born: 4th August 1856 Marital Status: Upper-social class, Married.

Place of Birth: London, England. Date Admitted to Asylum: 17th February 1884.

Goal: To escape the asylum and get back to her daughter before she dies.

Conflict: Her doctor, Victor Porter, experiments on her throughout her time at the asylum.

His methods cause her to develop hallucinatory, and delusional symptoms that we now

associate with Paranoid Schizophrenia.

Motivation: Rebecca’s daughter, Eve, has fallen into a coma and only has a few weeks to

live. Rebecca has to race against time and the legitimacy of her own mind to escape the

asylum, and become reunited with her daughter before she dies.

-Mannerisms- (up until her delusions and hallucinations begin):

Generally quiet, unless spoken to, in which case she appears sophisticated and well-

mannered. Has all the typical values expected of a Victorian woman, well-spoken, educated,

dutiful and faithful. Lacks the confidence to express herself to her husband, whom she is

devoted to.

Excited: slight smile, attempting to conceal her feelings.

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Nervous: becomes restless, overthinks the situation and acts rashly.

Lonely: silent and reclusive in person, though likes to express her feelings on paper.

Sad: tearful, clenches her hands together.

Scared: eyes widen and begin to water, mouth closed.

Surprised: eyes widen, mouth open.

-Physical Attributes-

Hair colour: Dark Brown Body Type: Slim

Hair Style: Long/Usually in a bun Height: 5 foot 4inches

Eyes: Green Weight: 49kg (110 Pounds)

Perfectly proportioned facial features, very pretty. Usually wears her hair in a bun, though it

is cut shorter when she arrives at the asylum. There are a few light brown freckles on her

lower cheeks and she has a birthmark on her back that she is very conscious of.

Background Information:

Rebecca grew up as an only child following the death of her brother when she was very

young. Born in London in 1856, she lived with her parents until she met James Ruswick at

the age of 18. They were married a few months later, and moved to James’ father’s estate on

the outskirts of London after his unexpected death. Aged 22, Rebecca fell pregnant and some

months later gave birth to their daughter Eve. The story begins six years later, when her

husband James, condemns Rebecca to Bethlem Asylum following a tragic accident on the

estate involving their daughter Eve.

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Name: Jane Annabelle Harrington (Rebecca’s closest friend in the asylum)

Age: 34 Gender: Female

Born: 23rd October 1850 Status: Upper class, Married.

Place of Birth: Sussex, England. Date Admitted to asylum: January 2nd 1882

-Mannerisms-

Confident and outspoken. Has been well educated and is unafraid to speak her mind. Is

completely insane by the time Rebecca is admitted to the asylum, and so she is extremely

unpredictable. Is diagnosed with chronic Mania due to her frantic and aggressive behaviour.

Sympathetic towards Rebecca, and trusts no one else. Secretive. Knowledgeable of

happenings within the asylum, and uses this knowledge to help Rebecca escape.

Excited: laughs uncontrollably. .

Nervous: taps her feet together and starts humming softly to herself.

Lonely: appears very distant.

Sad: has aggressive outbursts, including the use of bad language.

Scared: likely to have violent outbursts, hitting scratching and biting.

Surprised: she interprets surprise as being scared; and responds accordingly.

-Physical Attributes-

Hair Colour: Dark Brown Body Type: Anorexic

Hair Style: Short/Curly Height: 5 foot 2inches

Eyes: Hazel Weight: 33kg (73 Pounds)

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Dangerously skinny when she first arrived. Slowly recovering some weight. Deceptively

strong for a woman who is so skinny. Fingernails were all but removed from scratching the

nursing staff in one of her outbursts. Despite its scraggily appearance, she is proud of her hair

and the similarity in colour between their hair is the reason Jane approaches her in their first

meeting.

Background Information:

Jane used to be very similar to Rebecca before being admitted to the asylum by her husband

for not eating for days at a time. Although originally admitted for being unable to take care of

herself, she was diagnosed with Chronic Mania in the first few weeks of her arrival. As an

ex-teacher, she is intelligent and from an upper class background, both of which are

similarities that help create the bond between the two characters. She is unable to have

children, despite her own desires, and is sympathetic to Rebecca’s situation regarding Eve.

