This is the eighth part of a series. You can find part one here.
It’s time to acknowledge the elephant in the room: boarding-out is not unique to Geel. It existed throughout Europe before the construction of grand asylums and never really entirely went away.
The ideas most of us have of what care for the mad and intellectually disabled looked like in the past are wildly inaccurate.1 The most memorable accounts – and the ones most likely to be repeated – are the shocking and unusual. Thanks to these misconceptions, reading the actual history of care was a surprise.
There are two types of boarding-out: boarding-out arranged by families and support organizations and boarding-out arranged by an asylum. Prior to the creation of dedicated asylums, all boarding-out was arranged by families, community groups, and religious organizations.2
Prior to around the 1800s, people were only removed from the community for safety concerns. If a family could not manage care on their own, they were provided with assistance or another family was paid to provide foster care. If the family was deemed unable to pay, the church and other local charities provided the family with poor relief or contributed to the cost of boarding-out. Families restraining someone did so with court approval and oversight.
As early as the 1400s, Europe was building asylums in urban areas with large populations. In other places, sections of other institutions were dedicated to providing appropriate care for the mad. Private asylums were created, generally specializing in providing care for a specific type of patient and only hosting a small number of patients. All of these were approved by and overseen by the government.
Asylums weren’t built purely in response to need, since most of them were funded by acts of charity from the nobility.3 Generally they were run by the church and authorized and overseen by the local government. Initial funding came primarily from bequests. After that they relied on paying patients, church funding, government funding, donations, fundraisers, and admissions fees from gawking guests. Early asylums were small. The first asylum in the low countries opened in 1461 with room for six people. While policies varied, the asylums in Amsterdam and Utrecht only accepted the “raving” mad.4
The mildly mad who ended up in institutions generally ended up in the workhouse. This, of course, was an arrangement only made when the person in question was capable of working.
People requiring care, due to age-related infirmity or simple-mindedness, could be placed in leper houses. Leprosy was basically non-existent after the 16th century, so these institutions began expanding their services. Admissions contracts show families paid a significant amount in exchange for a promise of lifetime care, which the institution could cancel if the boarder behaved inappropriately.5
In the late 1600s one Amsterdam home for widows and single women over the age of 50 was home to so many mentally disturbed residents that they built a separate ward for them in response to complaints by other residents.
Patients could also be placed with doctors and members of the clergy temporarily – while they were undergoing treatment, as respite care, or while awaiting placement elsewhere.
Courts generally only authorized the restraint or sending away of the mad for a limited period, typically less than one year. Competency hearings were generally brought by the next-of-kin, with testimony from community members and the person in question. Families testified that they had exhausted their ability to provide care and demonstrated repeated attempts to find a cure before seeking support. Wards were regularly transferred between housing situations based on changing care needs.
Boarding-out in the Campine
People unfamiliar with rural life, including hospital psychiatrists, tend to assume rural people are highly tolerant of bizarre behavior. As Nancy Scheper-Hughes explained in Saints, Scholars, and Schizophrenics: Mental Illness in Rural Ireland:
“In fact, conformity is very highly valued in Ballybran, reserved behavior is the expected norm, and…all physical aggression is shunned. While the category of harmless “saints” – those eccentric but normally quiet and harmless people who keep to themselves – can live peaceable and integrated lives in the village despite certain eccentricities of behavior, tolerance is not to be extended to those persons who violate the strong Irish sanctions against expressions of sexuality, aggression, and insubordination to parental and religious authority. Such nonconformists are prime candidates for the mental hospital.”
Community ties can counteract this requirement for conformity somewhat.
There’s also the idea that in village life, support is provided informally between family and neighbors, without strict structures and policies. Even in the 1500s, the settlements of the Campine were intensely governed, with one village of 161 households having people holding 35 offices during the 16th century. This included the Heilige Geesttafel, “a parochial organisation governed by laymen” responsible for poor relief. In the Campine, government offices were prestigious roles which were controlled by the wealthiest villagers.
