Memory, Anniversaries and Mental Health in International Historical Perspective: Faith in Reform (Mental Health in Historical Perspective) 3031229770, 9783031229770

Table of contents :
Acknowledgements
Contents
Notes on Contributors
List of Figures
Marking Time: Memory, Mental Health, and Making Minds
Remembering the ‘Bad Old Days’
Repositories of Memory: Structures, People, Praxis
Part I: Governance
Part II: Practitioners
Part III: Casebooks
Part IV: Oral Histories
Part V: Personal Recollections
Notes
Governance
Carrying on with ‘Common-Sense’: Rebuffing Reform in Bombay’s Lunatic Asylums, 1894–1933
The Tale of the ‘veritable Cinderella’40
The Elusive Glass Slipper of Reform
A New Name for Cinderella: The Asylum Nomenclature Controversy
Conclusion
Notes
The New Socialist Citizen and ‘Forgetting’ Authoritarianism: Psychiatry, Psychoanalysis, and Revolution in Socialist Yugoslavia
Introduction
Socialist Revolution and ‘Reactionary’ Biological Psychiatry
A Moment of Fear and Ambivalence
Building an Activist Psychoanalysis
‘Revolutionary Personality’: Psychiatry of Non-Alignment
Conclusion
Notes
Practitioners
Appropriating Wilhelm Griesinger’s Asylum Reform Legacy (1868–2018): Some Reflections on Historiographic Narratives of Failure
Introduction: Griesinger’s Contested Legacies
A Synopsis of Griesinger’s Reform Programme
The Obituaries of 1868/69
The 25th Anniversary of Griesinger’s Death (1893) and the Early Twentieth Century
The 60th Anniversary of the Berlin Society for Psychiatry and Nervous Diseases (1927)
The Elision of Griesinger’s Reform Legacy in the Mid Twentieth Century
1967/68: The Triple Anniversaries and a Griesinger ‘Renaissance’
Evolving Narratives of Failure: Griesinger’s Reform Legacy After the Psychiatrie-Enquête
Conclusion: Moving Beyond Narratives of Failure
Notes
Remodelling the Sigmund Freud Museum, Vienna: Memories, Museums, and Curatorial Considerations
Notes
Casebooks
Madness, Memory and Delusion in Late Nineteenth-Century Colonial Barbados
Introduction
The Unreformed Asylum
Marginalised People
Conclusions
Notes
Gone but not Forgotten: Acts of Remembrance in the Late-Nineteenth and Early-Twentieth-Century Asylum
Introduction: Forgetting and Losing in the Total Institution
Remembering Photographs in the Institution
Temporal and Spatial Disruption
Networks, Relationships, and ‘Circuits’ of Feeling
Conclusion
Notes
The Institute for Imbecile Children: Remembering the Lives and Experiences of the Patients
Routes to the Institute
Daily Life and Experiences at the Institute
Transfer Routes
Casebook Photographs
Conclusion
Notes
Oral Histories
Surprise and Nostalgia: Staff Narrate the Closure of an American Psychiatric Hospital
Oral History and Narrative
Surprise
Nostalgia
Conclusions
Notes
An Exploration of the Function of Nostalgia in Oral Histories of Institutional Care
Introduction
Nostalgia and Oral History
Nostalgia in Oral Histories of Institutional Care
The Function of Nostalgia in Oral Histories of Institutional Life
Conclusion
Notes
Personal Recollections
Talking Personality: Reflections on Historical Words, Diagnoses, and My Own Experience
Introduction
Early History of Words and Meanings
The Enlightenment
The Growth of Psychiatry
Focus on Categories and Personality ‘Types’
My Experience: Words, Behaviour and Mental Health
Education and Psychoactive Medication
Alternatives to Psychiatry
Moving On
Personality Disorder—Is That Really Me?
Words and Acronyms
Can We Create a More Focused Terminology?
A Summary
Notes
‘If Your Memory Serves You Well’: Reflections on Becoming a Psychiatrist
Introduction
Beginnings
Medical School
Starting Psychiatry
Psychotherapy
Postgraduate Teaching
The Medical Humanities
The Personal Is Psychiatric
Aftermath and Final Reflections
Notes
Index

Citation preview

MENTAL HEALTH IN HISTORICAL PERSPECTIVE

Memory, Anniversaries and Mental Health in International Historical Perspective Faith in Reform Edited by Rebecca Wynter Jennifer Wallis · Rob Ellis

Mental Health in Historical Perspective

Series Editors Catharine Coleborne, School of Humanities and Social Science, University of Newcastle, Callaghan, NSW, Australia Matthew Smith, Centre for the Social History of Health and Healthcare, University of Strathclyde, Glasgow, UK

Covering all historical periods and geographical contexts, the series explores how mental illness has been understood, experienced, diagnosed, treated and contested. It will publish works that engage actively with contemporary debates related to mental health and, as such, will be of interest not only to historians, but also mental health professionals, patients and policy makers. With its focus on mental health, rather than just psychiatry, the series will endeavour to provide more patient-centred histories. Although this has long been an aim of health historians, it has not been realised, and this series aims to change that. The scope of the series is kept as broad as possible to attract good quality proposals about all aspects of the history of mental health from all periods. The series emphasises interdisciplinary approaches to the field of study, and encourages short titles, longer works, collections, and titles which stretch the boundaries of academic publishing in new ways.

Rebecca Wynter · Jennifer Wallis · Rob Ellis Editors

Memory, Anniversaries and Mental Health in International Historical Perspective Faith in Reform

Editors Rebecca Wynter Amsterdam School of Historical Studies University of Amsterdam Amsterdam, The Netherlands

Jennifer Wallis Faculty of Medicine Imperial College London London, UK

Rob Ellis School of Music, Humanities and Media University of Huddersfield Huddersfield, UK

ISSN 2634-6036 ISSN 2634-6044 (electronic) Mental Health in Historical Perspective ISBN 978-3-031-22977-0 ISBN 978-3-031-22978-7 (eBook) https://doi.org/10.1007/978-3-031-22978-7 © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 Chapter “The New Socialist Citizen and ‘Forgetting’ Authoritarianism: Psychiatry, Psychoanalysis, and Revolution in Socialist Yugoslavia” is licensed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/ by/4.0/). For further details see license information in the chapter. This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Cover illustration: Simon Webster/Alamy Stock Photo This Palgrave Macmillan imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

To all those gone and forgotten. You are remembered here.

Acknowledgements

We would like to thank, first and foremost, all the contributors for their dedication and hard work. We are especially thankful to the publisher, and everyone there who has helped us in one way or another, including Molly Beck and Lucy Kidwell. The Editors of the ‘Mental Health in Historical Perspective’ series, Matt Smith and Cathy Coleborne, have been fabulous and offered constructive advice and solutions. Gratitude is also offered to those involved in the anonymous review process. We are grateful to those whose support made this edited collection possible: the Institute of Advanced Studies, Social Studies in Medicine at the Institute of Applied Health Research, and Professor Jonathan Reinarz at the University of Birmingham; the University of Huddersfield; Queen Mary University of London; and the Society for the Social History of Medicine, which awarded us a conference grant in 2018. Academic generosity has been essential. Russell Group and post92 institutions have together made this possible. Small grants are the lifeblood of countless disciplines in Higher Education. We hope marketisation and political ideology will cease, and that funders will find their way back to the Humanities. It has been a long road to get here. The pandemic and numerous other reasons made for significant obstacles. We could not have asked for better companions on the journey with us than the excellent contributors to this volume. In turn, we hope we offer our readers good company.

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Contents

Marking Time: Memory, Mental Health, and Making Minds Rebecca Wynter, Rob Ellis, and Jennifer Wallis

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Governance Carrying on with ‘Common-Sense’: Rebuffing Reform in Bombay’s Lunatic Asylums, 1894–1933 Sarah Ann Pinto The New Socialist Citizen and ‘Forgetting’ Authoritarianism: Psychiatry, Psychoanalysis, and Revolution in Socialist Yugoslavia Ana Antic

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Practitioners Appropriating Wilhelm Griesinger’s Asylum Reform Legacy (1868–2018): Some Reflections on Historiographic Narratives of Failure Eric J. Engstrom Remodelling the Sigmund Freud Museum, Vienna: Memories, Museums, and Curatorial Considerations Daniela Finzi and Monika Pessler

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CONTENTS

Casebooks Madness, Memory and Delusion in Late Nineteenth-Century Colonial Barbados Leonard Smith

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Gone but not Forgotten: Acts of Remembrance in the Late-Nineteenth and Early-Twentieth-Century Asylum Katherine Rawling

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The Institute for Imbecile Children: Remembering the Lives and Experiences of the Patients Rory du Plessis

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Oral Histories Surprise and Nostalgia: Staff Narrate the Closure of an American Psychiatric Hospital Elizabeth Nelson, Emily Beckman, and Modupe Labode

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An Exploration of the Function of Nostalgia in Oral Histories of Institutional Care Verusca Calabria

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Personal Recollections Talking Personality: Reflections on Historical Words, Diagnoses, and My Own Experience Barbara Norden

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‘If Your Memory Serves You Well’: Reflections on Becoming a Psychiatrist Allan Beveridge

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Index

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Notes on Contributors

Ana Antic is Professor of European history at the University of Copenhagen. She specialises in the cultural and social history of psy disciplines, war, and decolonisation. She is the author of two monographs—Therapeutic Fascism: Experiencing the Violence of the Nazi New Order (OUP, 2017) and Non-Aligned Psychiatry in the Cold War (Palgrave, 2022)— and a large number of journal articles. Her current research explores the global history of transcultural psychiatry in the age of decolonisation. She heads the Centre for Culture and the Mind at the University of Copenhagen. Emily Beckman is Director and Assistant Professor of Medical Humanities and Health Studies in the School of Liberal Arts at Indiana UniversityPurdue University, Indianapolis (IUPUI) and co-Director of the Scholarly Concentration in Medical Humanities at the Indiana University School of Medicine. Allan Beveridge Until his retirement, Allan Beveridge was a Consultant Psychiatrist at the Queen Margaret Hospital in Dunfermline. He has written widely on the history of psychiatry and the medical humanities. He continues editorial work with the British Journal of Psychiatry and the Journal of the Royal College of Physicians of Edinburgh. Verusca Calabria is a senior lecturer in the Department of Social Work, Nottingham Trent University. Calabria is an interdisciplinary qualitative researcher working across disciplinary boundaries. Her doctoral research xi

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combined participatory-action-research with oral history to explore the transition from institutional to community care practices in Britain. Rory du Plessis is a Senior Lecturer in Visual Studies at the School of the Arts, University of Pretoria. He is the editor of the academic journal, Image & Text, and author of Pathways of Patients at the Grahamstown Lunatic Asylum, 1890 to 1907 (Pretoria: PULP, 2020). Rob Ellis is a Reader in History at the University of Huddersfield, UK. He has published widely on the histories of mental ill-health and learning disability and has worked in partnership to co-produce projects that have emphasised their contemporary relevance. Eric J. Engstrom is a research associate in the Department of History at the Humboldt University in Berlin. He has published widely in the history of psychiatry, including the monograph Clinical Psychiatry in Imperial Germany and a nine-volume edition of Emil Kraepelin’s correspondence. He is currently researching a book on the history of psychiatric governance in Berlin, 1880–1914. Daniela Finzi is a literature and cultural historian and a curator. She has been scientific director and board member of the Sigmund Freud Privatstiftung since 2016. She is also on the editorial board of the book series ‘aka-Texte’ (Turia+Kant) and ‘Sigmund Freuds Werke. Wiener Interdisziplinäre Kommentare’ (Vienna University Press, Vandenhoeck & Ruprecht). Modupe Labode is a curator of African American Social Justice History at the Smithsonian’s National Museum of American History. Labode taught History and Museum Studies at IUPUI from 2007 to 2019, where she was also a public scholar of African American History and Museums. Elizabeth Nelson is an Assistant Professor in the Medical Humanities and Health Studies Program at Indiana University-Purdue University, Indianapolis (IUPUI) and an adjunct Assistant Professor of Africana Studies and History. She also coordinates the Indiana Women’s Prison History Project. Barbara Norden received her psychology degree from The University of Oxford in 1968, and a Master’s in Social Science from Birmingham University in 1996. She has completed the Mental Health Research

