Editor: Waltraud Ernst

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.

9 Work and occupation in Romanian psychiatry, c. 1838–1945 Valentin-Veron Toma Along with other types of occupation, such as reading, writing and sporting activities, work has been used as a form of therapy in Romanian psychiatry from the mid-nineteenth century. For example, the first workshops for mental patients were created at the Mărcuța asylum in Bucharest in 1855, just seventeen years after the institutionalisation of psychiatry in the Romanian principalities. Work and other occupations were considered appropriate mainly in the treatment of long

in Work, psychiatry and society, c. 1750–2015

powers: the Meiji Era restoration (1868–1912) that led to the rise of modern Japan under the influence of Europe, and the reconstruction that took place after the Second World War led by the United States of America. The history of work or occupational therapy (OT) and rehabilitation science has followed a similar path. In pre-Second World War Japan, work and activity in a therapeutic context, later understood as OT, developed mainly from three fields: psychiatry, orthopaedics and internal medicine, and was particularly prominent in the treatment of tuberculosis.3

in Work, psychiatry and society, c. 1750–2015
Patient work in rural asylums in Württemberg, c. 1810–1945

, and especially in the history of psychiatry, the meaning of work performed by patients caught in the crossfire between therapy and economic benefit has only recently been considered.7 This chapter focuses on work performed by psychiatric patients in rural mental hospitals in Württemberg, in the south-west of Germany. It maps the development from early understandings of work as part of therapeutic regimes to work therapy bound up with humanist and medical ideas around 1900, and ends with National Socialist health policies and the association with the ability to work

in Work, psychiatry and society, c. 1750–2015
Reason and relation in the work cure

Retreat Near York, published June 1813, in which it is declared that of all methods to coax the melancholic patient back to reality and reason, work was to be regarded both the most effective and efficacious. As is well known in the history of psychiatry, the Description of the Retreat: An Institution Near York for Insane Persons of the Society of Friends, is the detailed and often lively account of the enigmatic Quaker Retreat in North Yorkshire, England, at which moral treatment – and thus work therapy by association – is widely credited to have had its English

in Work, psychiatry and society, c. 1750–2015
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The function of employment in British psychiatric care after 1959

that the process of regaining social competence was far harder for long-term patients from mental hospitals than we had at first thought … Many long-stay patients were too crippled (either by their long incarceration or by their original psychotic disorder) to manage the transition on their own.6 MAD0181_ERNST_v1.indd 335 08/10/2015 09:18 336 Work, psychiatry and society The transition from institutional to community-based care is often attributed to the development of biomedical therapies, most notably new drug treatment. Yet these therapies targeted clinical

in Work, psychiatry and society, c. 1750–2015

nineteenth century, patients mainly came from elite families who had left the old capital of Kyoto for the new one in Tokyo during the early 1870s.13 One reason why patients and their families were attracted to inns was that from the late eighteenth century they employed attendants (figure 8.2).14 The 8.1  Imai Inn, c. 1905. MAD0181_ERNST_v1.indd 183 08/10/2015 09:18 Work, psychiatry and society 184 8.2  A patient with two attendants and a cook in front of the waterfall, c. 1910. care and services offered by family-style inns constituted a welcome opportunity for

in Work, psychiatry and society, c. 1750–2015
Work as treatment in British West Indian lunatic asylums, 1860–1910

asylums in considerable numbers.11 In societies where work had such central significance, its effectiveness as a method of treatment in the asylum was conceivably enhanced. Patients’ MAD0181_ERNST_v1.indd 143 08/10/2015 09:18 144 Work, psychiatry and society advances towards ‘cure’ would be judged partly by their degree of willingness to engage in outdoor or indoor work, and the aptitudes, capabilities, and behaviours demonstrated while undertaking the tasks. Steady and consistent working, accompanied by socially appropriate behaviour, were important indicators of

in Work, psychiatry and society, c. 1750–2015
The policies of professionalisation in English mental hospitals from 1919 to 1959

working in these hospitals. It later became the Medico-Psychological Association and, in 1926, the Royal Medico-Psychological Association (RMPA). Nearly all of the presidents of the RMPA were medical superintendents and the medical commissioners of the Board were appointed from senior medical superintendents. The career of Sir Hubert Bond (1870–1945) illustrates this trend: after ­working in MAD0181_ERNST_v1.indd 315 08/10/2015 09:18 316 Work, psychiatry and society four different mental hospitals, he was from 1903 medical superintendent of two hospitals, before

in Work, psychiatry and society, c. 1750–2015
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Therapy and empowerment, coercion and punishment. Historical and contemporary perspectives on work, psychiatry and society

Introduction Therapy and empowerment, coercion and punishment. Historical and contemporary perspectives on work, psychiatry and society Waltraud Ernst Patient work was a major feature of lunatic asylums or mental hospitals during the modern period. It was considered not only therapeutic but also to contribute to the upkeep of institutions. Although many other aspects of psychiatric treatment have been focused on by historians, patient work has not received any in-depth, systematic assessment.1 This can largely be accounted for by the enduring emphasis in the

in Work, psychiatry and society, c. 1750–2015