Conclusion: Insanity and Enterprise
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Smith draws together the key themes explored in the book. He reiterates the historical significance of private madhouses in England from the mid-seventeenth century onwards. They were commercial responses to an increasing demand for specialist confinement of mentally disordered people whose families or parishes were unable or unwilling to manage them. Standards and conditions were shown to have varied considerably. Some enlightened proprietors pursued a curative ideal, actively implementing a range of medical and ‘moral’ treatment approaches in relatively comfortable surroundings. However, others conducted madhouses which conformed to the pervasive negative stereotypes of squalor, exploitation and abuse, condemned by critical public opinion and denounced by aggrieved former patients. Smith concludes by indicating areas for further fruitful research.