She desperately wanted children, and her disbelief in realising that she can’t is the reason she

for her condition.

Name: James Ruswick (Rebecca’s Husband)

Age: 37 Gender: Male

Born: 7th December 1847 Status: Upper class, Married.

Place of Birth: London, England. Inherited his father’s Estate

Background Information:

Ill tempered, but never violent towards Rebecca. He came from a wealthy family and was

brought up to withhold gentlemen-like qualities. Loved to play the piano, and would often

play to Eve. He loved Rebecca and would often tell her so, yet Eve was the most precious

thing to him. Physically strong and not very sentimental, like most Victorian men, he believes

Rebecca’s negligence towards Eve caused the accident, and rashly condemns her to the

asylum with no intention of seeing her again.

Name: Eve Ruswick (Rebecca’s Daughter)

Age: 6

Born: 29th June 1878

Place of Birth: London, England.

Gender: Female

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Background Information:

Before falling into a coma and suffering severe injuries, Eve lived six happy years with her

parents. She was an ordinary six-year-old girl, who, like her mother, loved to experience

nature. Rebecca would take her walking around the lake on the estate regardless of the

weather. Eve’s accident happened in February, the same month her mother was condemned

to the asylum for her apparent Hysterical symptoms, following her daughter’s ill health.

Name: Victor Thomas Porter

Age: 49 Gender: Male

Born: 17th June 1835 Status: Educated Working Class

Place of Birth: Oxford, England. Employment: Doctor, Physician.

-Mannerisms-

Abrupt, deep tone of voice. Does not often express emotion, unless one of his experiments

gives him the result he wants. Doesn’t talk much, instead prefers physical contact with his

patients, for example performing surgery. Has a tendency to tap his feet when he is intrigued,

a noise that haunts Rebecca as her condition deteriorates.

Excited: grins rather than smiles.

Scared: is not intimidated easily. Used to patient outbursts.

Surprised: becomes erratic, loses all logic and becomes excited.

Confused: always refers to his notes before and after a procedure.

Intrigued: taps his feet.

-Physical Attributes-

Hair Colour: Black Body Type: Broad but not muscular

Hair Style: Short/Neat Height: 5 foot 10 inches

Eyes: Blue Weight: 69kg (154 Pounds)

Background Information:

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Victor was born in England and eventually moved to London when his parents disappeared

when he was very young. He grew up in a boarding school which taught him the discipline he

instils on his patients. Although he is a doctor, he believes himself a scientist. Very

passionate about his work. He is determined to revolutionise science with a new discovery,

and so he likes to experiment using a variety of methods. Intelligent, yet he lacks logic when

devising his experiments, which is why so many of them fail.

-Plot & Story-

Chapter 1

Chapter Summary:

Rebecca Ruswick begins the narrative, explaining how she arrived at the Asylum and how

she was put in restraints upon her arrival. She describes Dr Porter, who categorises the

patients into groups and separates the men from the women.

Chapter 2

Chapter Summary:

Rebecca is unfamiliar with the daily routine she has to follow in the asylum. She is woken

early and is confused when she is taken to various rooms to work and for treatment. She is

taken to the Airing Ground where the female patients are given exercise and allowed to roam

around as they please. This is where she meets Jane Harrington. Later, she is taken for

another stage of treatment and is given a three-hour long Ice bath.

Key Emotions:

• Anger

• Fear

• Shock

Key points in chapter:

• Arrives at asylum

• Experience of Restraint Treatment

• First meets Dr Porter

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Chapter 3

Chapter Summary:

During her treatment the following day, Rebecca continually begs to have some contact with

Eve, though Dr Porter interprets this as Hysterical behaviour and devises a new form of

treatment, never before tested on a patient. He diagnoses her with Chronic Mania and begins

Insulin Therapy. Rebecca attempts to resist but her defiance only reinforces his diagnoses that

she is insane. At this point her physical deterioration is evident and she is ill for several days.