NOTES ON CONTRIBUTORS

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Network Advanced Course in Service User Research. Barbara has previously worked as a Service User Network Co-ordinator for Birmingham and Solihull Mental Health Foundation Trust. Monika Pessler was born in 1965, and is an art historian, curator, and a counsellor for systemic organisational development who has lived and worked in Vienna since 2000. After ten years as director of the Austrian Friedrich Kiesler Foundation, she took over as director of the Sigmund Freud Museum in Vienna in 2014. Sarah Ann Pinto is a social historian and author of Lunatic Asylums in Colonial Bombay: Shackled Bodies, Unchained Minds (Cham: Palgrave Macmillan, 2018). Her publications include journal articles, newspaper articles, and blogs. For a complete publication list visit her website: https://www.shackledbodiesunchainedminds.com. Katherine Rawling is Lecturer in Nineteenth-century British History at the University of Leeds and specialises in the history of medical photography. She has published with Social History of Medicine (2021) and Medical Humanities (2017). Her first book, Photography in English Asylums, c.1880–1914: The Institutional Eye is forthcoming with Palgrave Macmillan. Leonard Smith is Honorary Senior Research Fellow, Institute of Applied Health Research, University of Birmingham. His extensive publications on aspects of mental health history include Insanity, Race and Colonialism: Managing Mental Disorder in the Post-Emancipation British Caribbean, 1838–1914. He has worked professionally within mental health services for several decades. Jennifer Wallis is a Medical Humanities Teaching Fellow and Lecturer in the History of Science and Medicine at Imperial College London, UK. She has published widely on the nineteenth-century asylum and the history of medicine in the Victorian period. Rebecca Wynter is a historian at the University of Birmingham, UK. She has published widely on the histories of psychiatry, mental health, neurology, first response, and so-called ‘conversion therapy’. She is active in public history, working with museums, institutions, and people to reveal the past.

List of Figures

Carrying on with ‘Common-Sense’: Rebuffing Reform in Bombay’s Lunatic Asylums, 1894–1933 Fig. 1

Lunatic asylums in the Bombay Presidency, 1894 (Edmund Cox, A Short History of the Bombay Presidency [Bombay: Thacker and Co., 1887]; Images in Map: Author’s Photographs, 2014)

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Remodeling the Sigmund Freud Museum, Vienna: Memories, Museums, and Curatorial Considerations Fig. 1 Fig. 2 Fig. 3

Plaque of the World Federation for Mental Health, (© Stephanie Letofsky, 2021) Treatment Room, (© Hertha Hurnaus/Sigmund Freud Privatstiftung, 2020) Gentlemen’s Salon (© Hertha Hurnaus/Sigmund Freud Privatstiftung, 2020)

116 128 129

Gone but not Forgotten: Acts of Remembrance in the Late-Nineteenth and Early-Twentieth-Century Asylum Fig. 1

Case notes for Enid C., Holloway Sanatorium Case Book Females no. 17: Certified female patients admitted August 1905-March 1907, MS 5157/5160, Wellcome Collection, London

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LIST OF FIGURES

Fig. 2 Fig. 3

Fig. 4

Illustrated Sporting and Dramatic News, Saturday May 29 1909, p.13 © Illustrated London News Ltd/Mary Evans Notes and mounted photograph of Hilda S. (c.1905), Holloway Sanatorium Case Book no. 11, certified female patients admitted May 1898-May, MS 5157/5159, Wellcome Collection, London Notes and verso of mounted photograph of Hilda S. (c.1905), Holloway Sanatorium Case Book no. 11, certified female patients admitted May 1898-May, MS 5157/5159, Wellcome Collection, London

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The Institute for Imbecile Children: Remembering the Lives and Experiences of the Patients Fig. 1 Fig. 2 Fig. 3

Andrea and Gysbert (Western Cape Archives and Records Service, HGM 24, 46) The young George (Western Cape Archives and Records Service, HGM 24, 48) The mature George (Western Cape Archives and Records Service, HGM 24, 117)

197 200 201

An Exploration of the Function of Nostalgia in Oral Histories of Institutional Care Fig. 1

Half of Mapperley hospital wards (the male side), converted into luxury flats with commanding views over South Nottinghamshire (Image author’s own)

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Marking Time: Memory, Mental Health, and Making Minds Rebecca Wynter , Rob Ellis , and Jennifer Wallis

The history of mental illness, just like its treatments, can be contentious. How the past was and is remembered depends on the lens through which psychiatry is viewed, and on who or what is being recalled. Take, for example, Maudsley Hospital in London. Once lauded in the UK as a significant and pioneering step in the treatment of mental illness for its work with ‘acute patients’, recent historical assessments have

R. Wynter (B) Amsterdam School of Historical Studies, University of Amsterdam, Amsterdam, The Netherlands e-mail: [email protected] R. Ellis School of Arts and Humanities, University of Huddersfield, Huddersfield, UK e-mail: [email protected] J. Wallis Faculty of Medicine, Imperial College London, London, UK e-mail: [email protected]

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 R. Wynter et al. (eds.), Memory, Anniversaries and Mental Health in International Historical Perspective, Mental Health in Historical Perspective, https://doi.org/10.1007/978-3-031-22978-7_1

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sought to unpick its approaches to therapy. In particular, the psychological treatment of those who experienced same-sex love and desire and received the diagnosis of ‘sexual deviation’.1 The so-called ‘aversion therapy’ for gender nonconformity, women who had sex with women and, more prominently, men who had sex with men, was introduced by behavioural psychologists, but enthusiastically adopted by some psychiatrists. It is a source of significant regret and rejection by, and apology from professional bodies, healthcare providers, and universities.2 This example reminds us that the conceptualisation of mental illness, the groups on whom labels are placed, and treatments themselves, are not static and neither are their histories fixed. In these cases, how places and treatments are remembered depends very much on the notion of ‘innovation’ and what that meant to those responsible for the treatment, and those on the receiving end of it. The broader and inherent themes of power and agency are, of course, familiar to historians of mental health and illness, and this edited collection is a product of discussions, amongst historians and others, about their place in how we understand psychiatry’s past. Despite decades of academic debate, the barbarity of the past and the incremental nature of progressive reform remain as familiar tropes in popular and cultural memory. This was something at the heart of the quieter conversations around the 2018 bicentenaries of two sites at the vanguard of reforms in mental health, which the three editors have studied extensively: Staffordshire Lunatic Asylum in Stafford in the Midlands of England, and West Riding Lunatic Asylum in Wakefield in Yorkshire to the north.3 Likewise, 2018 saw the 200th anniversary of McLean Asylum for the Insane in Massachusetts (US), and the first Somerset Hospital in Cape Town (South Africa). Whilst the date also represented 210 years since the passing of the 1808 County Asylums Act, the significance of the bicentenaries and ‘birthdays’ of organisations offered an opportunity to reflect on the histories of mental health and its care more generally. After all, the year saw other significant foundational anniversaries around the globe—at Enniscorthy (Ireland), Barbados, Ranchi (India), Stromness (Australia), as well as for the British National Health Service, and the Mental Patients’ Union. Such anniversaries prompt an important question about the nature of remembrance and what that might mean in reality. Historical scholarship

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warns us against being too ‘Whiggish’, too progressive in our outlook— such anniversaries were not, and are not, an opportunity to ‘celebrate’ the often difficult, sensitive, and sometimes upsetting nature of the past. Instead, we ask, what might they tell us about remembering and reform? This edited collection attempts to begin to answer that question and is the first volume rooted in the history of psychiatry to focus holistically on memory. Taken together, its 12 chapters embrace a range of different nations in Asia, Africa, Europe, and the Americas, explore histories of mental health, patients, and service users; institutional medicine and governance; reform and policy; record-keeping and archives; oral histories; historical geography; personal recollections; medical ideas around memory; and the framing of recollection by heritage organisations. Against a global backdrop of retrieving more accurate and equitable history—as we have seen in The 1619 Project in the US and work by Corinne Fowler with the National Trust in the UK4 —as well as scholarship on commemorations and memorialisation, this volume develops discussions around the intersection of memory and empire, translocal and transnational histories, and does so through the lens of the understandings of and responses to mental disorder. It is no grand narrative, but rather an insight into how messy, and how complex, history is—how many different threads make up the warp and weft of the past, and the strange ways in which they intersect through the pattern of memory. This introductory chapter, therefore, considers the ways in which memory is integral to the history of psychiatry, asylums, and mental health, before each of the following 11 essays explores an aspect of memory and forgetfulness, anniversaries, remembering and misremembering, and, as will be outlined over the next few pages, how none of these can be discussed without recalling reform, change, and continuities. Through four brief examples, we will argue that memory and marking time—and specifically the constant incantation of the ‘bad old days’, uttered whilst negotiating the challenges of existing difficult conditions— have been integral to the development of modern mental healthcare. Indeed, as this volume demonstrates, this public incantation is one challenged by focusing on memory and its history. This chapter will then outline several key themes around how institutions and treatment paradigms are remembered culturally and personally, which we hope will help develop ideas about memory studies in the history of mental health and illness, before introducing the other pieces in this collection.

