earnings or their potential for violence.7 Yet to see medical
practitioners as the recipients rather than the providers of mentalhealthcare is also to run counter to the historiography of the asylum. Historians who would support the general outline of Foucault’s ‘great confinement’ thesis have characterised doctors as among those responsible for
defining, capturing, and incarcerating the insane. The rationales for
admitting pauper patients to county asylums or workhouses have
Mad doctors: lunacy and the asylum
circled around the limitations of domestic care
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, mentalhealthcare witnessed a spirit
of ‘therapeutic optimism’ as new somatic treatments and therapies
were introduced in mental hospitals. Chapter 2 examines
asylum determination procedure and beyond, there is evidence that
woman are not receiving the level of care that is necessary.
In 2004, the government released a five-year plan, Delivering Race
Equality in MentalHealthCare. This plan mentions refugees and asylum
seekers only very briefly. In November 2000, the DoH had published an
information booklet for NHS staff dealing with asylum seekers and refugees,
entitled Meeting the Health Needs of Refugees and Asylum Seekers in the UK:An
Information and Resource Pack for Health Workers (Burnett and Fassil 2000).The
in her cure both inside and,
increasingly, outside clinical and hospital settings was pushed by British
psychiatrists, psychotherapists, and other reformers from the 1960s.
Empowering the patient
Since the 1990s, a number of medical practitioners and others involved
in mentalhealthcare have written on recovery. In this vast literature,
we often encounter a distinction between ‘recovery’ and ‘rehabilitation’.
Recovery is usually defined as an approach by which people suffering
from mental illness are offered various empowerment techniques in
order to better cope
Recruitment and retention in mental health nursing in England, 1948-68
against dilution schemes throughout the period under discussion.
The early years of the NHS were marked by contentious debates
about the necessary skill mix on the wards as assistant or enrolled
nurses were introduced into mentalhealthcare. In 1943 the Nurses’
Act had provided a legislative framework that legitimated ‘a lower
stratum of nursing labour, that would then free the student nurse to
pursue an educationally orientated form of training’.60 Then, building
on the recommendations of the Athlone Report (1945), experienced
nursing orderlies and
leaders. If they expected a bland ministerial
delivery of the sort that was written for ministers by civil servants,
they were in for a shock. Powell was concerned by the amount of
beds taken up by mentalhealthcare and had been influenced by the
mental hospitals that he had visited.18 He delivered a rallying call for
the closure of the mental hospitals and their replacement by care in
the community for those needing services:
Now look and see what are the implications of these bold words. They imply
nothing less than the elimination of by far the greater part of this
-media controversy’, Media History, 6 (2000), 177–88.
22 See J. V. Pickstone, ‘Psychiatry in general hospitals: history, contingency and local
innovation in the early years of the National Health Service’, in J. V. Pickstone (ed.),
Medical Innovations in Historical Perspective (Houndmills, 1992), pp. 185–99, and
S. Cherry, MentalHealthCare in Modern England: The Norfolk Lunatic Asylum / St
Andrew’s Hospital c.1810–1998 (Woodbridge, 2003), pp. 231–40.
23 BBC WAC, S322/117/3, BBC audience research report, 12 November 1956, p. 5.
24 W. Sargant, ‘The Hurt Mind’, British
feared – the abandonment of moral
treatment, a purely clinical approach to patients, huge custodial hospitals, and a
sharply class-differentiated system of mentalhealthcare – all came to pass in the
late nineteenth century. What might be styled a ‘cult of pessimism’ thoroughly
supplanted the old cult of curability.26
The eclipse of moral therapy
In the last two decades of the nineteenth century, the era of moral therapy
ended in America. This happened as the spirit of the Kirkbride-style hospital was replaced by the custodial ethos of asylum bureaucracies, depriving
(Bethlehem: Lehigh University Press, 2006),
pp. 108–29; Steven Cherry, MentalHealthCare in Modern England: The Norfolk
Lunatic Asylum/St. Andrew’s Hospital c. 1810–1998 (Suffolk: Boydell Press, 2003),
pp. 53–82; Ellen Dwyer, Homes for the Mad: Life Inside Two Nineteenth-Century
Asylums (New Brunswick, NJ: Rutgers University Press, 1987); Nancy Tomes,
A Generous Confidence: Thomas Story Kirkbride and the Art of Asylum-Keeping,
1840–1883 (Cambridge: Cambridge University Press, 1984), pp. 188–263, passim;
James Moran, Committed to the State Lunatic Asylum: Insanity and
The policies of professionalisation in English mental hospitals from 1919 to 1959
Manning, The Therapeutic Community Movement: Charisma and Routinisation
(London: Routledge & Kegan Paul, 1989).
34 Vicky Long, ‘Rethinking post-war mentalhealthcare: Industrial therapy and the
chronic mental patient in Britain’, Social History of Medicine, 26:4 (2013), 738–58.
35 Maxwell Jones, ‘Industrial therapy of patients still in hospital’, Lancet, 2 (1956), 985.
36 Diane Waller, Becoming a Profession: History of Art Therapy in Britain, 1940–82
(London: Tavistock, 1991).
37 Nancy Wansbrough and Agnes Miles, Industrial Therapy in Psychiatric Hospitals