Alexander Morison - the Physician Alienist

Alexander Morison was described during his life as a physician alienist, who we would now describe as a psychiatrist, that is a physician who studies and treats mental illness. He came from Scotland and studied medicine at the University of Edinburgh. From 1823 he devised, promoted and delivered lectures on mental illness in London, and was later endowed with a permanent lectureship at the Royal College of Physicians in Edinburgh. Alongside this work, Morison retained his interest and continued to work, as a general physician.

Although Morison retained very close links with Edinburgh and other parts of Scotland, he spent a large part of his working life in London and the south east of England. Although private asylums (or psychiatric hospitals) like Bethlem existed during Morison’s working life, people who could afford to retain a personal physician during periods of mental illness of family members, did so.

Accordingly Morison spent part of his life travelling abroad with members of the aristocracy. He was also in Paris, where he learned about ways of treating and managing mental illness which were different from the rather more punitive methods in use in Britain at the time.

Morison became a Visiting Physician at Hanwell, Bethlem and the Surrey County Asylum, and also saw private patients in the community. Once a patient was referred to him he made several visits to assess their needs. He used a mode of assessment which included many elements of a modern assessment - appearance, attitude, behaviour, mood and affect or feelings, speech, thought process and content, perception, awareness, insight and judgment.

Throughout his life Morison kept a diary and the entries during the period in which he worked at Bethlem (1835-1852) describe his attempts to ameliorate the conditions and physical treatments given to patients at the time. The hospital which he knew was the building which now houses the Imperial War Museum which was built for Bethlem in 1815.

Patients were kept in what we would now regard as insanitary conditions – sleeping on straw for example – and could be chained up to protect themselves and others. With his private patients Morison tried not to use what were known as ‘restraints’ and instead to use mild purgatives, fresh air and exercise and to provide employment for his patients. He attempted to introduce these methods to Bethlem and to other hospitals where he was involved. In this respect Morison’s attitudes differed from those of some of his powerful colleagues and this led to difficulties for him.

Morison was the first person to lecture asylum staff about mental health and their duties in providing treatment, and he published articles and books on the subject. One very important book, ‘The Physiognomy of Mental Diseases,’ was first published in 1838. Morison’s view was that the physiognomy or the face, and its expressions, was a crucial diagnostic tool for someone who might be mentally ill. He commissioned an artist to draw head and shoulders portraits of about two hundred patients. These pictures illustrated their mental conditions alongside descriptions of their behaviour and their illnesses, and their recovery. Morison used these as teaching aids in his lectures.