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Remembering the ‘Bad Old Days’ The tradition of remembering ‘the bad old days’ of mental healthcare has been around for as long as lunacy reform itself. This is unsurprising, given that organisational or systemic reform can only really occur once there is an acknowledgement that change is needed, as has been demonstrated by research around institutional scandals and medical complaints; the complaint is, after all, a ‘reckoning with the past’.5 In his lecture series, published as What Asylums Were, Are, and Ought to Be in 1837, Scottish alienist (or proto-psychiatrist) W. A. F. Browne thought of the ‘old system’ as that which the 1815 Parliamentary Select Committee in London had publicly and comprehensively revealed at places such as Bethlem Hospital. The atrocities have been perpetrated within these bastilles, deridingly called asylums, under the pretence, and, in some cases, it is possible, at the dictation of benevolence, and under the sanction of science, or too little known to the public. Although belonging to the past, and generally repudiated at the time by those who from ignorance, or some less excusable cause, tolerated their continuance, they require to be exposed in order to accelerate as much as possible the progressive improvement, which shall destroy every lingering remnant of the system from which they sprung, every trace of their existence and influence.6

Browne carefully laid out across 35 pages the appalling treatment meted out to people with mental disorders in Scotland, Ireland, Wales, England, France, and Italy in his ‘What Asylums Were’ lecture.7 In his lecture, ‘What Asylums Are’, Browne recognised the important place of The York Retreat in change, and that reform was a process, not an end in and of itself. All the same, he railed against the creeping thoughtlessness of systemic and personal acceptance elsewhere. The present system is imperfect, and falls short of a standard which is evidently attainable chiefly because it is not founded on, or regulated by any broad or practical philosophical principle. Glimpses of truth occasionally break in upon the minds of those who are the guardians of the lunatic, and changes are effected in accordance with the discovery. But no grand attempt has been made to place every part of the treatment in harmony with his condition.8

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And whilst ‘What Asylums Ought to Be’ suggested one ideal future, Browne did not foresee that he himself would help engrain a pattern of myth and memory that would be repeated in public ad nauseam. His sentiments reflected others which locked mental healthcare into a holding pattern of despising the bad old days and failing to recognise the truth of the present; of standing in the midst of a dysfunctional system, but at the same time remembering what was framed as a more challenging and difficult past. Similarly, in 1903, London County Council (LCC) issued a commemorative booklet on the opening of the Ewell Epileptic Colony, part of the Epsom Cluster of five new mental health facilities. The Colony—inspired, in part, by American and continental European facilities, such as that at Bielefeld, Germany—appeared in the slim glimmer of time between fatalist degeneration and nihilist eugenics being in the intellectual (and practical) ascendency. In this space, key players within LCC, including politicians and medical staff, recognised that there was a significant gap in provision for people with epilepsy who were considered ‘insane’, and spent over £98,000 on the new, smaller, domestic villa system of arranging large asylums.9 In the booklet, civic pride and a description and images of the innovative design and progressive administration of the new site came second to an extended section on the ‘bad old days’, with the brutality of the Romans outlined and ‘the absence of progress and stagnation … up to the 19th century’ laid on thickly.10 Similar to the tropes presented in Browne’s work, this LCC publication described the 1800s as a turning point. It was this century that witnessed ‘an entirely new era’, in which the booklet’s authors recalled ‘the memories of Dr Robert Gardiner Hill … and Dr John Conolly’ for their pivotal roles in the introduction of non-restraint at the Lincoln and Hanwell Asylums, respectively. It is safe to assume that non-restraint advocates exaggerated the examples of physical restraint, including strait waistcoats, restraining chairs, and straps.11 However, in LCC’s 1903 booklet, their modern methods were juxtaposed with both a substantial description of Bethlem’s chained patient—made famous by the 1815 Select Committee and commemorated as James Norris (a misremembrance of his actual name, William)12 —and plates of the iconic nineteenth-century engraving of him, along with a twentieth-century photograph of mechanical restraints, allegedly removed by Conolly at Hanwell Asylum and preserved onsite.13 Presented as symbols of past triumph over abuse at the London asylums, managed by LCC from 1889 onwards,14 they presaged

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and framed the celebration of Ewell’s opening. At once, the commemorative booklet recollected the ‘bad old days’ and emphasised the innovative reforms instigated by new ways of thinking that were as political as they were medical. The development of print media has been central to the trinity of commemoration, the ‘bad old days’ and reform, which has been at the heart of western cultures of mental healthcare, or its imposition through invasions and empire, for over two hundred years. In the twentieth century, however, this has been sustained and disseminated by developing technology and media, including the ‘wireless’ or radio. In 1948, received wisdom collided with Received Pronunciation in Lamentable Brother, a ‘programme on the treatment of the mentally afflicted yesterday and to-day’. This British Broadcasting Corporation (BBC) ‘Home Service’ broadcast, airing a few months before the creation of the National Health Service (NHS) in the UK, recalled the familiar narrative of progress.15 The programme was produced by writer-director Nesta Pain, and informed by senior medical men. These included Pain’s close collaborator, Professor Alexander Kennedy, a key figure in twentieth-century psychiatry, who also spoke in the transmission. Interjecting between a scene of two men whispering and laughing about their ‘mentally afflicted’ neighbour, ‘Bob Norton’, the Narrator begins by taking the two men on a tour of history and later arrives at a midpoint: Well, there you have a glimpse of how this country regarded and treated the insane from medieval times up to those of Doctor Johnson – fear, ignorance, superstition prevailed. Two hundred years ago, and even later, the fate of the mentally sick was unimaginably dreadful. Deserted, they felt, by God and man, they languished not only in the public hospitals – Bethlem was the only one in Johnson’s time – but in the poor-houses, and, worse still, in the hundreds of private lock-ups which until 1774, anybody was allowed to keep for profit. Let’s just look at the kind of thing that could, and frequently did happen before the gradual enlightenment that started to show itself in the early 19th century ….16

The Narrator took Bob Norton’s two neighbours to ‘observe’ what were framed as the terrible conditions in which an eighteenth-century lunatic was kept. The advent of enlightened care was introduced through the group ‘watching’ William Tuke and practice at The Retreat at York in the 1790s, widely recognised as the blueprint for reformed,

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modern mental healthcare; then traced through ‘encountering’ Conolly and Gardiner Hill; and finally Lord Shaftesbury (1801–85), for whom lunacy reform was his life’s work. The ‘Great Men’ narrative then gave way to the two neighbours arriving at the heart of Bob’s story as it played out. They ‘witnessed’ Bob’s wife, Mrs Norton, and The Psychiatrist convincing him to become a voluntary patient at a county mental hospital, and later conversing about his treatment: MRS. NORTON: Yes, [the mental hospital’s] certainly doing him good. I suppose it’s because they tell such frightful tales about these places… PSYCHIATRIST: … I could hardly have put him in a General Hospital … could I? The public is inclined to view the “asylum” with … suspicion as well, because … they contain considerable numbers of chronic patients who may not get better. In this respect, there is a telling difference between a mental and a general hospital. It is this – we keep our failures!17

In this case, progress was exemplified by the introduction of the Mental Treatment Act in 1930,18 which had enabled the admission of temporary and, in the case of the fictional Bob Norton, voluntary patients. The semantic, medico-legal changes, including the replacement of ‘asylum’ with ‘mental hospital’ and ‘lunatic’ with ‘patient’, demonstrated ‘change’, but the production emphasised a need to address wider issues. The Narrator confirmed that after a few weeks Bob would be well enough to return home. The last word, however, went to Professor Kennedy who reminded the audience that ‘tonight, you have had a glimpse of the bad old days. Since then we have travelled a long way but there is still a lot further to go. That depends on improving public attitudes to mental diseases’.19 Whilst the broadcast was pressing progressive views, it is clear from the production notes, as well as the tenor of the script, that it was not always helpful for reducing the stigma that Kennedy had identified as an important and ongoing issue. Even if it was ‘the bad old days’ that were being described, the background to the play recalled stereotypical views of ‘patients’ and the treatments with production notes directing: ‘MUSIC FADES TO SHRIEKING WOMAN. SHRIEKS TO BACKGROUND … SHRIEKS UP AND FADE … THE MADMAN … MOANS AND GIBBERS … MADMAN BEGINS TO GIBBER … A TERRIBLE BABEL [sic] IS HEARD IN THE BACKGROUND …

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THE MADMAN RAVES AND BANGS AT HIS EARS’.20 The remembering practised by Lamentable Brother was curated by Pain, but rooted in the expertise of the medical men involved. As a corollary, this construction of the past both served to press for change, but in a limited, managed way by privileged voices. In these examples, we can see the persistence of hagiographical medical histories and the recurring theme of progress, juxtaposed with a reform in services or a change in their direction. This is not something that has been confined to the past, however, and the final day of 2018 saw the closure of inpatient provision at The York Retreat after 222 years of continual operation. Financial constraints had become overwhelming, and the report of the Care Quality Commission, the UK’s independent regulator of health and social care was damning, not of patient care per se, but of Quaker-infused management structures that did not work,21 or that the Commission did not understand and which did not sit comfortably alongside equivalents elsewhere. As far as we are aware, these are the first published words written by historians about the demise of an institution that has been pivotal to our understanding of the treatments and histories of mental ill health in the UK and further afield. Whilst others are sure to follow, they are important because The Retreat’s past and reimaginings of its ‘present’ have been informed by continuity, as well as change. As Anne Digby pointed out, The Retreat was itself the product of promised reforms,22 but, as it moved to a model of outpatient care, its refreshed website still acknowledges the place of its founder, William Tuke, its Quaker values, and its long lineage. The founding ‘approach of innovation and humane care continues to this day’, it claims. ‘Our aim is to continue Tuke’s legacy and deliver high quality, sustainable, renowned mental health services, alongside Autism and ADHD services, helping people to live well with themselves so that we all live better together’. For the post-2018 organisation, the year was not one of demise, but of reimagining. It is clear from the example of The Retreat that in mental disorder and its care, the recollection of the past and the noting of anniversaries elapsed was still framed by its heritage of ‘Helping people for 200 years’.23 The four examples above span two centuries and they remind us that memory depends on where you enter or leave a story. These examples, and indeed our wider exploration of memory and mental health, remind us of the importance of context. The intellectual work for this volume emerged amidst the so-called ‘culture wars’. World events since 2016 have

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made it abundantly clear that memory is contested. The global white supremacy movement is rooted in the myths around ‘The Lost Cause’ in the US and the Empire in the UK. Elsewhere, in France, Hungary, and Australia, for example, attacks on historians and History are likewise part of the refusal of fact and recollection of imagined and poisonous past glories.24 These discussions prompt reflections on memory as dependent on a myriad of intersectional factors—age, gender, race, ethnicity, religion, location, knowledge, and experience—which have not necessarily been recognised in how historians recount or recall the past. Historians also need to be cautious of their own place in this process of remembering and misremembering. Throughout the recollections of the past 200-andmore years, has been London’s Bethlem Hospital; its name debased and having, centuries before, become the by-word for pandemonium, and been stitched into the global cultural fabric in constant recall of the myth of ‘The Asylum’. Indeed, in 1985, early in the modern historiography of psychiatry and its institutions, Patricia Allderidge lamented print discussions of London’s oldest site. ‘Historians of psychiatry’, she wrote, including Andrew Scull, a key revisionist, did ‘not want to know about Bethlem as a historical fact because Bethlem as a reach-me-down historical cliché is far more useful. … Bethlem as the ultimate symbol of all that is evil is far too useful a space-filler. … The reading public seems preconditioned to accept that if it is bad enough, it is bound to be true’.25 Whilst the history of psychiatry itself has departed dramatically, both from Whiggish tropes and from the sort of cliché castigated by Allderidge, Bethlem and ‘The Asylum’ continue to dominate the popular narrative. This situation was generated, at least in part, by ‘The Great Confinement’ of Michel Foucault’s Madness and Civilization, or more precisely by its first incomplete translation, which has been comprehensively re-evaluated by scholars and in turn produced mistaken understandings in the historiographical memory.26 The medium—lecture, booklet, radio, internet, book, essay—has not dented the narrative of the bad old days. Indeed, the depiction of the psychiatric facility in fictional representations has often bolstered the tale, losing any stories of reform along the way. In films or movies, for example, the asylum and its residents have offered countless sensational narrative possibilities, from the silent short Le Systeme du Docteur Goudron et du Professeur Plume (1912) to the Hogarthian visions depicted in Bedlam (1946) or The Snake Pit (1948).27 In the twenty-first century, despite the fact that many large psychiatric sites have been closed, demolished,

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or repurposed, the institution continues to loom large in our cultural memory as a gothic trope, from the TV series American Horror Story to ‘ghost tours’ of disused hospital buildings.28 Indeed, it is notable that the very structure of the asylum itself, rather than the patients or doctors within it, often figures as a malign influence in recent representations. In Brad Anderson’s film Session 9 (2001), an asbestos removal team break down one by one as they work together at the abandoned Danvers Lunatic Asylum in Massachusetts. The film muddies the boundaries of fact and fiction, myth and reality, being filmed at Danvers Asylum before its demolition in 2006. Sets were dressed using furniture and case files that were left in the building upon the hospital’s closure, and murals on the walls are the same ones that would have been seen each day by patients on the wards. The power of the empty asylum, both in Session 9 and many other recent popular representations, derives from its ability to be neither here nor there, both historical and ahistorical, a kind of ‘portal’ where we might recall multiple, and sometimes conflicting, stories of the history of mental healthcare.

