The images within this book were created by Open University students. Andreas Vossler, co-editor of this book, organised this crowdsourcing initiative. As he explains: ‘We were overwhelmed by how many students submitted images for us to consider including in the book, with many submitting numerous photographs, paintings and drawings. It was difficult to select an image for each chapter, but we think they are amazing and we really hope you enjoy them.’
– Naomi, Andreas, David and David
References
Bion, W.R. (1967) ‘Notes on memory and desire’, in Langs, R. (ed.) Classics in psychoanalytic technique. New York, US and Oxford, UK: Jason Aronson, Inc., pp. 259–260.
Time to Change (2020) Mind your language! Available at: https://www.time-to-change.org.uk/media-centre/responsible-reporting/mind-your-language (Accessed date: 21 April 2020).
Chapter 1 The birth of psychiatry: questions of power, control and care
David W. Jones
Contents
Introduction 19
1 ‘Madness’ before psychiatry 22
2 The birth of psychiatry as the medical specialism of the mind 262.1 The asylum movement and moral treatment 272.2 Moral insanity and criminological expertise 33
3 The fall of asylums and the move to community care 35
Conclusion 37
Further reading 39
References 40
Introduction
‘Breathe’ by Joanna Crane
Questions about ‘mental health’ and ‘mental illness’ loom large amid many media discussions about the health and well-being of the population and society. Those individuals understood as suffering from some form of mental distress or unhappiness might be offered, or may seek, help from a variety of sources, including psychologists, psychiatrists, mental health nurses, social workers, counsellors and psychotherapists. All these professionals might become involved in the provision of care or treatment. They might be employed within state-run hospitals or clinics, or they might provide private treatment for those willing and able to pay. This chapter will suggest that our awareness of the contemporary scene of mental health and illness can be aided by understanding where its ideas and practices have come from.
This chapter presents a history of ‘psychiatry’, with the word used as shorthand for the development of a set of ideas and practices that deal with what came to be defined as ‘mental illness’. While the emergence of psychiatry was largely led by those who saw themselves as working within a medical specialism, many other interest groups and forces have shaped the development of the various institutions and practices surrounding the world of mental illness. Since any history limited to a single chapter can only tell part of the story, the focus here is on how that history needs to be understood as shaped by contradictory forces: power and control versus care and concern.
Indeed, it can reasonably be claimed that there are two contrasting versions of the history of psychiatry. The first might be called ‘the progressive view’ of the development of a dedicated field of practice that specialised in the treatment of ‘mental’ illness. It recognised areas of human suffering and misery that could be amenable to cure or alleviation if the right treatments were discovered and made available. The second, more critical view, is the anti-psychiatry perspective, which suggests that the profession of psychiatry and the surrounding notions of mental illness and health developed as important tools of a culture that has sought to marginalise and control those individuals whose behaviour deviates from the norm and might pose a threat to the social order.
Anti-psychiatry A term used to describe a broad coalition of people and ideas who have opposed the theories and practices of psychiatry.
The focus here is on the emergence of psychiatry within Great Britain, but it should be noted that its early development was embedded in European endeavours, with North American practices becoming important later on. It is certainly the case that psychiatry, now global in its reach, was very much a western enterprise. It is also important to be aware that, as this chapter deals with historical matters, it draws on language (e.g. ‘lunacy’ and ‘mad’) that would be considered offensive if used in the present day. These terms are preserved here, since there is uncertainty about how accurately they could be translated into modern language. Nowadays the term ‘mad’ tends to be equated with something like psychosis, where a person loses touch with reality, whereas in the past it has been used more generally to refer to states of mental turmoil.
Psychosis A psychiatric term that refers to an individual’s state of mind that is ‘out of touch’ with reality. The individual has no understanding that they are in this state. Typical symptoms include hallucinations (hearing, smelling or seeing things that are not there) and delusions (believing something to be true that others deem impossible).
This chapter aims to:
demonstrate how the field of psychiatry has been shaped through its development as a medical speciality, but also by the emergence of a psychological outlook that theorised a ‘mind’ that could become disordered and, therefore, could be subject to psychological treatment
show that wider issues of social policy and criminal justice have also left their mark on the field of psychiatry
highlight the considerable public debate surrounding the field, and the influence of popular opinion
explore the increasing scope of psychiatry, which now covers all areas of life (from cradle to grave) and an ever-growing array of disorders.
1 ‘Madness’ before psychiatry
While the recognisable profession of psychiatry only emerged in the nineteenth century, ‘madness’, as Porter (2002, p. 10) suggests, ‘may be as old as mankind’; follies, fools, madness, grief and despair are staples of Shakespeare’s plays (performed for the first time roughly between 1590 and 1610), for example. By the time that popular ideas and everyday concerns were being written down and printed (a process only just beginning in the seventeenth century), there was apparent interest in what we would now view as ‘mental illness’.
Psychiatry The specialist branch of medicine concerned with the treatment of mental illness.
Often mentioned as a milestone on the path to the establishment of a systematic literature was Robert Burton’s (1638) The anatomy of melancholy, first published in England in 1621. The word ‘melancholy’ here appears not to specifically mean ‘sadness’ in the modern sense, but rather conveys some general malaise or mental distress. It is a sprawling compendium of seventeenth-century knowledge and philosophy and an attempt to