Whatever the reason, by the 1980s the decline of the asylum population meant that the upkeep of these old-fashioned, and expensive-to-maintain buildings was a drain on resources. The government of the day therefore accelerated the closure of the asylums with its overt policy of ‘community care’ (Audit Commission, 1986). This policy promoted a shift of resources across a range of health and social care services, away from long-term institutional care and towards the support of people in their homes and communities. In some respects, this was nothing revolutionary; as will be described in Chapter 4, the post-war period witnessed an expansion of the diagnostic categories of mental disorder, which meant that mental illness was viewed as something prevalent across wider social groups. Thus, efforts were made to make services available to more people. While this book will discuss a number of initiatives in detail, an important dimension of all of them was the rise of child guidance clinics (Stewart, 2012). These may be the most remarkable sign of a government belief in the significance of mental health to the overall good of society. Monitoring children and treating poor mental health was considered to be an overall social good. These developments can be viewed through the different lenses of the contested perspectives – either as progressive developments that provided support for a greater range of difficulties, or as sinister means of control and manipulation. A significant move was attempted by the introduction of the Mental Health Act 1959 (in England and Wales). It sought to fully incorporate psychiatric services within the newly emerged National Health Service and the associated arms of an enhanced welfare state.
Conclusion
This chapter has provided a brief introduction to the complex topic of the history of psychiatry. Such a brief survey can only point out some important features of this contested terrain on which the buildings of the asylums loom large. Contrasting perspectives present different understandings of the development of the asylums, fuelled as they were by the idea of moral treatment. Was the development of moral treatment, as Foucault and Scull suggest, an oppressive tactic of a society that was desperately anxious to enforce particular standards of behaviour, and to physically confine those who threatened the social order? Or was this a far more humane response to distress and dependency? In favour of the more cynical view are the links that can be made between poor law legislation and the development of workhouses (and then prisons). Indeed, despite the nobler aspirations, the asylums did become the gloomy warehouses of misery that have haunted the imagination of the world of mental health.
Public and media responses to mental health problems have formed a very significant force that shaped psychiatry. Arguably, there is no other area of medicine and perhaps social policy that has been so much debated and fought out in the public sphere. It would only be fair to conclude that psychiatry has been shaped by anxieties about the threat to social order potentially posed by people who were viewed as different – something that could be ‘remedied’ by their confinement and treatment in order to ‘normalise’ their behaviour.
Alternatively, it can be claimed that the idea of moral treatment suggested a kinder regime that was reflected in the architecture of the asylums, which was profoundly different from that of the prisons and workhouses. By the middle of the nineteenth century, the asylums were being built in the fashion of fine country houses with often extensive and pleasant grounds. Likewise, medics who were searching for new diagnostic categories to explain serious offending were doing so with the immediate motivation of saving the accused from execution, which they would inevitably face if they were judged to be ‘sane’ (and therefore guilty).
Whichever version is ‘truer’, it is certainly the case that the legacy of the asylums was to be considerable. The mass construction of asylums dominated the context for mental illness until the last decades of the twentieth century – with subsequent community care polices being an overt reaction to the asylum tradition. In addition, moral treatment can also be regarded as a forerunner of the talking cures.
The birth of psychiatry was also significantly linked to the identification of ‘the mind’ as a site of exploration and treatment. Debate is unresolved as to the substance of that mind. With its roots in medicine, it may be no surprise that the medical specialism of psychiatry often falls back on the idea that the processes of the mind are simply determined by those of the body. However, as Chapter 3 will demonstrate, some strands in the world of mental health have strongly maintained that the mind is a psychological domain that can be understood and treated by psychological methods.
Porter (2004) pointed out that the voices of those most affected by the history of psychiatry have not been well heard. Chapter 2 will address this important issue.
Further reading
This text provides an overview of the complete history of ‘madness’. Chapter 6 specifically looks at the rise of psychiatry:Porter, R. (2002) Madness: a brief history. Oxford: Oxford University Press.
The following text offers more on the early roots of psychiatry as a branch of medicine and a psychological science:Jones, D.W. (2017) ‘Moral insanity and psychological disorder: the hybrid roots of psychiatry’, History of Psychiatry, 28(3), pp. 263–279.
Here, Porter gives a voice to some of those treated as mad throughout history:Porter, R. (1987) A social history of madness: stories of the insane. London: Weidenfeld & Nicolson.
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