Repositories of Memory: Structures, People, Praxis The persistence and pervasiveness of this cultural memory seems on the face of it to be the antithesis of nostalgia: nostophobia—a past recalled with dislike and, in this case, not simply repugnance, but disgust laced with titillation. But what we can begin to see from the examples above, where the terrible past and ideal future coexist at a single point in time, suggests something much more complex. Indeed, even the concept of nostalgia is freighted with entwined meanings. As a medical concern, nostalgia was first discussed by physicians in the seventeenth century and came to be understood as ‘a psychopathological condition affecting individuals who are uprooted, whose social contacts are fragmented, who are isolated and who feel totally frustrated and alienated’.29 Nostalgia was a debilitating mental state of homesickness that, historian George Rosen argued, largely disappeared from the psychological literature at the turn of the twentieth century before its resurgence, often associated with social dislocation.30 Michael S. Roth’s work outlined two periods of intense thinking about memory by doctors looking at the mind. The first, in late nineteenthcentury France, focused on ‘maladies of memory’—including nostalgia, as well as amnesia and histrionic hysteria—and arose at a point of rapid

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modernisation and amidst a fear of forgetting traditions. In this circumstance, ‘memory disturbances became a specific kind of problem—a problem not only of recall but of disease’, and therefore revealed what it was to be ‘normal’ in modern life.31 The second emerged as a result of Freud’s theories around trauma. As Roth further argues, these shifts in thinking about the psyche have influenced the practice of History.32 Whilst it is possible to see such concerns re-emerging now with attempts to fuse the history of experience and neurobiology,33 the boom in studies of shell shock and male mental states is a useful case in point. In part triggered by the discussion of feminist historian Elaine Showalter in her seminal book, The Female Malady,34 the growth has been swift: ‘we are now so accustomed to viewing shell shock as an integral part of the history of the First World War that it is surprising to realise that it was only in 2002 … that the first full-length English language historical monograph on trauma in this conflict was published’.35 Michael Roper’s The Secret Battle is the clearest entwining of the history of the medical conceptualisation of trauma and the study of its history, each drawing on memory.36 ‘Psychoanalytic ideas inform the whole account’, Roper explained, with ‘the unconscious effects of extreme emotional experience … [helping] me to understand the impact of trench warfare on the mind. It has also helped me with the methodological problem of how to discern states of mind from … often oblique clues’. Psychoanalysis, he continued ‘gives us insights into how the war came to be lodged in memory’.37 Whilst instability in emotions has been treated as a subject of study, mutability is a characteristic of memory itself. ‘Memories are not readymade reflections of the past, but eclectic, selective reconstructions based on subsequent actions and perceptions and on ever-changing codes by which we delineate, symbolize, and classify the world around us’;38 they are ‘unstable, plastic, synthetic, and repeatedly reshaped’.39 Foundational in thinking about how societies remember was sociologist Maurice Halbwachs’ early twentieth-century work on ‘collective memory’.40 Since the 1990s, this has been refined by the work of Aleida and Jan Assmann, and by the concept of ‘cultural memory’.41 It is here that the memory of asylums and other mental health treatments reside—and yet there is surprisingly little discussion of these two elements together. Certainly, a deep vein of mental health memoirs runs through the history of psychiatry,42 and these have become especially important to the field since Roy Porter’s 1985 clarion call to recover the voices of patients.43 But discussions around recall and about memory are limited; the clearest

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manifestation has been the discussions around the planning, use, and reuse of asylum buildings. Sarah Bennett, an arts practitioner, for example, used a former lunatic asylum to explore ‘the building … as a “witness” and container of memory relating to absent bodies’, by using her own physical form to connect with how the premises were experienced.44 Exploration of the material realm is essential for understanding ‘life inside’ an institution. Historical geographers and historians of architecture in particular have focused on the grounds and the structure as a means to access both the ideals of those directing the design of the institution and its usage. Notable here is the work of Clare Hickman, Chris Philo, Sarah Rutherford, Christine Stevenson, Leslie Topp, and Carla Yanni.45 The material culture work of Rebecca Wynter has been built on by scholars such as Jane Hamlett.46 Coupling these areas with the recent focus on asylum archaeology,47 the multi-dimensional trajectory of the historiography, including emotion,48 and also the body—an effective focus in the work of Jennifer Wallis49 —means we have a much deeper understanding of life as it was experienced inside. But there is more yet to do, and considering memory inside and outside of the psychiatric facility begins to demonstrate how an increasingly multi-layered history might look. Whilst Sarah Bennett’s advocacy of re-enactment suggests it should not be dismissed out of hand, it is evident from recent years just how profoundly problematic is the idea of role-playing in asylum spaces, whether that be ghost tours or escape rooms. Forgetting patients as individual people and remembering them in ethical ways continue to be live issues. Who was believed to merit memorialisation changed dramatically in the twentieth century, from single, often male, figures considered important, towards the masses who died in the war. Jay Winter, a leading historian of memory, has persuasively argued that how the Holocaust in particular has been memorialised, developed from the transformations ushered in by the First World War. However, he asserteded, gravity and focus on civilians and the horror of racial genocide also secured a universal truth. Memorialisation, he proposed, has also revealed both the totalising effect of narratives by the State, and attempts over the past 40-or-more years to recognise the groups and identities that exist within a state and have different stories to recall.50 Along with the developing historiography of mental disorder and its cultural representations, the politics of memorialisation helps to explain the increasing interest in asylums. In America, the graves of those who died in segregated

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Black psychiatric facilities were both forgotten by the authorities and in recent years have generated greater reverence than ever before,51 and this has itself encouraged the recognition of the diverse patient population in state asylums, such as that at Mississippi.52 This can be contrasted with the lack of attention given to the resting places of inmates elsewhere,53 and there seems to be an infinitesimally small number of memorials to asylum and mental hospital patients. The most prominent (yet almost entirely ignored) official physical remembrance in the UK is to the 51 women who died in London’s Colney Hatch Asylum fire disaster in 1903, with occasional others often left to community groups.54 One might imagine that the reuse of these buildings would yield a remembrance of sorts, but that has not necessarily happened. When the Staffordshire Asylum site was purchased for redevelopment as housing, one of the editors of the present volume was put in touch with the developers, who, after prompting and discussion, agreed to have a memorial plaque placed on one of the old, protected asylum trees. The text was written, but the contact at the developers left, and after further discussion, a fresh idea to place a plaque amongst the rafters of the old chapel was agreed. Unfortunately, the original developer sold the premises to another, and good intentions were lost in the instability of a construction project. Not necessarily forgetfulness per se, but a reminder of the other priorities that shape what is and is not ‘remembered’. Other scholars have explored the issues around memory and redevelopment. Bridget Franklin, for example, was amongst the first to begin sketching out the field of inquiry, tracing the many lives of the asylum— erection, change, closure—and, especially from 1990, with the wave of deinstitutionalisation that tracked across the western-styled facilities, ‘its reappraisal as heritage, and the consequent capacity to dissociate it from its former connotations’.55 Similarly, Graham Moon, Robin Kearns and Alun Joseph focused their attention on what, as they termed it, the ‘recycling’ of psychiatric sites did in terms of meaning and memory. Drawing on examples in Canada, Australia, New Zealand, and the UK, they argued that the construction of memory around such redevelopments employed ‘strategic forgetting’ and ‘selective remembrance’.56 Their conceptualisation of recycling also rotated around memory. The reuse of sites as places for psychiatric services, for example, is discussed as problematic, with efforts to sanitise the premises seeking to obliterate the past. Moon, Kearns and Joseph considered vast, derelict premises ‘in a postmodern landscape as spectral reminders that evoke memories and images of what

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was once mainstream and is now “other”’; as monuments to society’s failure.57 All the same, these sites are part of the fabric of the ‘western world’ and also the places it invaded, colonised, abused, and governed. The use of asylums in the apparatus of imperial governance has been a feature of more recent scholarship,58 one which will continue to expand as new places, territories, and archives are focused upon. This might reveal, for example, a different or even nuanced conclusion to Caroline Gibbeson’s UK-based assertions around ‘historic former asylum sites [… as] an excellent place typology to explore negatively perceived places resulting from historic stigmas, attachment and reactions to changes in that place through their redevelopment’.59 Gibbeson found that, unlike anywhere else in the scholarship, former stigmatised asylum sites were remembered fiercely positively by staff, who, rather than protest change in their use, actively welcomed redevelopment.60 Whether this sentiment surfaced as a direct result of the normalisation of changing and reforming mental hospitals that occurred across many decades (even centuries) is something for future researchers to explore; reform is inescapable from the history of the mental health services to the point of synonymy. This may be one reason why archive-based projects and museums have proliferated in recent years, often dependent on ‘lived experience’ and its increasing inclusion in the history of psychiatry, and in the shaping of modern-day services too. Whereas museums, or what we might now consider sites framing the public histories of psychiatry and mental illness, have sometimes wilfully disregarded some aspects of treatments in the past, they now tend to be more inclusive of a multiplicity of voices.61 Indeed, for a long time, hospital museums acted as a scientific resource for medical staff and their visitors. The exhibition content, co-curated by medical practitioners, could include old items (as was the case at Hanwell) to recall past praxis, and anything else that might be of interest to its predominantly medical audience.62 The great and the good were also invited to visit, but it was only in the twentieth century that mental health museums opened with a view to educating the public. Often on hospital sites, these were not always easily accessible and, sometimes, the focus of their narratives could be poorly defined and offered a patchwork of things remembered. In the UK, newer museums were framed by the ramping up of deinstitutionalisation in the 1970s and 1980s and, in these cases, medical staff were anxious to recall progressive reform and not forget the past when the large-scale inpatient facilities they worked in were finally