Key Emotions:

• Anxious

• Happy

• De-moralised

Key points in chapter:

• Rebecca unfamiliar with the asylum routine

• Meets Jane

• Consultation with Dr Porter

• First Ice bath treatment

Key Emotions:

• Sad

• Desperate

• Pain

Key points in chapter:

• Rebecca continues to ask for contact with

her daughter

• Rebecca is diagnosed with Chronic

Mania

• New method of treatment is introduced:

Insulin Therapy

• Physical deterioration- becomes ill

(exhaustion/mild pneumonia from Ice

bath).

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Chapter 4

Chapter Summary:

Rebecca’s insulin therapy has continued whilst she was asleep, despite having pneumonia

and being unconscious. She wakes several days later, in a separate room restrained to the bed.

She deduces that her treatment is over. She is unstrapped and taken to the Airing Ground for

some exercise. On the way there, Rebecca believes she can hear her daughter calling to her,

but recalls how terminally ill she was before she was taken from her. She finds Jane and tells

her that she has to find a way to escape.

Chapter 5

Chapter Summary:

After her routine treatments, all the patients on the ward are taken to the ‘Friends Room’.

Twice a week, the friends room gives Rebecca and Jane another chance to meet. This is

where they begin to plot their escape, but Rebecca has no idea of the layout of the asylum and

is confused and disorientated from the drugs she’s been given. Jane takes over the

conversation and tells Rebecca what they will need for their escape and devises a plan.

Key Emotions:

• Disorientated

• Weak/Numb

• Jumpy

Key points in chapter:

• Insulin Therapy continues

• Wakes several days later from coma-

Mental deterioration

• Auditory Hallucinations begin

• Taken to Airing Ground and finds Jane

• Tells Jane of her desperation to escape

and Jane agrees to help her

Key Emotions:

• Vacant

• Distant

• Desperate

• Driven

Key points in chapter:

• Meets Jane in the ‘Friend’s Room’

• Discusses plan to escape

• Jane tells Rebecca what they will need to

do

• Jane’s plan seems illogical and irrational

to Rebecca

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Chapter 6

Chapter Summary:

Rebecca’s schedule to work in the laundry room that afternoon gives her the opportunity to

sneak out. Using Jane’s information, Rebecca makes her way down the Gallery towards one

of the treatment rooms and takes a trephine from the surgical bench. She conceals it and

returns to the laundry room without being noticed. That night she hallucinates. She believes

that Dr Porter is watching her. He tries to kill her, and believing that he knows about the

trephine, she stabs him with it and he falls to the floor. Moments later, she realises it wasn’t

real. She hides the trephine inside her pillow and returns to bed. She does not sleep.

Chapter 7

Chapter Summary:

The next day, Dr porter decides to increase the insulin dosage for Rebecca’s therapy. She is

induced in several comas for the majority of the day, but is eventually allowed to return to her

regular routine. In the airing ground, Jane finds Rebecca and asks whether she has been able

to get the item for the escape. Rebecca tells her that she has got the trephine, but they still

need an idea of the layout of the Asylum in order to plan their escape. Jane tells Rebecca of a

consultation she had with one of the other physicians. She mentions the brilliant view of the

entire complex, visible from the Physician’s room. With that Rebecca assaults one of the

guards, and is taken to see Dr Porter to try and look for a way out of the grounds but she

cannot find one. Due to her outburst a the guard Dr porter increases Rebecca’s insulin dosage

again and tells her that he is watching her closely, revealing his interest in her.

Key Emotions:

• Unstable

• Unpredictable

• Scared

Key points in chapter:

• Becoming very desperate- time is running

out

• Sneaks out of Laundry Room

• Steals a trephine from one of the

treatment rooms

• Visual Hallucinations become more

severe

Key Emotions:

• Confused

• Sad

Key points in chapter:

• Wakes from induced comas

• Meets Jane in the airing ground as usual

• Rebecca tells Jane of the trephine

• Jane reveals information about the layout

of the Asylum

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Chapter 8

Chapter Summary:

A week later. Rebecca wakes from another coma, but she has become much more mentally

fragile. She believes she can see things growing on her every time she wakes up, and hears

her daughter calling constantly. She starts to believe she might be insane, and has started to

talk to herself when she is alone. She remembers that she was running out of time to see her

daughter and becomes extremely desperate. She finds Jane in the friend’s room, and after a

conversation about the urgency of the escape, Jane has an idea which she shares with

Rebecca. Despite both character’s irrationality, Rebecca’s desperation to see her daughter

causes her to agree, and they decide to execute their plan that same evening.

