Challenging the assumption that the stigma attached to mental illness stems from public ignorance and irresponsible media coverage, this book examines mental healthcare workers’ efforts to educate the public in Britain between 1870 and 1970. It covers a period which saw the polarisation of madness and sanity give way to a belief that mental health and illness formed a continuum, and in which segregative care within the asylum began to be displaced by the policy of community care. The book argues that the representations of mental illness conveyed by psychiatrists, nurses and social workers were by-products of professional aspirations, economic motivations and perceptions of the public, sensitive to shifting social and political currents. Sharing the stigma of their patients, many healthcare workers sought to enhance the prestige of psychiatry by emphasising its ability to cure acute and minor mental disorder. However, this strategy exacerbated the stigma attached to severe and enduring mental health problems. Indeed, healthcare workers occasionally fuelled the stereotype of the violent, chronically-ill male patient in an attempt to protect their own interests. Drawing on service users’ observations, the book contends that current campaigns, which conflate diverse experiences under the label mental illness, risk trivialising the difficulties facing people who live with severe and enduring mental disturbance, and fail to address the political, economic and social factors which fuel discrimination.
The function of employment in British psychiatric care after 1959
This chapter explores how the policy of psychiatric deinstitutionalisation transformed the nature and intended functions of employment for people with mental health problems in post-war Britain. It focuses on industrial therapy, which hospitals implemented as part of rehabilitation programmes designed to prepare long-stay patients for discharge. This involved patients undertaking industrial sub-contract work in spaces designed to resemble a factory environment. The chapter considers two earlier developments which informed the ethos of industrial therapy; the system of rehabilitation designed to meet the needs of disabled soldiers during the Second World War, and occupation and employment schemes developed for people with learning disabilities. It explores the operation of industrial therapy units, which had been established in most British psychiatric hospitals by the 1960s, and the creation of complementary extramural facilities. Finally, the chapter evaluates the tensions between individual therapeutic needs and labour market requirements which came to the fore in industrial therapy, before examining how the industrial therapy model came under pressure due to changing social and economic circumstances in the late twentieth century.
The introduction outlines the approach adopted within the book, and the main lines of argument, explaining why the decision has been taken to focus on healthcare professionals’ efforts to educate the public, rather than public opinion. Analysing recent British mental health anti-stigma campaigns, the introduction identifies common characteristics in terms of messages, objectives and difficulties encountered. It contextualises the book’s approach in relation to recent debates as to how the history of psychiatry and mental healthcare should be written, and provides a brief overview of key pieces of legislation which affected mental healthcare in the period under study. The introduction outlines how the plurality of groups working within the field of mental health, wielding divergent levels of power and status, affected discourses. A brief analysis of the concepts of stigma and discrimination is provided.
This chapter examines the efforts made by psychiatrists and patients to address the public and challenge the stigma attached to mental illness and its treatment. Analysing a selection of accounts authored by psychiatrists and patients, it considers how the shared world of the asylum and mutual experiences of discrimination created parallels in their narratives. Erving Goffman’s analysis of stigma is drawn upon to consider the difficulties facing former patients who sought to challenge the stigma of mental illness, and to shed light on writers’ strategies, which changed as treatment regimes evolved over time. Many former patients sought to reintegrate themselves into the community by distancing themselves from the ‘otherness’ of mental illness. The chapter argues that the frequently adversarial nature of the relationship between psychiatrists and patients hindered collaborative efforts to tackle the stigma attached to mental illness and its treatment. Furthermore, psychiatrists’ preconceptions regarding the public inhibited their efforts to engage in meaningful dialogue.
This chapter explores mental healthcare politics, demonstrating the impact of the economic and political climate on professional strategies, and revealing the interconnected fates of different professional groups. It focuses on psychiatric nurses and psychiatric social workers, examining how these two occupational groups represented mental illness and sought to obtain public support as they attempted to establish a distinct role in the field of mental healthcare. As mental healthcare policy and practice evolved, these occupational groups had to adapt to find a new role. Revealing the challenges facing insecure professional groups who tried to balance their interests with those of their patients, the chapter argues that we need to examine the relative power and status of different occupational groups, and consider efforts to destigmatise mental illness within the context of the broader goals of that occupation.
