Henri Dagonet, « Photographies de trois malades de la Clinique de la Faculté à l’Asile Sainte-Anne », dans Henri Dagonet, Album de 49 planches rassemblant 76 photographies d'aliénés, Paris, 1888-1889, p.84, (online)..
Both historical and sociological, the garment is, as Roland Barthes puts it, “the particular signifier of a general signified”. It summons both the visual identity of its wearers and collective norms external to them. The ambiguity of this item is particularly striking in the case of clothes worn by the patients of psychiatric institutions. Up to the mid-20th century, patient uniform is compulsory, defined by its twin impersonal and therapeutic nature. Within the institution, clothing is both a device to uniformize the patients and the hospital staff, allowing the inception of a hierarchised order and also a tool underpinning the therapeutics and hygiene of the establishments. It should therefore come as no surprise that the dress in mental asylums inspired over the 19th and 20th centuries a relatively rich medical and administrative literature.
As from the end of the 18th century, the issue of clothing for those called demented or insane appears in medical literature. For pre-Revolutionary doctors, the insane’s dress has a disciplinary and a hygienic function. Daily worn by the inmates, the item must be devised fit for withstanding their agitated states. It includes white underwear in hardwearing canvas cloth, baggy trousers, and tow stockings. Though fairly sketchy, early epochal descriptions testify to the intent to medicalise institutions which, for the most part, offer a very basic material and hygienic environment.
In the first part of the 19th century, when physician Philippe Pinel’s theses according to which the insane is seen as a sick person who can be healed, clothing becomes an essential component of the institution’s internal regime and an agent of their moral treatment. Indeed, according to the so-called therapeutic isolation principle the purpose of which is to keep the patients separate from society, the role of clothing is to detach them from all symbolic or sentimental elements tying them back to their past identity and thereby liable to trigger their agitation. Asylum regulations specify that upon admission, each patient is stripped of all personal belongings which are stored for the duration of their stay. The patients are then given their uniform the mostly plain colours of which help distinguishing them from the nursing staff and curbing evasions. The patients’ uniform yet varies according to sexes and units. For this reason, patients admitted in care or nursing homes – and who pay a higher fee than the other patients – are not as a rule compelled to wear the uniform and may keep their personal belongings, the mark of their social status.
Designed to support the treatment, garments are also used in the asylum as indicators of the patients’ general state. Doctors’ reports as well as the varied treaties on the construction of mental asylums highlight in this respect the importance of clothing which can at a glance inform the physician on his morning round of the level of cleanliness of his ward and of his lunatics’ mental state. A display of lax state of dress, holes in the underwear, the very refusal to dress may give some indication of the patient’s composure and in the event affect the length of their stay in the establishment. A blank canvas on which the signs of madness show up, the patient’s dress provides moreover a snapshot of the general quality of a ward, nay, of the hospital as a whole. In the 19th century, medical reports unanimously rail the disregard for hygiene requirements.
A personal but depersonalised object, the patients’ clothing is yet called into question at the beginning of the 20th century as the carceral nature of the psychiatric institution is stigmatised. Accordingly, driven by public authorities and reforming psychiatrists, the personal dimension of some objects is affirmed. The 21 August 1952 circulaire regarding psychiatric hospital regulations encourages the humanisation of the living and admission conditions in these establishments which are henceforward destined to become healing and readjustment centres. In that text, the health minister requests that the nurses’ traditional uniforms be supressed and above all that the patients may keep several of their “civvy” clothes towards fostering their social readjustment thus limiting the deleterious effect of extended stays.
A study of clothing helps bringing out the internal functioning of the asylum institution over the past two centuries. The many debates around it as attested in medical literature underscore its polyfunctional dimension. It is both a device to uniformise the interned population, to denote the patients’ psychic state and the state of cleanliness of the establishments. In this respect, clothing in mental homes expresses equally the institutional norms applying to all its inmates and its social purpose.
Read more in the dictionary : Excess mortality in psychiatric hospitals
Read the paper in French : Uniforme asilaire
References :
Coline Fournout, « Qu’est-ce que l’humanisation en psychiatrie ? Retour sur une transformation du paradigme hospitalier en France dans les années 1950 », PSN, vol. 19, no. 1, 2021, pp. 31-47.
Benoît Majerus, « La baignoire, le lit et la porte. La vie sociale des objets de la psychiatrie », Genèses, vol. 82, no. 1, 2011, pp. 95-119.
To quote this paper : Gaspard Bouhallier, “Asylum uniform”, in Hervé Guillemain (ed.), DicoPolHiS, Le Mans Université, 2024.