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closed.63 More recently, those museums and larger organisations have been working with a broader sweep of stakeholders to develop a more democratic memory of the past.64 Sometimes, this might be about the ongoing issues and challenges faced by people with lived experience but, as others have stressed, giving people a voice does not necessarily mean that people in positions of power are prepared to listen.65 This brings us to an important point about who and what is remembered. Histories of mental health are complicated by the fact that some illnesses, and indeed some treatments, can impair the memory or, at the very least, cast doubt on its veracity. Since at least the eighteenth century, people’s recollections were a core part of the administration of ‘lunatic asylums’ and the praxis of so-called ‘mad doctors’; they remain central to assessments of potential causes, triggers, and turning points in mental illness. In nineteenth-century casebooks, the recollections of families and friends often appeared as evidence to support admission, narrating memories of troubling recent events or episodes. Conversely, patients themselves were often unable to offer a detailed narrative of their lives. In the case of General Paralysis of the Insane (GPI), for example, the failure of memory was identified by some writers as the first step towards a progressive, more general, decline. ‘Memory fails’, wrote Dr William Julius Mickle, about the diagnosis of GPI, ‘especially for recent events and recent mental acquisitions… In some cases, impairment of memory and the various results to which it gives rise, are the principal or only points actually noticed by the friends of the patient’.66 The patient’s failures of memory are ‘remembered’ to the doctor or admitting officer by the patient’s loved ones, an absence of information forming a vital piece of a diagnostic puzzle. Moreover, memory and the marking of time is not only central to institutional, or even psychological experience and diagnosis. The body has also been part of both remembering and understanding the past within lived experience and psychiatric assessment. On admission to facilities there was, and still is, a physical assessment. Bodies recall abuse, mistreatment, medical intervention, and self-harm; they can be read even when the patient refuses, or is unable, to speak. Corporeal forms are interrogated for evidence of previous treatment and personal history.67 They may provide evidence, both during life and after death, about their treatment and experiences within the institution, as well as hints about the aetiology of mental illness.68 The nineteenth-century search for a solution to the puzzle that was GPI, for example, led many asylums to conduct postmortem examinations on a large scale, searching for physical lesions left

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by the disease that could explain its wide variety of physical and mental symptoms. At the same time, the post-mortem discovery of fractured or broken bones, of bedsores and bruises, turned the spotlight back on the asylum regime, with the evidence of the body used to inform broader debates about attendant qualifications, violence, and physical restraint.69 Whilst family history had always been a core part of the assessment, from the later nineteenth century this took a more sinister turn. At this point, the body and its vestigial traces became something to scrutinise and fear. Building on earlier ideas around phrenology, atavism moved onto centre stage with the work of Italian psychiatrist Cesare Lombroso (1835–1909), which posited that faces and forms could be read for character and that this was part of inherited characteristics—that one could be a ‘born criminal’, for example, or an inevitable lunatic. These notions were bound up in the idea of degeneration, that racial and family inheritance was remembered by body and mind. The theories of nineteenth-century degenerationist psychiatrists such as Benedict Augustin Morel imagined the body as a repository for malign influences, with alcoholism in one generation linked to insanity in another. The theory would be stretched and adapted in the early twentieth century to form the basis of the new ‘science’ of eugenics. With its origins in England and its exportation around the world, the concept of remembered traits capable of being passed on shaped social health in a variety of ways. From lifelong detention to programmes of sterilisation, and even the wholesale murder of patients under the Nazis’ T4 initiative, those vulnerable people defined as mentally ill or mentally deficient bore the brunt. Physical memories can therefore carry huge risk from external forces, but physical changes in ageing and the numerical marking of age have been central to assessments for care too, and birthdays have dictated people’s passage into, out of, and through the institution, especially in relation to the numerical move from childhood to adulthood by people with learning disabilities.70 On the other hand, Alzheimers Disease—note, not Alzheimer’s, part of the gradual abandonment of commemoration by losing ‘discoverers’ possessive apostrophes in naming conventions—is widely seen as an indicator of ageing. Alzheimers has itself shielded how far the history of dementia stretches back, which can be traced from at least the seventeenth century. Through this history, it is possible to follow the development of a diagnostic category, which has both carried with it the baggage of the original meaning of the term (as still visible in the word ‘demented’) and the conscious forgetfulness of

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this origin in its conceptualisation.71 The development of the diagnosis of Alzheimers (named after Alois Alzheimer, German psychiatrist and neuropathologist) in particular points firmly to the gradual emergence of neurology as a separate profession from psychiatry. Indeed, it was at the interface between functional and organic, psychiatry and neurology, that new diagnostic procedures centred on time were introduced. Whereas testing recall for potentially concussed or amnesiac patients by asking ‘what year is it?’ might have a much longer lineage, ‘clock drawings’ were introduced in the twentieth century by pioneering British neurologist Henry Head. In his 1926 monograph, the ability to draw an analogue clock face was, in Head’s words, ‘“a splendid method of revealing [a patient’s] disabilities”’.72 Time has also been the key to severing the assumption that the neuropsychiatric characterisation of ‘shell shock’, which emerged during the First World War, is just an earlier name for post-traumatic stress disorder (PTSD). As Edgar Jones and others have identified, the two categories are different and culturally contingent, as demonstrated by the way the recall of trauma in PTSD is experienced and described as ‘flashbacks’, reflecting shifts in filmmaking and decades of mass cinemagoing.73 Psychoanalysis was a core influence on both neurology and the emergence of the place of psychological ‘trauma’ and the loss of memory. Buried deep within the psyche, this might be recovered by the skilled practitioner using techniques such as hypnosis but, as some of the treatments of shell-shocked soldiers in the First World War showed, this was not necessarily a benign process.74 Indeed, the end of the nineteenth century had seen Sigmund Freud establish new ways of looking at the self and its constitution through experience. His ‘talking therapy’ offered the means to unlock repressed memories. (Though this would later go on to spawn ‘false memory syndrome’ and the subsequent 1990s suing of psy-practitioners for their alleged seeding.75 ) Yet the ideas spawned by Freud and assessments of individuals’ ability to join personal and objective time, such as historical chronology, were employed to assess and diagnose neurological and psychiatric conditions.76 Moreover, not all practitioners believed that talking therapies were progressive anyway. The well-known and influential British psychiatrist William Sargent opposed psychoanalysis and Richard Hunter and Ida Macalpine, psychiatrists and historians, similarly explained that psychiatry should be less about listening and more about looking for symptoms.77

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For those with loved ones living with the devastating impacts of dementia, or indeed trauma, the nomenclature and its origins are less important than the practical support they need to deal with its consequences. Historical object handling and even singing songs from the old days form the basis of ‘Dementia Toolkits’.78 The aim here is less about diagnostics and more about respite but, once again, it reminds us of the social and cultural context of recall and remembering and the changing nature of psychological and psychiatric understandings of what memory ‘is’, where it comes from, and why and where it goes. They are also important reminders about the ongoing challenges of how we ‘do’ the history of psychiatry and mental health and why memory is so important in understanding its past, present, and future. Oral history, and more emphatically the witness seminar, has been considered a professional, formal, and ‘elite’ space,79 yet it offers historians and the people with whom they work a new way of understanding the past. Using the recollections of a diverse collection of practitioners, policymakers, and service users, for example, Turner, Hayward, Angel, Fulford, Hall, Millard, and Thomson examined the transcripts of a series of witness seminars in an effort to destabilise historical myths.80 Again, we find the point at which one steps into a story fundamentally altering the narrative of the past. For those recollecting, ‘before the inauguration of the post-war welfare state, mental health was one of the better-funded public welfare services, with large capital investments in asylums and a national regulatory system in the Board of Control’.81 Rob Ellis’ recent book underscores both the heights of investment in the nineteenth and early-twentieth centuries, and also the gradual erosion by (local Conservative) politicians after the establishment of county councils under the 1888 Local Government Act.82 Turner et al.’s conclusions very firmly point to the yawning chasm historians have left, especially between the 1880s and the First World War, but equally, those overlooked by scholarly focus due to archival accessibility. The editors of the current volume have worked within this era, and we see in this edited collection a series of chapters which, by the expertise of the authors and the lens of memory and anniversaries, uproot the myths around lunatic asylums and mental hospitals, psychiatric praxis, and the lived realities of life and mental health in-and-outside institutions. It is through memory and a greater appreciation of life-course that the experiences of people can be seen as marked by change and more clearly visible as part of a continuum rather than dominated by working at, or admission to, a psychiatric hospital.

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In the coming pages, we present some of the key, up-to-date research which explores memory, anniversaries, mental health, and reform in international, historical perspective. Originating in a workshop held in London in 2018, this is not an exhaustive geographical account, but it is one that provides initial forays in a range of contexts from the early-nineteenth century up to and including the twenty-first century. In each case, we have encouraged the authors to focus on the issues of anniversaries, memory, and remembrance in ways that allow them to explore the issues of reform and the factors that shaped it. The 11 chapters have been organised into five parts: Governance, Practitioners, Case Books, Oral Histories, and Personal Recollections. Under these headings, the themes of memory and forgetting take on different meanings, depending on the ‘local’ circumstances in each case.

Part I: Governance This first part of this volume explores the management of mental ill health in India and Yugoslavia, and both chapters consider the geo-political factors that shaped the governance of mental illness. The histories of asylums and mental ill health in India are increasingly well-served in the historiography of psychiatry, yet Sarah Pinto’s contribution (Chapter 2) begins to complicate the colonial narrative around lunatic asylums by airing the complexity at play around ideas of reform. Focusing on the six public asylums of the Bombay Presidency after the 1894 Indian Hemp Commission Report, Pinto considers how memory in this scenario was a collision of inherited practices from British rule and resistance against outsiders. The chapter focuses on reforms after the 1894 report, which stated that the treatment available at facilities where people who were deemed mentally ill due to using hemp ‘would not be permitted in any asylum managed on scientific lines’.83 Attempts by British specialists, including Dr Major W. S. J. Shaw, Superintendent of the Yerawada Central Asylum, to reform institutional care are charted; so too is how non-specialist doctors and Indian staff resisted new initiatives by deploying their claim of greater local and cultural understanding of their Indian patients. Tried and tested techniques, imported from the metropole, but used and honed in Bombay for decades, were ‘common sense’; a potential fresh wave of British invaders cast science as an interloper. Pinto, then, reveals how inherited practice and new reform had very precise meanings at a specific point in time and space.

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In Chapter 3, Ana Antic builds on the recent and developing interest in Eastern European psychiatry to consider its development in post-Second World War Yugoslavia.84 The country’s split from the Soviet Union in 1948 heralded profound change, not only in the social and political arenas, but also in psychiatric practice. Antic describes the psychological consequences of war and revolution (growing numbers of ‘war neurotics’, for instance), as well as the impact that these events had on the character of postwar psychiatry in Eastern Europe. Years before R. D. Laing explicated the oppressive role of the family in western European psychiatry, practitioners such as Nikola Nikolic were instrumental in the growth of a radical socialist psychiatry that aimed to liberate the individual from authoritarian social structures, including the traditional family. For Yugoslav psychiatrists, ‘forgetting’ these outdated structures was a political act, and the doctor’s office was a site for political activism. This revolutionary outlook led to the formation of a radical socialist statefunded psychiatry; it is a story that provides a valuable historical contrast to the more ‘underground’ radical psychiatry of the 1960s, yet one that has been largely absent from the historiography of twentieth-century psychiatry. There are always discussions to be had about the continued privileging of medical voices in volumes such as this but, as the discussion above shows, they play a critical role in defining the past, present, and future of psychiatry and this is something that is explored more fully in the next part.

