Anecdotal evidence of the testimonies of patients who received treatments for sexual deviations and medical attitudes towards them are scattered in the recorded accounts of gay, lesbian, bisexual, transgendered, intersex and queer/questioning (GLBTIQ) people. This book examines the plight of men who were institutionalised in British mental hospitals to receive 'treatment' for homosexuality and transvestism, and the perceptions and actions of the men and women who nursed them. It explores why the majority of the nurses followed orders in administering the treatment - in spite of the zero success-rate in 'straightening out' queer men - but also why a small number surreptitiously defied their superiors by engaging in fascinating subversive behaviours. The book is specifically about the treatments developed for sexual deviations in the UK. Transvestism was also treated fairly widely; however, not to the same extent as homosexuality. After an examination of the oppression and suppression of the sexual deviant, the introduction of aversion therapies for sexual deviance is considered. During the 1930s-1950s, mental health care witnessed a spirit of 'therapeutic optimism' as new somatic treatments and therapies were introduced in mental hospitals. The book also examines the impact these had on the role of mental nurses and explores how such treatments may have essentially normalised nurses to implement painful and distressing 'therapeutic' interventions . The book interprets the testimonies of these 'subversive nurses'. Finally, it explores the inception of 'nurse therapists' and discusses their role in administering aversion therapy.
Treatment Act 1930, which was geared towards a model
of treatment, where patients would have greater autonomy; and the
Mental Health Act 1959 that put a new emphasis on community care.
In the period between these two Acts, nurses witnessed what has been
described as ‘therapeuticoptimism’; as new therapeutic options particularly somatic (physical) therapies for treating psychiatric patients
were introduced.2 The introduction of these new approaches raised
expectations of curative treatment, in keeping with the nomenclature
of the new 1930 Act. This chapter explores these
because they reduced the degree
of voluntariness on the part of the patient.
These mixed public discourses of sexual deviation also created
uncertainty for the nurses in this study. The nurses were also exposed
to a number of contextual factors in their clinical practice, which
may have influenced their decision to administer aversion therapy to
cure sexual deviations. The introduction of the Mental Treatment Act
1930 brought a wave of therapeuticoptimism around the possibility
of curative treatment for mental patients. This led to the introduction
of new somatic
and act purposefully.
As Virginia came to realise in The Snake Pit, by the middle of the twentieth
century most of the work performed by psychiatric patients had little if any
claim to the status of therapy. A hundred years earlier, however, work by
patients was often part of a therapeutic regimen. While this did not survive
the death of therapeuticoptimism in the late nineteenth century, the start of
the twentieth century saw a revival in the use of and faith in work therapy. It
centred in New England, where clergy, psychologists and physicians briefly
‘humanitarianism 1 science 1 government inspections 5 “the
great nineteenth-century movement for a more humane and intelligent treatment of the insane”’.34 Viewing the asylum as an instrument of social control
which psychiatrists exploited as a mechanism for professional aggrandisement,
revisionists pointed to the ways in which psychiatry perpetuated notions of
social, gender and racial inequality. Such studies traced how therapeuticoptimism gave way to pessimism as theories of degeneration reinforced policies
of custodialism by the 1870s, transforming asylums into custodial
Is it time to change our approach to anti-stigma campaigns?
again, efforts to destigmatise mental illness focused on ‘promising’ patients, at the expense of ‘chronic’ patients. Thus, the new therapeuticoptimism embodied by physical treatment methods, for example, was
achieved in part by segregating those whose illnesses were more long standing
and less amenable to somatic treatment methods, while the appeal of admissions wards was enhanced by removing chronic patients to segregated wards.
My concern is that current anti-stigma campaigns also focus upon acute, minor
and transient experiences of mental disorder, and similarly
Nursing shell-shocked patients in Cardiff during the First World War
Anne Borsay and Sara Knight
doctors tried to establish which treatments worked best with which
symptoms, informed by competing approaches to understanding and
managing mental illness.
The therapeuticoptimism originally associated with moral management techniques had dissipated as late nineteenth-century public
asylums struggled with unresponsive chronic cases and the routines of institutional life were gradually reworked to deliver mass
rather than personalised care.32 At the same time, the influence of
Sigmund Freud’s psychoanalysis was penetrating British medicine.
One of the most renowned
economic and social rather than a
racial problem.49 The Surinamese racial framing of leprosy was influential, but ultimately only of relevance in the colonies.
The therapeuticoptimism that Schilling expressed in 1769 had completely disappeared in Suriname half a century later. There was no cure
for leprosy. Van Hasselaar described all failed methods of treatment,
including sulphur baths and purgatives, decoctions of juniper or wild
Leprosy and colonialism
rosemary, and the administration of sarsaparilla or mercury.50 These
were typical remedies
Therapy and empowerment, coercion and punishment. Historical and contemporary perspectives on work, psychiatry and society
Harris deftly maps the waxing and waning of moral and psychological
approaches and of patient work from the early days of therapeuticoptimism
to the rise of reductionist neurology in the 1880s, followed by ‘a revival in the
use of work therapy’ at the start of the twentieth century – in New England
in particular. The belief in the formation of good habits through regular
work (which, as patients at Bethel, Maine, sang, while sawing wood, ‘sets our
spirits free!’), dovetailed with wider national sentiments of prosperity from
natural resources and new technologies and
and suppression of the
sexual deviant are examined in Chapter 1. The narrative of the ways in
which homosexuals and transvestites have been regarded and treated
by British society are explored and the introduction of aversion therapies for sexual deviance considered. The mixed and muddled messages nurses were receiving about these individuals are also discussed.
During the 1930s–1950s, mental health care witnessed a spirit
of ‘therapeuticoptimism’ as new somatic treatments and therapies
were introduced in mental hospitals. Chapter 2 examines