Tracing innovations in mental healthcare policy and practice in Britain from the late nineteenth century through to the 1970s, this chapter reflects upon the intimate relationship between understandings of mental illness, therapeutic models and the professional aspirations of occupational groups working within the field of mental healthcare. It argues that efforts to advance mental health and destigmatise some forms of mental distress served to reinforce the stigma and reduce the resources available for severe and chronic mental illness and people diagnosed as mentally defective. The chapter explores whether asylums/mental hospitals operated as sites of reform in which new treatment approaches were adopted, or whether new measures functioned to undermine the prestige and viability of these institutions. It also asks whether reforms addressed the needs of long-stay patients, or only aimed to help acute cases of mental disorder.
This chapter argues that the image of the violent, chronically-ill male mental patient predominated throughout the twentieth century, and has played a pivotal role in debates on health care policy and perceptions of risk and mental illness. It commences by tracing the historiographical debate on gender and mental illness, before analysing how the psychiatric nurses’ union mobilised the image of the violent and depraved madman to bolster claims for higher pay and to attempt to prevent women from nursing male patients. It explores how psychiatric nurses reignited these discourses and fuelled stigma by arguing for the retention of and investment in institutional provision following the inclusion of psychopathy into the remit of nursing under the 1959 Mental Health Act, and the Government’s decision to abolish mental hospitals and establish services in the community. The chapter concludes by arguing that the stigmatising image of patients generated by nurses in turn rebounded to tar the professional status of nurses.
This chapter explores the interactions of voluntary, professional and state provision in the field of mental health throughout the period 1870 to 1970, focusing on the Mental After Care Association: the only voluntary group in this sector whose history spans the entire period under study. This long, unbroken chronology offers an unrivalled opportunity to explore how it affected, and was in turn affected by, other agents in the field of mental health, illuminating the interconnections between state provision, healthcare professionals, patients/service users, the public and voluntarism. The chapter explores how the Association represented mental illness when trying to solicit public support, and demonstrates how professional groups worked through the Association to advance their objectives. The strategies adopted by the Association in different eras are contextualising by drawing a comparison to the path taken by the National Association for Mental Health.
This chapter examines the role played by healthcare professionals in the production of British Broadcasting Corporation programming on mental health issues in the mid twentieth century. It outlines debates regarding the factors which shape media coverage and the capacity of television to influence public opinion before examining the Corporation’s growing interest in mental health issues. The chapter focuses on ‘The Hurt Mind’, the first television show broadcast in Britain in 1956 which was devoted to mental illness. Shaped by the views of William Sargant, the main consultant for the series, the programmes sought to reduce public fear surrounding mental illness by informing the audience of ‘the facts’. In practice, however, the series offered a rather one-dimensional analysis of the problems posed by mental illness which precluded debate and did little to alleviate public concerns regarding electroconvulsive therapy and psychosurgery. Analysis of the making of this programme illustrates how the relative power of different organisations in the field of mental health affected their capacity to influence the media.
Is it time to change our approach to anti-stigma campaigns?
The book concludes that healthcare workers’ efforts to destigmatise mental illness by educating the public were inherently flawed. There was no consensus amongst healthcare workers about what message should be imparted to the public, because different professional groups disputed what mental illness was and how it should be treated. Furthermore, healthcare workers’ professional agendas and intra- and inter-professional disputes sometimes conflicted with their desire to destigmatise mental illness. By drawing attention to their success in curing acute patients, healthcare workers inadvertently reinforced the stigma attached to enduring mental health problems. Drawing on service users’ observations and these historical findings, the conclusion evaluates contemporary campaigns such as Time to Change which aim to destigmatise mental illness. It suggests that the focus of such campaigns upon recovery, minor mental health issues and public attitudes is misplaced, and that attention should be drawn to structural discrimination and government policies which curtail the opportunities of people who suffer from severe mental illness.