Boarding-out would have been managed by the poor table and the canon.6 Every parish in the southern low countries had a poor table. They provided relief to those unable to work and during times of economic misfortune. These laymen, the poor masters, needed to be of good character and capable of writing and financial management, as detailed written records were kept. These poor tables would have been the ones from the local parish determining who should be boarded-out, where they should be sent, and managing payment.7 This was done with the approval of the court. The source of much of the poor table’s income was through bequests of annuities and leases which were given in exchange for annual church services in their memory, jaargetijden.
The beginning of the asylum age
At the end of the 18th century, views of the mad were shifting among cultural elites throughout Europe and North America.8 Custodial care was no longer viewed as sufficient, as scientific medicine put forth belief in the possibility that all could be cured with proper treatment. Growing interest in creating an ideal population rendered it unacceptable and possibly dangerous to have “defective” people living in society.
Writings by men of medicine made it seem like they are saving the neurodivergent from dungeons and squalor. In some cases they were. Most of the time, though, they were removing people from their families and community to be placed in closed institutions where they could be monitored, controlled, and subjected to involuntary treatments.9
According to Andrew Scull’s Masters of Bedlam, asylum care was promoted by cultural elites and were unpopular with the masses. This was part of the larger trend of professionalization. New notions of the need for treatment and isolation were spread by propaganda and educational institutions. The new regulations were easiest to enforce among the urban poor. Rural families could easily avoid the scrutiny of the urban elite. The wealthy preferred to continue boarding-out for reasons of privacy.
When Belgium became a country, the laws created the Colony of Geel – a designated territory for boarding-out. It was legally an asylum and overseen by the same authorities as other asylums. Boarding-out was no longer permitted in the rest of Belgium.
Candidates for boarding-out
The mad who were sent to be boarded-out, in Geel or anywhere else, could not be “raving mad.” They could not be aggressive or have any history of sexually inappropriate behavior. Their condition needed to be relatively stable. They needed to be capable of engaging with and being part of a family and the community. They could not require around the clock supervision or high levels of personal care.
Boarders were designated as “clean” and “unclean” and payment to the host family was based on this designation. Accommodations and payment were also based on their social class, regardless of the current financial situation of the boarder.
Writings about Geel today emphasize that it’s foster care for the mentally ill, with specific mentions of schizophrenia and psychosis. This left me with an inaccurate impression. A significant portion of boarders in Geel have always been intellectually disabled. In 1905, 35% of boarders at Geel were “congenital idiots and imbeciles,” another 37.5% were “cases of chronic, secondary, organic, or senile dementia,” and another 10% were epileptic. I was surprised to read about people boarding in Geel in the 1970s due to their epilepsy diagnosis.
These were not people who were locked away before the age of the asylum.
“But the medieval period wasn’t really a great age of imprisonment, at least compared with many that came before or after it. For mass incarceration no period rivals the 20th and early 21 st centuries: the prison systems of modern countries, whether large and small, democratic or dictatorial, all easily outdo those of the Middle Ages in scale; often they are, or recently have been, far more vicious and unpleasant too, with systematic and ‘scientific’ cruelty. Prison states such as Stalin’s Russia, Nazi Germany, or the Kims’ North Korea match the myth of Gothic gloom and horror far more fully than any medieval state, and the numbers of prisoners involved have been vastly greater; and such prisons remain common in today’s world.”
“Once medieval castles and palaces became unfashionable and uncomfortable to live in, and lost most of their military value, the relative importance of their other functions – as centres of local administration, law courts, or prisons – grew. This has been particularly true of urban royal castles, which – unlike many of their noble country cousins – were not much appreciated by their owners except as functional centres of power.”
