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Bonnie Evans

The 1950s were turbulent, dramatic and provocative times for people interested in social change and its impact on child psychology. The 1950s was an important decade for psychological research that took 'society' and social causes within its remit. By the early 1950s, children classed with 'psychosis', 'schizophrenia' and 'autism' stood at the heart of controversies over the social and emotional development of children. The Maudsley psychotic clinic was founded partly to get 'childhood psychosis' recognised as a legal category and also to reinforce the role of medically trained child psychiatrists in determining the treatment that 'psychotic' children received. All of the children in the psychotic clinic were given a battery of tests on arrival in order to determine their physiological functions and their levels of intellectual and social development. Tests could help to build a picture of the child's internal conceptual framework and his sensory-motor functions.

in The metamorphosis of autism
Open Access (free)
Perceiving, describing and modelling child development
Bonnie Evans

Autism is an essential concept used in the description of child development and its variances. This introduction presents an overview of the key concepts discussed in the subsequent chapters of this book. The book traces the radical transformation of the concept of autism in Britain, exploring the reasons behind the shift and the impact that it has had on psychological sciences relating to infants and children. It locates changes in psychological theory in Britain in relation to larger shifts in the political and social organisation of schools, hospitals, families and childcare. The book explores how government entities have dealt with the psychological category of autism. The history of child psychology in Britain has largely been compartmentalised into the history of child guidance, the history of intelligence testing, the history of special education and the history of psychoanalytic theory.

in The metamorphosis of autism
A history of child development in Britain
Author: Bonnie Evans

This book explains the current fascination with autism by linking it to a longer history of childhood development. Drawing from a staggering array of primary sources, it traces autism back to its origins in the early twentieth century and explains why the idea of autism has always been controversial and why it experienced a 'metamorphosis' in the 1960s and 1970s. The book locates changes in psychological theory in Britain in relation to larger shifts in the political and social organisation of schools, hospitals, families and childcare. It explores how government entities have dealt with the psychological category of autism. The book looks in detail at a unique children's 'psychotic clinic' set up in London at the Maudsley Hospital in the 1950s. It investigates the crisis of government that developed regarding the number of 'psychotic' children who were entering the public domain when large long-stay institutions closed. The book focuses on how changes in the organisation of education and social services for all children in 1970 gave further support to the concept of autism that was being developed in London's Social Psychiatry Research Unit. It also explores how new techniques were developed to measure 'social impairment' in children in light of the Seebohm reforms of 1968 and other legal changes of the early 1970s. Finally, the book argues that epidemiological research on autism in the 1960s and 1970s pioneered at London's Institute of Psychiatry has come to define global attempts to analyse and understand what, exactly, autism is.

Bonnie Evans

This chapter examines the radical transformation of autism. It examines why the shift in meaning occurred by placing it into the context of legal and political changes in Britain concerning the rights of children, and the impact of these changes on the construction of scientific studies of children. In order to effect a major shift in the meaning of autism, there also had to be a major shift in the organisation of social life. In the 1960s, a new psychology of autism was used to challenge the social ideology of intervening in, and supposedly rectifying, child 'maladjustment'. The 1960s witnessed a revived interest in questions highlighted by earlier developmental psychologists concerning the primacy of sense perceptions in the development of early thought. In an international study group on infantile autism in 1970, a number of researchers put forward proposals for the central 'cognitive disorder' from which infantile autism developed.

in The metamorphosis of autism
Open Access (free)
George Campbell Gosling

The voluntary hospitals underwent a great many changes during the interwar years. The pre-National Health Service (NHS) hospital did not become a site for generating profit. Yet payment did find a place, even as the hospital remained essentially a philanthropic institution. The idea that the working classes should pay in to the system, the various schemes that facilitated this in the community and the almoner who policed it in the hospital, and the idea of opening up the hospital to middle-class patients, were all inventions of the nineteenth century. Yet it was not until the interwar years that any of them became the norm, or even commonplace. In both principle and practice, the change brought about was more complex than a simple switch from medical charity to private healthcare, a reformulation rather than a rejection of philanthropy.

in Payment and philanthropy in British healthcare, 1918–48
Open Access (free)
George Campbell Gosling

