Admission to the DCLA was a procedure of complex negotiations between the patient’s relatives or other members of the wider community, local authorities as well as medical and legal experts (Melling, Forsythe & Adair, 1999). It has been argued that with increasing industrialisation 19th century asylums have been used willingly by relatives to ‘dump’ their unwanted, intolerable and unproductive family members (Scull, 1979). In-depth research on the DCLA does not support such statements, but it has become clear that many families viewed the DCLA as the last option after a variety of other actions failed including boarding out the patient with relatives and – in the case of the financially better-off – travelling. Ann’s biography also contradicts such broad-brush statements, as she was gainfully employed up to the commencement of her illness. Rather than unwillingness, it was often the inability of families to continue to care for the insane that propelled them towards the asylum. Family crises or the threat to the integrity of the family (Melling, Forsythe & Adair, 1999) frequently preceded a patient’s committal. It is therefore not surprising that families featured prominently in the admission of patients. They were often the first to notice that ‘something is not right’ with the patient and would alert the authorities when the patient’s behaviour became intolerable. From the time that elapsed between the commencement of the illness and the committal to hospital we can show that most families tried hard to cope on their own and avoid involving third parties. Close-knit family relations offered the best protection from admission – for emotional as well as economic reasons (Suzuki, 1997). Most DCLA patients had been cared for by spouses, parents and children, less frequently by siblings (Suzuki, 1997). The breakdown of such care systems through death, illness or desertion rendered patients vulnerable to admission. Similarly, patients who lacked these systems entirely, for example single people whose family lived at a great geographical distance or people who had themselves distanced socially from their relatives were at higher risk of being admitted. They were frequently more severely ill as well, as more time had elapsed before authorities were alerted about their condition.

Ann’s admission document

However, once members of the community had drawn the attention of the authorities to a particular person, a magistrate or Relieving Officer could commit them to an asylum, after a certificate of lunacy was signed by a physician, surgeon or apothecary (Adair, Forsythe & Melling, 1998). In these early admissions, the patient’s voice is entirely absent from the committal process, clearly assuming their incapability to consent to their own treatment. Ann’s family features prominently in her committal to the DCLA. After her stay at the St Thomas Asylum, she returned to live with relatives where her violent outbursts became a problem.

In some cases other people of the wider community were involved in the admission process. Frequently this concerned employees whose inability to perform their tasks had been brought to the attention of their employers. Such patients were usually admitted after a rather short duration of their illness. Although her case notes reveal that Ann once been gainfully employed, it is not discernible whether this was still the case on her second admission, neither can we find out whether her employer was involved in her committal.