“The very term ‘dungeon’ did not originally mean prison, but rather the ‘great tower’ (the donjon) of a castle, which often (as at Portchester) formed the most secure place to put prisoners in later times: the etymology reflects the change of function.” https://issuu.com/marlborough_college/docs/mc_1122_reflections_revised_nov_2022_for_website
For the most part, care was organized through the church: “if someone belonged to a particular church community, that church provided (to some degree) certain support facilities. Most commonly, the church (community) provided poor relief or, in the cases of the mad, paid for admission into institutions or arranged for them to be boarded out with a fellow church member. However, individuals could also, and did, provide social provisions in the early modern local community. Frequently, they did so by means of financing support systems of care. Even though the state and the Church were greatly involved in providing care for citizens, the citizens of those cities paid for most of this care through either taxes or alms.”
Recall that church membership and tithing was far less voluntary than it is today. https://pure.uva.nl/ws/files/39144263/Thesis_complete_.pdf
“The first asylum in the Netherlands was founded in s’Hertogenbosch in the fifteenth century. In 1442, Reinier van Arkel left a statement in his will, that a part of his inheritance should be used to found an institution for the mad.89 Relatively soon after, in 1461, an asylum was established in Utrecht: for the rest of the northern Low Countries, this example was not followed for more than a century. In 1562, Amsterdam became the third city in the Northern Netherlands to establish an asylum. One explanation for this delay was the fact that multiple other institutions in these cities – plague houses, leprosaria and hospitals – had fulfilled the task of caring for the mad until that time. Yet, between 1550 and 1650, at least 14 references were made regarding foundations of separate wards or institutions for the mad in the Dutch Republic.” https://pure.uva.nl/ws/files/39144263/Thesis_complete_.pdf
At one point Utrecht had 18 hospitals, all of which had agreements to transfer patients to the asylum only when it was decided they needed to be locked up or tied down. https://pure.uva.nl/ws/files/39144263/Thesis_complete_.pdf
“Depending on the amount of money that was paid for admission, these people were either admitted into a private accommodation or assigned a place in the wards for simple-minded men or women. An extensive look through the late seventeenth- and eighteenth-century sources show that this Amsterdam institution only admitted the simple-minded because, unlike the mad, they could function within the daily routine of the institution. In general, this meant they should not display aggression or cause commotion and were capable of caring for themselves on a minimum level.” https://pure.uva.nl/ws/files/39144263/Thesis_complete_.pdf
Around the 18th century, Geel flourished as a center for the insane. It's in this one period when, for the first time, insane people who do not participate in religious rites come to Geel. From that time on, various insane people were placed at the poor table. Where placement in private homes was previously arranged by the canons, placement agents, appointed by the almshouse, will now also house the insane. So, in addition to a religious organization, a more profane one emerged.” https://www.canonsociaalwerk.eu/1850_krankzinnigenwet/1984%20Demolder%20ontstaan%20psychiatrie%20Belgie.pdf
There were similar organizations for Jewish and, later, Protestant communities. The only people likely to be excluded would be “vagrants and vagabonds” who were not part of the local religious community. https://www.academia.edu/29419857/Unity_in_diversity_Rural_poor_relief_in_the_sixteenth_century_Southern_Low_Countries
“As is by now generally acknowledged, in Britain the massive internment of the mad in what were asserted to be therapeutic institutions is essentially a nineteenth-century phenomenon. Though fugitive references to madhouses can be traced back to the seventeenth century, and perhaps before, and though a recognizable “trade in lunacy” clearly became established over the course of the eighteenth century, only after 1800 did systematic provision begin to be made for segregating the insane into specialized institutions. The birth of the asylum in its turn was intimately bound up with the emergence and consolidation of a newly self-conscious group of people laying claim to expertise in the treatment of mental disorder and asserting their right to a monopoly over its identification and treatment (Scull, 1996, 3).” https://amzn.to/48SBKGN
These treatments included stimulated drownings, although none of the treatises I read cited ancient shrines as an inspiration for this.