Part II: Practitioners Eric J. Engstrom’s chapter (Chapter 4) on the career and legacy of Wilhelm Griesinger (1817–68) reminds us of the historiographical battles that take place when remembering the ‘Great Men’ of psychiatry’s past. In this case, however, Griesinger’s ‘profound’ influence on German and international psychiatry means that even in the twenty-first century, the assessments of his contributions are ‘generally favourable’. Eschewing further analysis of his textbook (Pathology and Therapy of Mental Illness, 1845), Engstrom instead focuses on Griesinger’s attempts to reform German asylums to understand how and why his reputation waxed and waned. Like reformers in other parts of the world, Griesinger advocated for a re-orientation of asylums into acute and chronic services and the chapter leads us through initial professional resistance to the controversial ‘professional dynamite’ that was On Mental Asylums and Their Further

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Development in Germany (1867), and into the longer-term appraisals of his legacy. At the heart of this is an attempt to recover ‘what is lost in the narratives of failure’, especially as, in this case, the views of failure included critiques from the Nazi regime and were further complicated by the postwar separation of East and West Germany. Daniela Finzi and Monika Pessler’s study of Vienna’s Freud Museum (Chapter 5) provides a unique insight into the place of memory, both in the Freudian corpus and in the ways that both it and the man himself have been remembered. The chapter charts a longer-term story of memory and forgetting, starting with the addition of, first, a simple plaque at Freud’s former home in the 1950s. Weaving Freud’s theories into the story of the Museum’s development, Finzi and Pessler note the absence of any detail surrounding the Freuds’ flight from Austria following the Anschluss and Nazi pogroms but, as they make clear, the history of the Museum’s development is dependent on understanding its place internationally. Its origins are to be found in a prompt from the then US president, Lyndon B. Johnson, to the Austrian Chancellor; the development of its collection of material culture was dependent on items brought ‘home’ from overseas; the refreshing of the museum’s content, exhibitions, and interpretations reflects the international constituency of its many visitors; and the many international collaborations reflect Freud’s central place in western psychoanalysis in the twentieth century, as do the Museum’s fundraising efforts. Despite challenges to the prejudices behind psychoanalysis, Finzi and Pessler emphasise the Museum’s attempts to place Freud’s life and work within this wider international and historical framework.

Part III: Casebooks In Part III, attention is turned to the impact that reforms had on patient experiences, and in Chapter 6, Leonard Smith considers the mental health responses of Barbadians to the island’s circumstances in the immediate post-emancipation era. Whilst the implementation of the metropole’s technique of moral management proved impossible in poor material circumstances, the imported white medical superintendents recalled praxis there as well as the racism embedded in British society and training. As part of the fleeting reforms of the late 1800s, Barbados Lunatic Asylum began keeping case notes and a relatively detailed daily log. These constitute ‘almost unique first-hand accounts of the circumstances and

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experiences of black people or persons of colour, who were deemed to be suffering from mental disorders, in the nineteenth-century British Caribbean’.85 Seen through ‘a white medical lens’,86 the recollections of islanders and the inheritance of poverty manifested in their mental and physical ill health. Patients spoke of their past associations with the plantation system, the local 1876 Confederation uprising, and African life. Whether the recollections were white or Black, racist or homeland, they weighed heavily on the mental health experiences of people of colour. Katherine Rawling (Chapter 7), drawing on the records of Holloway Sanatorium in Surrey, UK, questions the assumption that nineteenthcentury asylums were merely sites of forgetting. Although described by Andrew Scull as ‘cemeteries for the still living’ that kept their residents out of sight of local communities,87 Rawling demonstrates that the asylum could also be a place where close friendships were forged, and where patients and staff might build relationships much like those within a family. Indeed, in looking at the photographs contained within the Holloway archives, she builds on those recent trends to explore historical sources often overlooked in the past, arguing that photographs were used to forge connections and remembrances ‘across time and space’.88 Portrait photographs, as well as photographs clipped from popular magazines and pasted into casebooks, were part of a network of exchange: patients gave portraits of themselves to friends, and staff collected photographs of former patients many years after they had left the institution. Rather than being ‘lost’ to the institutional world of the asylum, then, Rawling’s analysis of the Holloway material suggests that, for some patients, the asylum was a place where they could be cherished and, yes, remembered. Rory Du Plessis (Chapter 8) focuses on the Institute for Imbecile Children in Grahamstown, South Africa and its ‘forgotten’ residents. There, Superintendent Thomas Duncan Greenlees, despite his initial reforming aims of training and education, came to lament the supposedly ‘hopeless’ state of the children in his care. In annual reports, Greenlees constructed a narrative of learning disability as deficiency, focusing on impairment rather than potential. Yet, as recent historical work has made clear, the institutional documents at the heart of the history of psychiatry can contain numerous preconceptions and omissions.89 Within the pages of asylum casebooks, patients are often ‘pathologised’, reduced to diagnostic labels and sets of data. Documents like casebooks need to be understood as

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complex and dynamic narrative constructions with multiple purposes— to bolster contemporary psychiatric theory, for instance, or to satisfy asylum inspection regimes. Du Plessis uses casebooks and photographs to illuminate experiences of the Institute that contradicted Greenlees’ deficiency narrative: patients who derived satisfaction and self-worth from gardening, or who demonstrated a particular aptitude for looking after other children. Contrasting with the official narrative that is preserved in Greenlees’ annual reports, the stories that Du Plessis explores go some way towards reclaiming a ‘useable past’ of learning disability,90 within which the children’s positive presence in the world is recognised and memorialised.

Part IV: Oral Histories In Part IV, the chapters use the voices of patients and former patients to unpick the past. Like some of the findings in the earlier part, we can begin to see a sense that, for some patients and staff at least, the bad old days were not as bad as they might have been presented. This is, no doubt, informed by the structural, financial, and other issues related to community care. In Chapter 9, Elizabeth Nelson, Emily Beckman and Modupe Labode consider the themes of surprise and nostalgia in their research on the Central State Hospital in Indiana, in the midwestern US. Their careful work not only illuminates the entanglement of memory and politics amongst members of staff, but also, alongside Verusca Calabria’s following chapter (Chapter 10), enables us to think through the commonality and differences of the experience and operation of nostalgia in oral testimony in two different national settings, and the way that different historians understand the memories of their subjects. Nelson, Beckman and Labode complicate the discoveries of Calabria. In Indiana, the catalyst for deinstitutionalisation was dramatic—the result of serial scandals—with the surprise of staff at the closure announcement ‘demonstrating the extent to which patient mistreatment and death had been largely normalised’.91 The subtleties in individuals’ elision and overwriting of reform and reality through familial and treasured memories of working lives present institutional historians with much food for thought. Verusca Calabria (Chapter 10) takes the case study of two psychiatric hospitals in Nottinghamshire, in the English Midlands, to consider memories of ‘positive aspects of care within mental hospitals … and regrets about the institution’s demise’.92 First considering the role of

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nostalgia in oral histories more widely, she then narrows in on the interviews she conducted with 20 individuals who had lived or worked at Mapperley and Saxondale hospitals between 1948 and 1994, as well as recollections of their families and friends. Calabria finds, not only that the force of reform (in this case for care in the community) has worked to forget positive elements of the past, but also that it has preserved strong feelings within a personal history which produces nostalgia. Nevertheless, Calabria argues that the careful collection of oral testimony means that there can be a ‘critical evaluation of the interplay between individual and collective memory, the reconstruction of memory and narrative and, crucially, the impact that co-producing oral histories can have on the lives of the respective individuals and communities’,93 and even on wider policy.

Part V: Personal Recollections In this final part, attention is turned to recent personal experiences and individual and autobiographical understandings of reform. In Chapter 11, Barbara Norden presents us with an understanding of the patient’s view of mental healthcare from the perspective of someone with lived experience of diagnosed mental ill health. Norden provides a brief overview of the changing nature of medical terms, diagnoses, and interventions which are drawn from her own desire to understand, as she describes it, ‘what was wrong with her’. Moving from the US to Germany to London in the 1960s, she became very aware of the different approaches to mental ill health, which reminds us of the additional barriers faced by new and recent migrants when accessing mental health services and also the cultural milieu that shapes both it and the responses to it.94 Equally important, however, her chapter shows us her activism and advocacy, the richness of life beyond a diagnosis, and how the definitions of mental illness imposed on people can impact notions of self and wellbeing. She reflects on the implications of some of that language and provides some thoughts on its future. Allan Beveridge (Chapter 12) also offers a unique reflection on psychiatry in the UK during the last quarter of the twentieth century, as he reflects on his own experiences of psychiatric training in the early 1980s. Discussing his memories of working at the Royal Edinburgh Hospital as well as broader developments in theories of and treatments for mental illness, Beveridge paints a rich picture of contemporary practice. As in

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Barbara Taylor’s memoir The Last Asylum (2014),95 the psychiatric landscape of late twentieth-century Britain is shown to be one of rapid change and reform: the move to community care; new interest in genetic models of mental illness; the growth of service user groups, and the diversification of the psychiatric profession. It was also an era of growing historical interest in psychiatry, and Beveridge describes his own research in this field using the records of the Royal Edinburgh, taking inspiration from Roy Porter’s call to examine ‘the patient’s view’.96 As well as providing valuable insight into the nature of late twentieth-century psychiatry, Beveridge alerts us to the ways in which a ‘Great Man’ narrative has characterised both historical accounts and medical training itself. Taken as a whole, these chapters are important reminders that memory and the marking of time are not only psychological, psychiatric experiences, or physical markers, they are also governed by historical factors. They contextualise the processes of reform and remembering, and shape what and whom we choose to recollect, and how we choose to remember them. As this volume shows, those choices are complicated by shifting understandings of mental health and illness, but that the promise of, and faith in, reform remains an important constant. The instability of and the challenges to memory—as an emotional recall of the past, a celebration or lamentation, a biological function, an intrusion or loss in mental health, a construction of individuals, governments, and groups, and a host of other layered readings, meanings, and materials—that this edited collection studies should be remembered whenever change comes to psychiatry and mental healthcare. For without the conscious recognition of our identities as host, hostage, or hostile to the past, there can be no meaningful and lasting progress—whatever that means to those enacting reform.

Notes 1. Edgar Jones, Shahina Rahman, and Robin Woolven, ‘The Maudsley Hospital: Design and Strategic Direction, 1923–1939’, Medical History, 51(3), 2007, 357–378. Michael King, Glenn Smith, and Annie Bartlett, ‘Treatments of Homosexuality in Britain Since the 1950s—An Oral History: The Experience of Professionals’, British Medical Journal, 328(7437), 2004, 429. 2. Rebecca Wynter, ‘‘Conversion Therapy’ and the University of Birmingham, c.1966–1983’ (June 2022), https://www.birmingham.ac.uk/ Documents/news/conversion-therapy-full-document-final-8-june-2022. pdf (accessed: 8 August 2022).

