Surname:

Perceval

First name:

John Thomas

Era:

19th century

Field of expertise:

Psychiatry
Therapeutic pedagogy
Politics

* 14.02.1803

† 28.02.1876

British army officer, asylum inmate, pioneer of the user movement in psychiatry

John Thomas Perceval (1803–1876) was the tenth child of Spencer Perceval (1762–1812) and his wife, Jane (née Wilson). His father served as prime minister under King George III from 1809 and was shot dead in the lobby of the House of Commons by John Bellingham, a failed merchant, in 1812 (Treherne 1909: 193 ff.; cf. Gillen 1972). Two years after this event, Perceval’s mother married the army officer Sir Henry Carr. Born into the ruling elite of the United Kingdom, Perceval was, as he put it, “nursed in the lap of ease and scrupulous morality”. At the age of 18, he joined the military. He ended his military career nine years later, after deployments in Portugal and Ireland, in the rank of a captain: he no longer wished to be “a blind instrument of power” (cf. Bateson 1961: 10). He initially thought of entering politics but then enrolled at Magdalen College, Oxford, in 1830 to study theology (Hamilton 2004: 89).

Crisis and hospitalisation

After his first term in Oxford, Perceval went to see friends and family in the north of England and then embarked on a spiritual journey to Scotland to visit a controversial religious community in Port Row (today Rhu). This group, led by John McLeod Campbell (1800–1872), was said to speak in tongues (“Row Heresy”; cf. Perceval 1961: 16 ff.; Hervey 1986: 251; MacGregor 1950). Perceval allegedly started experiencing visions and hearing imaginary voices around that time; in Port Row, his behaviour became so unpredictable that he was eventually asked to leave the community (Hamilton 2004: 89). He left Scotland to visit friends in Dublin where he developed acute symptoms (ibid.; Podvoll 1990: 110). His friends had him restrained and alerted his eldest brother, Spencer Perceval (1795–1859), who came to take John Perceval back to England in December 1830 and put him in a private asylum near Bristol. This institution, Brislington House, was known for its wealthy clientele and its regime of comparatively few restrictions. Its director at that time was Edward Long Fox (1761–1835) (Smith 2008). In February 1832, Perceval was transferred to the equally well-equipped and expensive Ticehurst House in Sussex, then directed by Charles Newington (1781–1852). He was released from Ticehurst in December 1834 after having convinced his family to arrange for private care (MacKenzie 1992: 92).

Shortly after his release, Perceval married Anna Lesley Gardner. The couple went to live in Paris for some years. They had four daughters: Jane Beatrice (1835–1893), Alice Frederica (1836–1941), Selina Maria (1838–1925) and Fanny Louisa Charlotta (1845–1862). 

Perceval’s Narrative

Perceval had already begun to note down his treatment experiences while at Brislington House. Now in Paris, he started writing an autobiographical book, the first volume of which he published anonymously in 1843; the second volume followed in 1840 under his own name. The work, totalling over 700 pages, was titled A Narrative of the Treatment Experienced by a Gentleman, During a State of Mental Derangement. The first volume described Perceval’s childhood and youth and explained the events leading up to his committal, with the main part recounting his asylum experiences. The second volume described his recovery and included numerous letters. In a contemporary review for the journal British and Foreign Medical Review (Forbes 1841: 106), the reviewer recommended the book to all psychiatric practitioners, emphasising the instructive value of Perceval’s meticulous descriptions of “imaginary”, delusional reasons for action and his response to treatment. In 1961, Gregory Bateson republished the volumes together with a new introduction.

Subjective theory of illness

Perceval believed his mental crisis to have resulted from his persistent problems of religious identity. In Dublin, he assumed, he had suppressed his nagging doubt in faith at the threshold of consciousness – however, the more he rejected this doubt, the stronger became the religious certainties: “I perished from an habitual error of mind, common to many believers, and particularly to our brethren the Roman Catholics, that of fearing to doubt, and of taking the guilt of doubt upon my conscience; the consequence of this is, want of candour and of real sincerity; because we force ourselves to say believe what we do not believe, because we think doubt sinful” (Perceval 1961: 36; emphasis added).

Treatment experiences

The treatment Perceval was given at Brislington House and Ticehurst obviously did not meet his expectations of how a member of the upper class would be treated, as he was temporarily put into a straitjacket and tied to his bed. In hindsight, he conceded to having been an unruly patient who posed a danger to himself and others. He admitted that he had planned to kill himself, developed his own private language, made up a fake biography and hallucinated incessantly. At Brislington House, for example, he mistook the asylum for his parental home. He described the staff’s actions and attitudes as follows:

“The first symptoms of my derangement were, that I gazed silently on the medical men who came to me, and resolutely persisted in acts apparently dangerous. No doubt there were also symptoms of bodily fever. But from that moment to the end of my confinement, men acted as though my body, soul and spirit were fairly given up to their control, to work their mischief and folly upon. I mean, that I was never told, such and such things we are going to do; we think it advisable to administer such and such medicine, in this or that manner; I was never asked, Do you want anything? Do you whish for, prefer any things? Have you any objection to this or to that? I was fastened down to bed; a meagre diet was ordered for me; this and medicine forced down my throat, or in the contrary direction; my will, my wishes, my repugnancies, my habits, my delicacy, my inclinations, my necessities, where not once consulted, I may say, thought of. [...] The persons round me consulted, directed, chose, ordered, and force was the unica and ultima ratio applied to me” (Perceval 1961: 120 f.).

