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This edited book offers a systematic critical appraisal of the uses of work and work therapy in psychiatric institutions across the globe, from the late eighteenth to the end of the twentieth century. Contributors explore the daily routine in psychiatric institutions within the context of the wider socio-political and economic conditions. They examine whether work was therapy, part of a regime of punishment, or a means of exploiting free labour. By focusing on mental patients’ day-to-day life in closed institutions, the authors fill a gap in the history of psychiatric regimes. The geographic scope is wide, ranging from Northern America to Japan, India and Western as well as Eastern Europe, and authors engage with broader historical questions, such as the impact of colonialism and communism, the effect of the World Wars, and issues of political governance and care in the community schemes.

A case study in psychiatry and colonial rule
Waltraud Ernst

European efforts to establish psychiatric institutions in India date back to the eighteenth century. Provision for the confinement of the mentally ill was first made in Calcutta some time prior to 1787. In 1794, the 'Madras Lunatic Asylum' was opened to afford 'security against the perpetration of those acts of violence which had been so frequently committed by unrestrained lunatics'. Each of the presidency towns of Calcutta, Bombay and Madras could boast its own 'asylum for the European insane'. Despite its relative insignificance in quantitative terms, psychiatric provision for Europeans in India was an integral part of European social relief measures. The repatriation of asylum inmates thus conveniently removed the problem of European vagrancy from India and limited the expense of maintaining pauper patients in costly psychiatric institutions in India. In the early nineteenth century, psychiatry had become an integral part of the colonial system of social welfare and control.

in Imperial medicine and indigenous societies
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Therapy and empowerment, coercion and punishment. Historical and contemporary perspectives on work, psychiatry and society
Waltraud Ernst

This chapter discusses the conceptual and methodological concerns connected with the central themes of the book. It reflects on varied definitions of human activity as labour, work and action, from the Ancients to Adam Smith, Karl Marx, and Hannah Arendt, contrasting these with NAZI ideas on forced labour and its supposedly liberating effects. The ways in which work and activity have been integral to medical ideas and practices in both Western and non-Western healing traditions and psychiatric regimes are explored, and the different themes covered by the contributors to the book are presented.

in Work, psychiatry and society, c. 1750–2015
Patient work in colonial mental hospitals in South Asia, c. 1818–1948
Waltraud Ernst

This chapter focuses on the organisation of patient work in the mental institutions established by the British for both Europeans and Indians in South Asia. It explores the changing and plural meanings of work in relation to prevalent medical ideas and practices in different institutional settings in British-held territories from the early nineteenth to the middle of the twentieth centuries. Different aspects of work will be discussed, such as work as therapy; means to combat idleness; patients’ empowerment; institutional profit; and forced labour. The incentives used by staff to induce patients to engage in physical labour and the punishments employed in cases of non-compliance will be scrutinised. It will be shown that gender, social and caste prejudices and sentiments affected the types of activity patients were expected to engage in, and how, with the emergence of professionalised occupational therapy from the early twentieth-century, patient work became increasingly acceptable also with regard to European patients. The link between intensive work regimes and the concomitant decreased use of other treatment methods such as sedation, prolonged rest and hydrotherapy from the 1920s onwards will be explored.

in Work, psychiatry and society, c. 1750–2015
Comparative and transnational perspectives, c. 1700–1990s

This book addresses head-on one of the central debates in the history of alcohol and intoxication, the supposed ‘medicalisation’ of alcohol from the nineteenth century onwards. The chapters show that the very concept of medicalisation as used in the history of medicine and psychiatry needs to be more closely interrogated, with each case study in the volume demonstrating the complexities of medicalisation in practice: limited funding, state control of healthcare, ideological constraints and tensions between legislation and traditional cultural practices. The engagingly written chapters call attention to the many obstacles and challenges that historians face when they explore the relationship between medicine and alcohol. The volume also explores the shift from the use of alcohol in clinical treatment, as part of dietary regimens, incentive to work and reward for desirable behaviour during earlier periods to the emergence of ‘alcoholism’ as a disease category that requires medical intervention, is covered by medical insurance and is considered as a threat to public health. The book’s broad international scope goes well beyond the focus on Western Europe and the USA in existing historical writing. Despite the wide-ranging geographical focus, key themes are consistently brought out: definition and diagnosis, links between alcohol and crime, the rhetoric of social and economic degeneration, the impact of colonialism and the role of families in alcohol treatment.

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Comparative and transnational perspectives on alcohol, psychiatry and society, c. 1500–1991
Waltraud Ernst
Thomas Müller

The Introduction offers a road map for the debate about the relationship between alcohol, psychiatry and society. It identifies how cultural, political and social factors underpinned both medical and public attitudes towards alcohol and drunkenness, and how these changed over time. The ways in which medical ideas about alcohol and its effects were closely bound up with social, cultural and in particular racial attitudes are examined. It is argued that the quests for a definitive nosology of alcohol-related diseases and for therapeutic strategies and public health measures were characterised by both local circumstances and global developments. There is no one single story of the ‘birth of alcoholism as a disease’, nor one single history of how alcohol was represented as a medical, moral and political problem.

in Alcohol, psychiatry and society