This introduction presents an overview of the key concepts discussed in the subsequent chapters of this book. The book looks at four new arrivals in British hospitals from the late nineteenth century, each of which became commonplace in the interwar years. These were: patient payments, hospital almoners, hospital contributory schemes and middle-class patients. Two core principles will be discussed as underpinning these four new arrivals in British hospitals. The first will be termed economic reciprocalism. A combination of change and continuity characterised the second principle of class differentiation. The book sets up the city of Bristol as a case study to explore the operation and meaning of hospital payments on the ground. It places the hospitals firmly within the local networks of care, charity and public services, shaped by the economics and politics of a wealthy southern city.

in Payment and philanthropy in British healthcare, 1918–48
Open Access (free)
George Campbell Gosling

Payment in the doctor-patient relationship continued along traditional class lines, with working-class patients treated on an honorary basis and middle-class patients agreeing a fee. The rhetorical and political strategies adopted by advocates of private provision were based on the premise that middle-class patients needed to be brought in to a revised notion of the sick poor. By establishing a system of class differentiation governing access to the voluntary hospitals, a new patient contract was constructed for working-class patients. Payment, either directly by the patient or indirectly via a contributory scheme, was in effect an act of good citizenship rather than earning the right to treatment. In between taking and refusing payment, a profession might distance itself from the payment taken. Providing free treatment to the poor was a professional activity doctors traded on lucratively in their private practice.

in Payment and philanthropy in British healthcare, 1918–48
George Campbell Gosling

This chapter examines why the voluntary sector and wider mixed economies of healthcare, welfare and public services should be so well developed in Bristol. To do so, it considers the social, economic and political factors at play in the city. The poor law was one of the two pillars of Victorian welfare. The other was philanthropy. Municipal interventionism, in both economic and social fields, was evident in Bristol from the early to mid-nineteenth century. If action was slower than many wanted from local government, there was significant activity from other sectors, including private enterprise, as can be seen from the case of private asylums. Poor Law infirmaries have sometimes been seen as the nucleus of a public hospital service. While the voluntary hospitals were leading charitable institutions in their own right, they were also deeply embedded within local networks of care.

in Payment and philanthropy in British healthcare, 1918–48
Open Access (free)
George Campbell Gosling

Taking a wider view of the patterns of provision, it is clear that the relocation of middle-class patients requiring institutional care, from the nursing home to the hospital, was only partially achieved over the early twentieth century. The specialist services of Bristol's hospitals, particularly in maternity care, contributed to a dual hub split between the two cities, jointly providing hospital services to the region's middle classes. This variation in locality, size and type of hospital both explains the atypicality of Bristol and nuances the 'insufficiency' of private provision identified by Bridgen. Understanding the type of hospital (i.e. general or specialist) can help us gain some understanding of what kinds of medical treatment were being provided to middle-class patients. Placing our focus on the idea and the act of payment both heightens and diminishes the significance of 1948 as a watershed in the history of British healthcare.

in Payment and philanthropy in British healthcare, 1918–48

This book examines the payment systems operating in British hospitals before the National Health Service (NHS). An overview of the British situation is given, locating the hospitals within both the domestic social and political context, before taking a wider international view. The book sets up the city of Bristol as a case study to explore the operation and meaning of hospital payments on the ground. The foundation of Bristol's historic wealth, and consequent philanthropic dynamism, was trade. The historic prominence of philanthropic associations in Bristol was acknowledged in a Ministry of Health report on the city in the 1930s. The distinctions in payment served to reinforce the differential class relations at the core of philanthropy. The act of payment heightens and diminishes the significance of 1948 as a watershed in the history of British healthcare. The book places the hospitals firmly within the local networks of care, charity and public services, shaped by the economics and politics of a wealthy southern city. It reflects the distinction drawn between and separation of working-class and middle-class patients as a defining characteristic of the system that emerged over the early twentieth century. The rhetorical and political strategies adopted by advocates of private provision were based on the premise that middle-class patients needed to be brought in to a revised notion of the sick poor. The book examines why the voluntary sector and wider mixed economies of healthcare, welfare and public services should be so well developed in Bristol.