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3. Rebecca Wynter, ‘‘Good in All Respects’: Appearance and Dress at Staffordshire County Lunatic Asylum, 1818–54’, History of Psychiatry, 22(1), 2011, 40–57; Rob Ellis, ‘A field of Practise or Mere House of Detention’ (University of Huddersfield: Unpublished PhD Thesis, 2001); Jennifer Wallis, Investigating the Body in the Victorian Asylum Doctors, Patients, and Practices (London: Palgrave Macmillan, 2017). 4. The 1619 Project was developed by Nikole Hannah-Jones, The New York Times and New York Times Magazine to place the consequences of slavery and the contributions of Black Americans at the very center of the United States’ national narrative (Jake Silverstein, ‘Why We Published the 1619 Project’, New York Times Magazine, 20 December 2019, https:// web.archive.org/web/20200131014950/https://www.nytimes.com/int eractive/2019/12/20/magazine/1619-intro.html [accessed: 06 January 2022]). The first output appeared in August 2019, and in November 2021 Nikole Hannah-Jones (ed.), The 1619 Project: A New Origin Story (New York: Penguin Random House, 2021). The UK’s National Trust, which cares for historic properties, including many country houses, has worked extensively with Corinne Fowler to reveal a more accurate history of the properties: Sally-Anne Huxtable, Corinne Fowler, Christo Kefalas, and Emma Slocombe (eds.), Interim Report on the Connections Between Colonialism and Properties Now in the Care of the National Trust, Including Links with Historic Slavery (Swindon: National Trust, September 2020). 5. See discussions in: Ian Butler and Mark Drakeford, Scandal, Social Policy and Social Welfare, Revised 2nd edn (Bristol: The Policy Press, 2005; 2003); Jonathan Reinarz and Rebecca Wynter (eds.), Complaints Controversies and Grievances in Medicine: Historical and Social Science Perspectives (London: Routledge, 2015), quote from 2. 6. Andrew Scull (ed.), The Asylum as Utopia: W.A.F. Browne and the Mid-Nineteenth Century Consolidation of Psychiatry (London: Routledge, 1991; 1837), 99. 7. Ibid., 98–133. 8. Ibid., 141. 9. LCC/MIN/01033, London Metropolitan Archive (hereafter LMA), Opening of the Epileptic Colony, Ewell, Surrey, on Wednesday, July 1st, 1903, by His Grace The Duke of Fife, K.T., G.C.V.O., P.C., Lord Lieutenant of the County of London, Ewell Colony: Signed Minutes, pp. 38, 5–11, excluding the unpaginated images of Norris and mechanical restraint. 10. Ibid., 6. 11. Nancy Tomes, ‘The Great Restraint Controversy: A Comparative Perspective on Anglo-American Psychiatry in the Nineteenth Century’, W. F. Bynum, Roy Porter, and Michael Shepherd (eds.), The Anatomy of

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12.

13.

14. 15.

16. 17. 18.

19. 20. 21.

22.

23. 24.

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Madness Volume III: The Asylum and Its Psychiatry (London: Routledge, 1988), 190–225, 193–194. Rebecca Wynter and Leonard Smith, ‘Introduction: Historical Contexts to Communicating Mental Health’, Rebecca Wynter and Leonard Smith (eds.), ‘Communicating Mental Health’ special issue, Medical Humanities, 43(2), 2017, 73–80, 75. LCC/MIN/01033 LMA, Opening of the Epileptic Colony, 3–4, plus the unpaginated images of Norris and mechanical restraint that appear between 10 and 11. Rob Ellis, London and Its Asylums 1888–1914. Politics and Madness (London: Palgrave Macmillan, 2020). C. Gordon Glover, Lamentable Brother, BBC Home Service, 27 January 1948, 1. ‘Pain, Nesta, Scripts and Discussions with Professor Alexander Kennedy, 1949–1952’, S300/37/2, BBC Written Archives Centre, Reading. Ibid., 10. Ibid., 33. See, for example, Nicole Baur, ‘Family Influence and Psychiatric Care: Physical Treatments in Devon Mental Hospitals c.1920 to the 1970s’, Endeavour, 37(3), 2013, 172–183. Glover, Lamentable Brother, 49. Ibid., 6–8. ‘The Retreat—York. Quality Report. Date of Inspection Visit 31 July 2019’, Care Quality Commission, 2 October 2019, https://api.cqc.org. uk/public/v1/reports/a6ca8916-2feb-40d9-bafa-9c66087c4abc?202101 15020436 (accessed: 24 April 2021). Anne Digby, ‘Changes in the Asylum: The Case or York, 1777–1815’, The Economic History Review, 36(2), 1983, 218–239. Digby wrote one of the founding texts of the 1980s surge in the history of institutional responses to mental ill health: Madness, Morality and Medicine. A Study of the York Retreat, 1796–1914 (Cambridge: Cambridge University Press, 1985). ‘About Us: History of the Retreat’, The Retreat, York, https://theretrea tyork.org.uk/our-history/ (accessed: 24 April 2021). See, for example, Laura Ansley, ‘‘The Culture Wars—They’re Back!’: Divisive Concepts, Critical Race Theory, and More in 2021’, Perspectives on History, 11 August 2021, https://www.historians.org/publicationsand-directories/perspectives-on-history/september-2021/the-culturewars%E2%80%94theyre-back-divisive-concepts-critical-race-theory-andmore-in-2021 (accessed: 11 August 2022); Katie Donington, ‘Relics of Empire? Colonialism and the Culture Wars’, Stuart Ward and Astrid Rasch (eds.), Embers of Empire in Brexit Britain (London: Bloomsbury, 2019); David Olusoga, ‘Historians Have Become Soft Targets in the

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25.

26.

27.

28.

29. 30.

Culture Wars’, The New Statesman, 8 December 2021, https://www.new statesman.com/culture/2021/12/historians-have-become-soft-targetsin-the-culture-wars-we-should-fight-back (accessed: 11 August 2022). For a deeper history of the culture wars, see: Andrew Hartman, The War for the Soul of America: A History of the Culture Wars (Chicago, Il: University of Chicago Press, 2015). Patricia Allderidge, ‘Bedlam: Fact or Fantasy’, W. F. Bynum, Roy Porter, and Michael Shepherd (eds.), The Anatomy of Madness: Essays in the History of Psychiatry. Volume II Institutions and Society (London: Tavistock, 1985), 17–33, 18. Michel Foucault, Madness and Civilization: A History of Insanity in the Age of Reason, Trans. Richard Howard (London: Routledge, 1995; 1961). A new translation was published in 2007: Michel Foucault, A History of Madness, Trans. Jonathan Murphy and Jean Khalfa (London: Routledge, 2007). This made clear that the 1961 edition was considerably less voluminous than the original, which meant that misreadings and misunderstandings had grown up around the text. The spat which then emerged as a result of a review of this translation by Andrew Scull, highlights the challenges of re-evaluation and revisionism in the historiography. See Andrew Scull, ‘Scholarship of Fools: The Frail Foundations of Foucault’s Monument’, Times Literary Supplement, 5425, 23 March 2007, 3–4; Colin Gordon and Bill Luckin, ‘Letters to the Editor. In Defence of Foucault’, Times Literary Supplement, 5427, 6 April 2007, 17; Andrew Scull, ‘Foucault and Madness’, Times Literary Supplement, 5429, 20 April 2007, 15; Colin Gordon, ‘Extreme Prejudice: Notes on Andrew’s Scull’s TLS Review of Foucault’s History of Madness’, Foucault Blog, 20 May 2007, https://foucaultblog.wordpress.com/2007/05/20/extremeprejudice/ (accessed 09 August 2022). See also Richard Prouty, ‘Madness, History and Foucault’, One-Way Street: Aesthetics and Politics, 23 March 2007, https://onewaystreet.typepad.com/one_way_street/2007/ 03/madhouses_and_e.html (accessed 09 August 2022). Jennifer Wallis, ‘A Dangerous Madness: Opening the Door to Asylum Horror’, Julian Upton (ed.), Offbeat: British Cinema’s Curiosities, Obscurities and Forgotten Gems (London: Headpress, 2012), 278–285. See Troy Rondinone, Nightmare Factories: The Asylum in the American Imagination (Baltimore: Johns Hopkins University Press, 2019); Tracy Mack and Geoffrey Reaume, ‘Asylum “Ghost Tours” Are Grotesque Tours’, Public Disability History, 24 May 2021, https://www.public-dis abilityhistory.org/2021/05/asylum-ghost-tours-are-grotesque-tours.html (accessed 10 January 2022). George Rosen, ‘Nostalgia: A ‘Forgotten’ Psychological Disorder’, Psychological Medicine, 5, 1975, 340–354, 340. Ibid.

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31. Michael S. Roth, ‘Remembering Forgetting: Maladies de la Memoire in Nineteenth-Century France’, Memory, Trauma, and History: Essays on Living with the Past (New York: Columbia University Press, 2012), 3– 22, 4. See also: Ian Hacking, Rewriting the Soul: Multiple Personality and the Sciences of Memory (Princeton NJ, Princeton University Press, 1995). 32. Ibid., xiii–xxxv. 33. Rob Boddice and Mark Smith, Emotion, Sense, Experience (Cambridge: Cambridge University Press, 2020). 34. Elaine Showalter, The Female Malady: Women, Madness and English Culture, 1830–1980 (London: Virago, 2007; 1985). 35. Tracey Loughran, ‘Masculinity, Shell Shock, and Emotional Survival in the First World War’ review essay (review no. 944), Reviews in History, August 2010, https://reviews.history.ac.uk/review/944 (accessed 11 August 2022). 36. Michael Roper, The Secret Battle: Emotional Survival in the Great War (Manchester: Manchester University Press, 2009). 37. Ibid., 14–25. Quote from 15. 38. David Lowenthal, The Past Is a Foreign Country Revisited (Cambridge: Cambridge University Press, 2015), 210. 39. Jay Winter, Remembering War: The Great War Between History and Memory in the Twentieth Century (New Haven: Yale University Press, 2006). 40. Maurice Halbwachs, ‘The Social Frameworks of Memory’, Lewis A. Coser (ed., trans. and Introduction), On Collective Memory (Chicago: University of Chicago Press, 1992). 41. See especially Jan Assmann, ‘Communicative and Cultural Memory’, Astrid Erll and Ansgar Nünning in collaboration with Sarah B. Young (eds.), Cultural Memory Studies. An International and Interdisciplinary Handbook (Berlin and New York: de Gruyer, 2008), 109–118; Aleida Assmann, ‘Re-framing Memory. Between Individual and Collective Forms of Constructing the Past’, Karin Tilmans, Frank van Vree, and Jay Winter (eds.), Performing the Past: Memory, History, and Identity in Modern Europe (Amsterdam: Amsterdam University Press, 2010), 35–50. 42. There are too many here to mention, but they run across the period covered by this book, from W. Cowper, Memoir of the Early Life of William Cowper, Esq. Written by Himself. And Never Before Published (London: R. Edwards, 1816), to Barbara Taylor, The Last Asylum: A Memoir of Madness in Our Time (London: Hamish Hamilton, 2014). For more see, Gayle Hornstein, Bibliography of First-Person Narratives of

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43.

44. 45.

46.

47.

