The Sunny Side of the Asylum

Montrose Harbor today

Source: Matthew Smith

You wouldn’t think to find one of the world’s most innovative asylums in Montrose, Scotland. Montrose is a small town between the cities of Aberdeen and Dundee. It became a significant trading center during the 17th century and grew wealthy during the 18th and 19th centuries (partly as a result of substantial, however short-lived, profits from the slave trade), but it remained a small burgh, one of many important ports on the east coast of Scotland.

So, why would such a place become the site of one of the most influential asylums in the history of psychiatry? The best answer to that question comes in the form of a name, and that of a woman, Susan Carnegie, who lived between 1743 and 1821.

Susan Carnegie was born Susan Scott, the daughter of landed gentry: David Scott, an executive with the Bank of Scotland, and his wife, Mary. She grew up in Edinburgh during the height of the Scottish Enlightenment, which gave rise to the economics of Adam Smith, the philosophy of David Hume, the science of Joseph Black, the literature of Robert Burns, and even the university where I work, the University of Strathclyde, founded in 1796 as Anderson’s Institution.

Most influential for young Susan was William Cullen, the Professor of Chemistry and later of Medicine at the University of Edinburgh, who lived nearby. Cullen was interested in mental health and downplayed the efficacy of the medicines available at the time. Instead, he recommended relaxation and exercise. Such ideas would soon be making a difference to the mentally ill in Montrose and its environs.

In 1769, Susan married George Carnegie, a merchant based in Montrose. George had been something of a maverick himself, fighting for Bonnie Prince Charlie in the 1745 Jacobite uprising and, after the Pretender’s defeat at Culloden, fleeing to Gothenburg, Sweden, where he used his business acumen to rescue his family’s fortunes. While in Gothenburg, George Carnegie also became involved in charitable enterprises, including managing a poor box for British sailors in western Sweden who had become shipwrecked or ill. Once married Susan also became heavily involved in charitable works in Montrose, including those to support the poor, the unemployed, and the “mad.”

During the 1770s, Susan Carnegie became convinced that Montrose was in need of an asylum. At that time, mentally ill people who couldn’t afford to stay at a private madhouse were kept in the local jail, situated in Montrose’s tollbooth in the center of town. Here, the inmates were in full view of the public, who were just as likely to leer at and insult the poor souls as they were to offer them a crust of bread.

Appalled by the conditions experienced by such unfortunate people, Susan developed a proposal for a public asylum—the first in Scotland and one of the first anywhere. Although she was wealthy, this was not necessarily enough to convince the town’s leaders and those of the local Kirk (church) to go along with her plan. She therefore recruited an important ally: Alexander Christie, a well-respected merchant. The plan was ultimately successful, and the Montrose Asylum opened in 1781.

Montrose Town Council was often reluctant to give Susan Carnegie the credit she was due for founding the asylum, a fact she noted in her correspondence. But her role in shaping Montrose Asylum was far from over.

One of Carnegie’s roles was to recruit subscribers for the asylum—in other words, convince people to donate money to support the charitable endeavour. She succeeded in securing the asylum’s future long after her death. (George Carnegie also attracted the odd subscriber.) Susan Carnegie further contributed to Montrose Asylum’s financial success by suggesting that its managers apply for a Royal Charter. In addition to its prestige, a Royal Charter would allow the asylum to hold stock and land and accept these sorts of financial donations too. In 1811, eight years after she suggested it, the asylum became the Royal Lunatic Asylum, Infirmary and Dispensary of Montrose. In the 19th century, the institution was renamed Sunnyside Royal Asylum.

But Carnegie’s greatest contribution may have been her influence over the asylum's approach to mental health care. Early on, she successfully pushed for the asylum to have resident medical superintendents. Prior to that, Montrose’s physicians rotated in month to month, never really getting to know the patients. But as of 1799, the physicians adopted Carnegie’s suggestion and switched to a yearly rotation, accepting a salary as compensation. Finally, in 1834, 13 years after Carnegie’s death, the asylum hired a permanent medical superintendent. This was W. A. F. Browne, who would become one of the most influential Scottish psychiatrists of the 19th century, pioneering occupational therapy, art therapy, and non-restraint.

Although Browne gets a great deal of credit for his achievements, which grew in importance after he was poached by Elizabeth Crichton (another female mental health reformer from Scotland) to set up Crichton Royal in the southwest of Scotland, he was following in the example set by Susan Carnegie in Montrose Asylum’s first 50 years. Carnegie always advocated kind, caring treatment, especially for the so-called pauper lunatics, who were cared for without charge. She ensured the buildings and grounds were clean and well cared for and that patients were treated by highly trained physicians.

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The history of mental health treatment includes a number of celebrated female reformers. In addition to Elizabeth Crichton, it is worth mentioning Dorothea Dix, who pushed for public asylums in the United States, and, more recently, Judi Chamberlin, who advocated for the rights of the mentally ill. But the first woman to really make a difference was Susan Carnegie. Her efforts predate even the pioneering reforms of the Tuke family at the York Retreat and Philippe Pinel in France. More people should know about the accomplishments of Susan Carnegie, a true figure of the Scottish Enlightenment.