Key Emotions:

• Shaky

• Irritable

• Scared

• Irrational

Key points in chapter:

• Wakes from a week-long coma

• Finds Jane in the friends room

• Speaks to her about the plan

• Discusses the details of the plan and

agree to escape that evening

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Chapter 9

Chapter Summary:

That evening, Rebecca and Jane try to escape. Rebecca begins to hallucinate compromising

the success of their plans to escape. Jane sneaks away from the other patients on the Gallery

who are being escorted to their beds. Rebecca follows her and finds herself unable to

distinguish what is and isn’t real. She sees patients staring at her who aren’t really there, and

she becomes paranoid they will alert the staff to their plan. Rebecca follows Jane into a

nearby Water Closet to hide. They continue towards the main hall, but are discovered a

passing steward. Rebecca panics and freezes, but Jane stabs him with the trephine before he

can alert the staff. Jane returns the trephine to Rebecca and opens the door. Fortunately, the

Entrance Court door remains unlocked for visitors and the pair continue out onto the front

gardens. However, Jane is captured by the pursuing guards, allowing enough time for

Rebecca to flee into the nearby woods. Jane urges her to keep going, despite Rebecca’s

reluctance to leave her friend behind.

Key Feelings:

• Scared

• Excited

• Hopeful

Key points in chapter:

• Initiates escape plan

• Jane and Rebecca hide in a Water Closet

to avoid detection

• Discovered by steward, who is then killed

by Jane

• The pair flee the Entrance Court onto the

front gardens

• Jane is re-captured, and Rebecca escapes

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Chapter 10

Chapter Summary:

The woods ran for miles and surrounded the Ruswick estate, which Rebecca often walked

with her husband James when she was younger. As she moves deeper into the woods she

begins to see oddly formed creatures, which she believes are hostile towards her. After

walking for several miles through the woodland, Rebecca collapses and falls through the

undergrowth onto her husband’s estate. She drags herself through the gardens towards the

main house. To avoid attracting attention, she opens the cellar door at the back of the house

and climbs inside. She continues to hallucinate, believing that she sees Eve run past the cellar

doorway into the Entrance Hall. Rebecca checks the hall is clear before continuing, realising

she would be too exhausted to resist capture if discovered. Upon hearing Eve’s voice calling

to her she follows her up the stairs and onto the landing, where she sees her husband standing

in the doorway of her daughter’s bedroom. She moves silently across the landing towards

him with the trephine clutched tightly in her hand.

Chapter 11

Rebecca makes a noise on the landing which causes James to turn towards her. Before he can

defend himself she sinks the trephine into his neck and, ignoring his screams, drops the

weapon and runs into the room to see her daughter lying on the bed. She holds her daughter

in her arms, and upon seeing Eve smile at her, discovers she is not too late – or so she

believes.

Key Feelings:

• Deprived

• Unpredictable

• Enthralled

Key points in chapter:

• Reaches the Ruswick Estate

• Enters the house through the cellar

• Her hallucinations are now extreme

• Rebecca follows Eve’s imagined voice

upstairs

Key Feelings:

• Vacant- unemotional

• Relieved

Key points in chapter:

• Rebecca murders her husband

• Sees her daughter lying in her bed

• Rebecca is re-united with her daughter

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-Seminar & Workshop -

Material

Setting

What is it like/how do the characters feel in these places?

The tapping of his heel was steady, luring me in like a fly to a lamp. I would have preferred

the chair for company. The wooden back of the chair was hard as he invited me to sit down

opposite him. He began to speak to me, although I wasn’t really there- distracted I suppose. A

musky smell had drifted down the hall which made me cough, interrupting me as if there

were no need for words. It seemed to come from the apothecary. I’ve seen the doctors go in

there sometimes, and when they come out they’re carrying bottles and sharp objects. One of

the bottles was glowing yellow the other day you know. I saw it.

