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cure rates continued to stagnate. 35 This period witnessed both the normalization of the asylum system and repeated critiques from patients’ rights groups, legal sceptics, and families of the mad. The war did not instantly transform mental health care, and the term ‘shell shock’ was not coined until 1915; yet the war certainly put mental health concerns in an entirely new context. The decades leading up to the war anticipated many trends of twentieth-century psychiatry while still playing out Victorian debates
–69. 5 N. Tomes, ‘The Anglo-American Asylum in Historical Perspective’, in C. Smith and J. Giggs (eds), Location and Stigma: Contemporary Perspectives on Mental Health Care (Boston, 1988), pp. 14, 19; N. Tomes, The Art of Asylum Keeping: Thomas Story Kirkbride and the Origins of American Psychiatry (Philadelphia, 1994), p. xix; M. Finnane, ‘Asylums, Families, and the State’, History Workshop Journal 20:1 (1985), p. 135; S. Garton, Medicine and Madness: A Social History of Insanity in New South Wales, 1880
fifty years were devoted to figuring out the implications of this early work, including the fallout when asylums continued to expand while failing to meet their early promises. While this text follows the recent historiographical shift to decentre the asylum from the history of mental health care, it is impossible to ignore asylums as they loomed large in both patient experience and the cultural understanding of madness for men and women. The rise of the asylum in the second half of the nineteenth century is astounding. At mid-century there were