THERE WAS A SHIFT in the understanding of lunacy in the early 1800s. The Enlightenment had turned its back on old superstitious notions that madness was somehow connected to ignorance and sin; the madness of George III made the admission of insanity more socially acceptable and popularised the idea that it was an illness that could be treated.

And the Dissenters, particularly Quakers, had begun to promote a new, humane system of dealing with insanity. What they called “Moral Treatment” encouraged good diet, exercise, and work in ordered farms and gardens. Samuel Tuke (a pioneer of this style of treatment) wrote that in cases of madness the “intellectual, active and moral powers are usually rather perverted than obliterated”.

In the first half of the 19th century there was a huge growth in private and public hospitals for the insane. The old regime of barred cells and “strait-waistcoats” began to give way to more kindly systems. Madhouses became asylums, madmen became patients.

We can glimpse this new regime in accounts of John Clare during his 23-year stay in the Northamptonshire General Lunatic Asylum. The newspaper editor Spencer Hall visited him as he worked in the asylum gardens, “rather burly, florid, with light hair and somewhat shaggy eyebrows, and dressed as a plain but respectable farmer, in drab or stone-coloured coat and smalls, with gaiters, ... and altogether as clean and brushed up as for market or fair”. Clare was convinced that he was being kept there to be “fed up for a fight” (he had delusions that he was a famous prize fighter). When Hall suggested that his reputation as a poet outshone his reputation as a fighter, Clare replied: “Oh poetry, ah, I know, I once had something to do with poetry, a long time ago: but it was no good. I wish, though, they could get a man with courage enough to fight me.”

These tensions between asylum containment and open fields, between delusion and reason, run through Tom Pow's extraordinary new book of poems, Dear Alice: Narratives of Madness. The collection circles around the Crichton Asylum in Dumfries - now part of Glasgow University. Founded in the 1830s, the asylum was initially part of the same humane impulse as Samuel Tuke's “Moral Treatment”. Its 150-year existence charted a shifting and evolving understanding of mental illness and the permeability of identity. This social history is at the root of the book.

But madness remains a mystery. And the profound pain and distress of the afflicted makes a harrowing counterpoint to the therapeutic systems that have attempted to cure (or at least constrain) them. In Nightwatch, 1842 the poet treads the asylum corridors as a nurse and notes down the “fractured plots” of the lunatic narratives that are cried out in the darkness:

... I give due ballast
to the most frivolous claims -
become master of reason
when I've need to flatter
the restless and noisy:
“What spikes your night are pictures”,
I tell them. One's convinced
That shadows cut her like knives ...

In Questions of Judgement we see the inmates working the fields of the Crichton Home Farm Steading:

... They are judged
by simple needs: a plenitude of food,
fresh air and exercise. Each evening
heading home, the huge clock-face
confronts them like a new moon
binding them to the slow seasons
of growth ...

Two poems in the collection feature Charcot and Freud, and there is a sequence that addresses the collective madness of the First World War (when Crichton was a place of convalescence). But it is when Tom Pow speaks of the patients themselves, their case histories, their torments and consolations, that the book finds its heart. We read of M, who, during her menstruation tried to rescue a hen from a pond, and was mad for the rest of her life. We meet Angus McKay, piper to Queen Victoria, who lost his mind “over study of music”. And in Grass we meet Angus McPhee, who in the 1970s and 1980s was weaving grass into clothes at Crichton “for the weaver's own joy and to praise/ The industry of hands”.

In Resistances Pow ends with a coda that speaks for all the inmates as they address the note-takers who have recorded them:

the things I could tell you but again
you would sift them through the grid
of your understanding and then
you would not be speaking for me
which is all I ask
this clouded evening that somewhere
in the silence there is someone
who speaks with indifference
in a small voice
for me

The final poem of the cycle is addressed to “The Great Asylums of Scotland”. In it Pow sets the noble impulses that built them against the suffering the buildings have contained, and their present dereliction:

In attic rooms the sky's light pours over
a tide-wrack of maps, plans, records - a
grid
to lay over a waste of rage, grief, anger
and pain. None of that will make a cairn ...

The grid, Tom Pow implies, is of our making: the grid of reason and rationality. The old asylums are empty now. That grandiose 19th-century impulse has been left behind. And what of their inmates?

... though of the mad, little could be
salvaged -
not one knitted pullover, not one apron -
... The melancholy we mourn
they transformed into bread, milk, sunlight.

John Clare, bent over his spade in the Northampton asylum, would nod his amen to that.

Dear Alice: Narratives of Madness by Tom Pow
Salt Publishing, £12.99 Buy the book

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