‘Rebecca, is everything okay?’

I nodded.

‘We’re going to try something – different today’, he said.

I swallowed hard and laid on the bed.

Writing Exercise: Rebecca’s experience of a consultation with Dr Porter in the Physicians

Room in Bethlem Hospital. Focused on Rebecca’s senses.

1. Physicians Room

- Afraid of the unknown, doesn’t

know what to expect

- Feels unimportant/animalised

- Anxious/threatened/ confused

afterwards: is this her last

moment alive?

- Cure room rather than Treatment

room

- Smell of the apothecary- coughs

2. Airing Ground

- Communal

- Feels a sense of freedom, frees

her mind and body

- Excitement/able to converse with

Jane

- Smoke from the factories in the

city

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Writing Exercises

Experience of a modern day Asylum

Every week I have to sit in this damn room with nothing to look at but a desk, a pencil pot, a

box of paperclips and some paperwork with my name on it. I try not to look at the walls; too

white. Too busy. There are paintings that hang above the desk either side of the room, worn

and leaning ever so slightly to the right; which if you are a regular like me is completely

infuriating. I’d say it’s to cover the shabby white paint finish. I asked them to straighten them

once, the pictures I mean, but they just laughed and told me to focus on the questions.

There is a window behind the desk where we have our little ‘chats’; it saves me from

looking at her dull face. That is, Miss Sue Barsden- my psychiatrist. Yes, I have a

psychiatrist. They all think I’m mad, even my dear brother, Sammy; I reckon they’re totally

convinced but no one has openly admitted it to me yet.

I see all sorts of things through that window you know, like Lucy she should be here

any minute -Its usually about this time. I often wonder if I’m peering through it into another

world, silently observing from behind the thin glass panels. I’m staring now, but nothing has

happened just yet; sometimes it just takes a while but I always see her.

One sentence paragraph

They say you can cure insanity, at least they tried to, not that I was insane because I wasn’t, I

just found it a little difficult familiarising myself with my new residence, that’s what they call

it now, a residence, despite the cold hallways and damp bed sheets which are not really bed

sheets due to the fact they have been worn down, so thin in fact I could almost tear them

apart, and yes I have tried but it’s not as easy as you would think you know, tearing up a bed

sheet.

First-person narrative (Attempt 1): I tried to get across the patient’s frustration and anger

towards her doctor, and the unpredictability in the behaviour of an individual with mental

illness, like Rebecca in my novel. Written in a similar style to The Yellow Wallpaper.

First-Person Narrative (Attempt 2): This was a seminar exercise where I had to make a one-

sentence paragraph. It is about a woman who believes she is not insane and has no awareness

of her surroundings. It could be edited to become one of Jane’s utterances in a converdation

with Rebecca in the asylum as a form of her nonsensical rambling.

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Writing in Diary form

April 12th?

I’ve been here almost a month now. I think. You lose track of time in this place. Yesterday

they took me into a room and tied me down to one of the beds in the ‘patients’ room, where

Dr Porter was waiting for me as usual. I saw another patient come out just as I was going in-

he was strange though, his limbs were hanging over the arms of the two other doctors who

were carrying him out. He never even looked at me. Rude. Anyway I went in for my regular

meeting with Dr Porter who said he was going to try something new, to make me better so I

could go home! ‘It’s just a precaution’ they said. The straps felt cold around my arms and

legs as he tightened them, covering the bruising from the day before. He’s very precise! I

didn’t struggle. It’s not worth it, besides Dr Porter says it will only increase the dosage they

give me and I’ll be asleep for even longer.

Practising with Dialogue

‘Jen- Jenny did you hear me?’

‘Yes.’

‘So how are you feeling today?’

‘Fine.’

‘That’s good to hear, today we are going to move on from our normal set of

questions…’

There did you see it? I thought it was just me at first but I definitely saw her then.