Analysing the therapeutic milieu of Brislington House, Leonard Smith (2008: 181) concluded that Perceval acknowledged its high standards of treatment, while conceding that these standards could not always be maintained when dealing with a difficult patient like himself (hence the isolation room, cold baths and restraints). Perceval’s hospitalisation at Ticehurst House and the “moral treatment” practised there have been reconstructed by Charles McKenzie (1992: 62 ff.). According to him, Perceval’s account offers a good picture of the material and social situation at this institution but does not help in assessing whether he was accurate in his criticism of the treatment.

Recovery

The second volume of Perceval’s Narrative includes a detailed description of his recovery. Claiming that “many persons confined as lunatics are so only because they are not understood, and continue so because they do not understand themselves” (Perceval 1961: 220), he argued that therapeutic understanding required adequate circumstances: “A lunatic appears insensible, but his is, perhaps, the most alive of any mind to ridicule, and the contemptibleness of his state. But he is, as I may say, unconsciously alive to it. He does not acknowledge his own feelings, because his mind is deeply engrossed in painful and excruciating conflicts; he is already troubled by a thousand horrible and fanciful ideas of danger; the victim of inward  and preternatural sarcasm, contumely, and derision. But he acts strangely, from what he suffers unacknowledged and not understood by himself. If indeed, he were in quiet, peaceful circumstances, if he were secure he might find his mind reflect to his conscience perfectly, what the trouble occasioned by internal and external alarm prevents him noting” (Perceval 1961: 141).

Perceval suggested that just like the derangement had resulted from loosing the ability to doubt, regaining this ability was the key to his recovery: “shocked” by the experience that some of the prophecies of his hallucinated voices failed to materialise, he was increasingly able to distance himself from them and interpret them as dictates of conscience having taken on a life of their own. Becoming aware of the situational context of his delusions had reduced their presence and enabled a systematic examination of evidence (like, for example, his baptism certificate), as “many delusions that I laboured under, and which other insane persons labour under, consist in their mistaking a figurative or a poetic speech for a literal one; and this observation may be of importance to those who attend to their cure. […] During the progress of my recovery there, I kept watching minutely all my experiences and my conduct, and that of other patients, comparing their cases with my own, drawing such conclusions as in those painful circumstances I was” (Perceval 1961: 271 ff.). He concluded by explaining that, at Ticehurst House, he gradually calmed down and managed to address his family entanglements.

Criticism of treatment

Perceval demanded the legal protection of asylum inmates from (unnecessary) physical violence, arbitrary observation and shaming, an end to postal censorship, the right to choose one’s attending doctor, access to legal representation, the right to receive visits from friends and adequate medical treatment: “My mind was not destroyed, without the ruin of my body. My delusions, though they often made ridiculous, did not derange my understanding unaided by the poisonous medicines and unnatural treatment of my physicians” (Perceval 1961: 69).

Following the tradition of earlier testimonials presented by asylum inmates from Britain (for example, by Alexander Cruden or Samuel Bruckshaw), Perceval thus referred to the concept of inalienable civil liberties (Hunter & Macalpine 1962: 392; Podvoll 1990: 11; Wise 2012) – which were, however, suspended for asylum inmates: “I open my mouth for the dumb [...] I intreat you to replace yourselves in the position of those whose sufferings I describe, before you attempt to discuss what is to be pursued towards them. Feel for them: try to defend them. Be their friends – and argue not hostilely” (Perceval 1961: 4).

Alleged Lunatics’ Friend Society

In 1845, Perceval joined forces with other former patients to found the Alleged Lunatics’ Friend Society (ALFS) in London. He became the organisation’s chairman. Other prominent members were Richard Paternoster, Luke James Hansard, Richard Saumarez, Gilbert Bolden and John Parkin (Wise 2012; Scull 2015: 45; Paternoster 1841). The ALFS called for more adequate forms of asylum treatment and more effective protection from arbitrary compulsory hospitalisation. Despite accusations of selfish motives (as raised in The Times in 1858; cf. Hervey 1986), the Society achieved the release of several asylum patients, for example, in the forensic case of Arthur Legent Pearce. Perceval also published Pearce’s poetry in 1851. In 1854, he published a further book about the case of Eduard Peithmann (1803–1866), which had also been commented on by Karl Marx (1854) in the New York Daily Tribune (cf. Wise 2012; Meier-Peithmann 2011; Podvoll 1990: 111; Perceval 1854). The ALFS’s campaign strategy included sending letters to the government, politicians and the press. The organisation published reports in 1851 and 1858, which presented proposals for reform but were hardly noticed by the general public (Hunter & Macalpine 1962: 393 f.). The public impact remained rather limited; the ALFS probably never had more than a maximum of 60 people involved and ceased its activities around 1860. Its basic demand – that compulsory psychiatric admission be preceded by a court hearing – was fulfilled in 1890, fourteen years after John Perceval’s death. After obviously again suffering from mental problems, Perceval died at Munster House Asylum in the London borough of Fulham in 1876, at the age of 73. He is buried in Kensal Green Cemetery in London.

John Perceval called for consistent reforms of the asylum system at a very early point and is thus considered a pioneer of the user movement in psychiatry. His Narrative is a classic on the situation of the asylum system in 19th-century Britain (Shumway 2016) and one of the most significant first-person accounts of the experience od madness “from within” (Wise 2012; Gault 2008; Brückner 2007: 216–229; Hunter & Macalpine 1962: 392). The 1961 re-edition by Bateson has then also inspired the more recent recovery movement and alternative concepts of treatment in psychiatry (cf. Schlimme & Brückner 2017: 36 ff.; Podvoll 1990; Mosher, Hendrix & Fort 1994; Runte 2000).

Literature

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Burkhart Brückner, Annette Baum