‘Jen, I said I’m going to show you some photographs if that’s okay?’

‘Sure.’

‘Can you tell me what you see?’

‘A castle.’

‘Okay. Can you tell me if you see anything different about this next photo?’

‘There’s a barred gate- but the gates are shut’.

‘And what about this one?’

‘The same, only now there is a woman behind it’

‘And this one?’

‘Now there’s a girl too. She’s trying to reach for the woman but the gate won’t open.’

(Attempt 1): Rebecca’s diary entry after 3 weeks of treatment. Confused, lost track of time.

Submissive to her routine treatment.

(Attempt 1): Asylum consultation between a patient suffering from hallucinations, and her

doctor.

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‘Keep going Jenny’

‘She’s crying…’

‘It’s okay!’

‘No, the woman wants to get to her she needs to get to her. Let her through!’

‘Okay, okay thankyou Jenny. That will do for now. I just need a quick word with Sam

outside and we’ll leave it there.’

Sue’s chair scraped across the laminate floor as she stood up and walked towards the

door, but my gaze is still fixed on the girl outside the window.

‘It seems to me that the accident has affected her perception of reality. I think it would

be a good idea if she…’

Sue smiled at me before pulling the door shut, aware that I was able to hear her despite being

on the other side of the room. Lucy’s gone again. That can happen you know, if you aren’t

paying attention; she just disappears for a while but she’ll be back.

‘Jen, come on sis let’s get going’ I heard Sam say as they both re-entered the room.

‘Go where?’

‘We have to go away for a while’

‘But I can’t leave her?’

My husband John doesn’t seem to understand that. No matter how many times I say it. What

kind of mother would that make me!

‘Jenny come on’

She’ll be back soon; she always comes back.

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-Bibliography-

Websites:

https://prezi.com/r2bguokfl0u2/asylums-and-treatments-of-mental-illness-in-the-victorian-

era/

http://thetimechamber.co.uk/beta/sites/asylums/asylum-history/the-history-of-the-asylum

http://www.victorianlondon.org/health/bethlehemhospital.htm

http://studymore.org.uk/4_13_ta.htm#Bethlem1860s

https://historicengland.org.uk/research/inclusive-heritage/disability-history/1832-1914/daily-

life-in-the-asylum/

http://www.jtrforums.com/showthread.php?t=7317

http://www.britannica.com/topic/lobotomy

http://serendip.brynmawr.edu/bb/neuro/neuro01/web1/Goff.html

https://en.wikipedia.org/wiki/Trepanning

http://www.vam.ac.uk/content/articles/i/introduction-to-19th-century-fashion/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1574422/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1973489/?page=2

https://en.wikipedia.org/wiki/History_of_psychiatric_institutions#Emergence_of_public_lunatic_asyl

ums

http://www.cerebromente.org.br/n04/historia/shock_i.htm

Videos:

https://www.youtube.com/watch?v=oswUssXzFlY&nohtml5=False

https://www.youtube.com/watch?v=YA_MwaRLzm8&ebc=ANyPxKqPk0u0xMJdLq3dqRjmxTXC3

5rrkzhPi3MLdoOvCYRWk4TDnAUCGf-wGN6iesiH2JmJVcGyA-7y3NRYfLZDeiU1uiLr0Q

https://www.youtube.com/watch?v=YA_MwaRLzm8&ebc=ANyPxKqPk0u0xMJdLq3dqRjmxTXC3

5rrkzhPi3MLdoOvCYRWk4TDnAUCGf-wGN6iesiH2JmJVcGyA-7y3NRYfLZDeiU1uiLr0Q

https://www.youtube.com/watch?v=4DjQ-V2YELQ

https://www.youtube.com/watch?v=EtgzpAbxcRI

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Books:

Gale, Colin and Robert Howard Presumed Curable. Hampshire: Wrightson Biomedical Publishing

Ltd. (2003)

The Committee on Nomenclature and Statistics of the American Psychiatric Association, Diagnostic

and Statistic Manual: Mental Disorders. Washington: American Psychiatric Association Mental

Hospital Service, (1952) : p.26-27.