Madness in English, 5th edn (2011), https://www.gailhornstein.com/att achments/Bibliography_of_First_Person_Narratives_of_Madness_5th_edi tion.pdf (accessed: 15 January 2022). This too is the top of the iceberg, given these are anglophone texts, plus misses many newspapers and periodicals, for example. Roy Porter, ‘The Patient’s View: Doing Medical History from Below’, Theory and Society, 14(2), 1985, 175–198; Rob Ellis, Sarah Kendal, and Steven J. Taylor, ‘Voices in the History of Madness: An Introduction to Personal and Professional Perspectives’, Rob Ellis, Sarah Kendal, and Steven J. Taylor (eds.), Voices in the History of Madness. Mental Health in Historical Perspective (London: Palgrave Macmillan, 2021), 1–22. Sarah Bennett, ‘Re-enacting Traces: The Historical Building as Container of Memory’, Memory Connection, 1(1), 2011, 143–156. See, for example, Clare Hickman, ‘The ‘Picturesque’ at Brislington House, Bristol: The Role of Landscape in Relation to the Treatment of Mental Illness in the Early-Nineteenth Century’, Garden History, Summer 2005, 47–60; Chris Philo, ‘“Fit Localities for an Asylum”: The Historical Geography of the Nineteenth-Century “Mad Business” in England as Viewed Through the Pages of the Asylum Journal’, Journal of Historical Geography, 13(4), 1987, 398–415; Sarah Rutherford, ‘Landscapes of the Mind and Body’, Context, 72, 2001, 1–5; Christine Stevenson, Medicine and Magnificence: British Hospital and Asylum Architecture, 1660–1815 (New Haven and London: Paul Mellon Centre for Studies in British Art and Yale University Press, 2000); Leslie Topp, Freedom and the Cage: Modern Architecture and Psychiatry in Central Europe, 1890–1914. Buildings, Landscapes and Societies (University Park, PA: Penn State University Press, 2017); Carla Yanni, The Architecture of Madness: Insane Asylums in the United States (Minneapolis: University of Minnesota Press, 2007). Wynter, ‘‘Good in All Respects’’. See, for example, Jane Hamlett, At Home in the Institution: Material Life in Asylums, Lodging Houses and Schools in Victorian and Edwardian England (London: Palgrave Macmillan, 2015); Nicole Bauer and Joseph Melling, ‘Dressing and Addressing the Mental Patient: The Uses of Clothing in the Admission, Care and Employment of Residents in English Provincial Mental Hospitals, c.1860–1960’, Textile History, 45(2), 2014, 145–170. See, for instance, Katherine Fennelly, An Archaeology of Lunacy: Managing Madness in Early Nineteenth-Century Asylums (Manchester: Manchester University Press, 2019); Linnea Kuglitsch, ‘Materia Medica, Materia Moral: An Archaeology of Asylum Management and Moral Treatment in the United States, 1840–1914’ (University of Manchester: Unpublished PhD Thesis, 2019); Shawn Phillips, ‘‘Just Can’t Work Them Hard Enough’: A Historical Bioarcheological Study of the Inmate Experience

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48.

49. 50.

51.

52.

53.

54. 55.

56.

57. 58.

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at the Oneida County Asylum’, Thomas Knowles and Serena Trowbridge (eds.), Insanity and the Lunatic Asylum in the Nineteenth Century (London: Pickering and Chatto, 2015). See, for example, Catherine Coleborne, ‘Families, Patients and Emotions: Asylums for the Insane in Colonial Australia and New Zealand, c. 1880–1910’, Social History of Medicine, 19(3), 2006, 425–442; Mark Neuendorf, Emotions and the Making of Psychiatric Reform in Britain, c.1770–1820 (London: Palgrave Macmillan, 2021); Angela McCarthy, ‘Madness, Transnationalism, and Emotions in Nineteenth- and Early Twentieth-Century New Zealand’, Michael Rembis, Catherine J. Kudlick, and Kim Nielsen (eds.), The Oxford Handbook of Disability History (Oxford: Oxford University Press, 2017), 293–326. Jennifer Wallis, Investigating the Body in the Victorian Asylum: Doctors, Patients, and Practices (Cham, Switzerland: Palgrave Macmillan, 2017). Jay Winter, ‘The Generation of Memory: Reflections on the “Memory Boom” in Contemporary Historical Studies’, Archives & Social Studies: A Journal of Interdisciplinary Research, 1, March 2007, 363–397. See, for example, Zosha Stuckey, ‘Race, Apology, and Public Memory at Maryland’s Hospital for the ‘Negro’ Insane’, Disability Studies Quarterly, 37(1), 2017, https://doi.org/10.18061/dsq.v37i1.5392. See discussions on the Asylum Hill Project at the University of Mississippi Medical Center: https://asylumhillproject.org/Asylum_Hill/About-Pro ject/The-Descendant-Community.html; https://asylumhillproject.org/ Asylum_Hill/Memorial/Memorial.html (accessed: 7 August 2021). See also: Maryland’s Bellevue Asylum, https://www.findagrave.com/mem orial/13095337/bellevue_asylum_memorial. Claire Hilton, ‘Even in Death, Patients and Staff Were Never Quite Equal: Exploring Asylum Cemeteries’, History, Archives and Library blog, Royal College of Psychiatrists, 30 July 2021, https://www.rcpsych. ac.uk/news-and-features/blogs/detail/history-archives-and-library-blog/ 2021/07/30/aylum-cemetries (accessed: 7 August 2021). See, for example, ‘Memorial Garden, Menston’, http://www.highroyds hospital.com/memorial-garden-menston/ (accessed: 4 January 2022). Bridget Franklin, ‘Hospital—Heritage—Home: Reconstructing the Nineteenth Century Lunatic Asylum’, Housing, Theory and Society, 19(3–4), 2002, 170–184, 171. Graham Moon, Robin Kearns, and Alun Joseph, The Afterlives of the Psychiatric Asylum: The Recycling of Concepts, Sites and Memories (Farnham: Ashgate, 2015). Ibid., 11. See, for instance: Waltraud Ernst, Mad Tales from the Raj: Colonial Psychiatry in South Asia, 1800–58 (London: Routledge, 1991); Christienna Fryar, ‘Imperfect Models: The Kingston Lunatic Asylum Scandal

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59.

60. 61.

62. 63. 64.

65.

and the Problem of Post-emancipation Imperialism’, Journal of British Studies, 55(4), 2016, 709–727; Richard C. Keller, Colonial Madness: Psychiatry in French North Africa (Chicago: University of Chicago, 2007); Sloan Mahone, ‘The Psychology of Rebellion: Colonial Medical Responses to Dissent in British East Africa’, Journal of African History, 47, 2006, 241–258; Sloan Mahone, Psychiatry and Empire (London: Palgrave Macmillan, 2007); James H. Mills, Madness, Cannabis and Colonialism: The ‘Native Only’ Lunatic Asylums of British India, 1857–1900 (London: Palgrave MacMillan, 2000); Julie Parle, ‘The Fools on the Hill: The Natal Government Asylum and the Institutionalisation of Insanity in Colonial Natal’, Journal of Natal and Zulu History, 19, 2001, 1–39; Julie Parle, States of Mind: Searching for Mental Health in Natal & Zululand, 1868–1918 (Pietermaritzburg: UKZN Press, 2007); Sarah Pinto, Lunatic Asylums in Colonial Bombay: Shackled Bodies, Unchained Minds (London: Palgrave Macmillan, 2018); Leonard Smith, Insanity, Race and Colonialism: Managing Mental Disorder in the Post-emancipation British Caribbean, 1838–1914 (London: Palgrave Macmillan, 2014); Sally Swartz, ‘The Black Insane in the Cape, 1891–1920’, Journal of Southern African Studies, 21(3), 1995, 399–415; Sally Swartz, ‘‘Work of Mercy and Necessity’. British Rule and Psychiatric Practice in the Cape Colony, 1891–1910’, International Journal of Mental Health, 28, 72–90. Carolyn Gibbeson, ‘Place Attachment and Negative Places: A Qualitative Approach to Historic Former Mental Hospitals, Stigma and PlaceProtectionism’, Journal of Environmental Psychology, 71, 2020, 1–8, 2, https://doi.org/10.1016/j.jenvp.2020.101490. Ibid., 1–8. See, for example, Catharine Coleborne and Dolly MacKinnon (eds.), Exhibiting Madness in Museums: Remembering Psychiatry Through Collection and Display (London: Routledge, 2012). Rob Ellis, ‘‘Without Decontextualisation’: The Stanley Royd Museum and the Progressive History of Mental Health Care’, History of Psychiatry, 26(3), 2015, 332–347. ‘British Medical Association’, Leeds Mercury, 29 July 1869, 4. Coleborne and MacKinnon (eds.), ‘Exhibiting Madness in Museums’; Ellis, ‘‘Without Decontextualization’’. Rob Ellis, ‘Heritage and Stigma. Co-producing and Communicating the Histories of Mental Health and Learning Disability’, Medical Humanities,43(2), 2017, 92–98; Rob Ellis and Catherine Coleborne, ‘Coproducing Madness: International Perspectives on Public Histories of Mental Illness’, History Australia, 19(1), 2022, 133–150. Megan Alikhanizadeh, Corey Hartley, Sarah Kendal, Liz Neill, and Gemma Trainor, ‘‘Often, When I Am Using My Voice… It Does Not

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66. 67.

68.

69. 70.

71.

72.

73.

74.

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Go Well’: Perspectives on the Service User Experience’, Ellis, Kendal, and Taylor, Voices in the History of Madness, 383–401. William Julius Mickle, General Paralysis of the Insane, 2nd edn (London: H.K. Lewis, 1886), 13–14. For example, Wynter, ‘‘Good in All Respects’’, 44; Sarah Chaney, Psyche on the Skin: A History of Self-harm (London: Reaktion Books, 2017); Gayle Davis, ‘The Cruel Madness of Love’: Sex, Syphilis and Psychiatry in Scotland, 1880–1930 (Amsterdam: Rodopi, 2008); Jennifer Wallis, ‘Bloody Technology: The Sphygmograph in Asylum Practice’, History of Psychiatry, 28(3), 2017, 297–310; Katrina Gatley, ‘The Spouse, the Neurological Patient, and Doctors’, L. Stephen Jacyna and Stephen T. Casper (eds.), The Neurological Patient in History (Rochester: University of Rochester Press, 2012), 81–106. See for example Kai Sammet, ‘Controlling Space, Transforming Visibility. Psychiatrists, Nursing Staff, Violence, and the Case of Haematoma Auris in German Psychiatry c.1830 to 1870’, Jonathan Andrews, James E. Moran, and Leslie Topp (eds.), Madness, Architecture, and the Built Environment: Psychiatric Spaces in Historical Context (London: Routledge, 2007), 287–304. Jennifer Wallis, ‘The Bones of the Insane’, History of Psychiatry, 24(2), 2013, 196–211. See, for example, discussion in Rebecca Wynter, ‘Pictures of Peter Pan: Institutions, Local Definitions of ‘Mental Deficiency’, and the Filtering of Children in Early Twentieth-Century England’, Family & Community History, 18(2), 2015, 122–138. German Berrios, ‘Dementia During the Seventeenth and Eighteenth Centuries: A Conceptual History’, Psychological Medicine, 17, 1987, 829– 837. See also: German Berrios, ‘Delirium and Confusion During the Nineteenth Century: A Conceptual History’, British Journal of Psychiatry, 139, 1981, 439–449. Elias Hazan, Frances Frankenburg, Megan Brenkel, and Kenneth Shulman, ‘The Test of Time: A History of Clock Drawing’, International Journal of Geriatric Psychiatry, 33, 2018, e22–e30, e24, https://doi.org/ 10.1002/gps.4731. Edgar Jones, Robert Hodgkins Vermaas, Helen McCartney, Charlotte Beech, Ian Palmer, Kenneth Hyams, and Simon Wessely, ‘Flashbacks and Post-traumatic Stress Disorder: The Genesis of a 20th-Century Diagnosis’, British Journal of Psychiatry, 182, 2003, 158–162. Rhodri Haywood, ‘Medicine and the Mind’, Mark Jackson (ed.), The Oxford Handbook of the History of Medicine (Oxford: Oxford University Press, 2011), 524–542, 530; Peter Leese, Shell Shock. Traumatic Neurosis and the British Soldiers of the First World War (Basingstoke: Palgrave Macmillan, 2002), 34–35.

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75. For more on false memory syndrome, see: Elizabeth Loftus and Katherine Ketchum, The Myth of Repressed Memory: False Memories and Allegation of Sexual Abuse (New York: St Martin’s Press, 1994). For more on the legal cases see, for example: ‘Recovered Memory Lawsuit Sparks Litigation’, Psychiatric Times, 16(12), 1 December 1999, https://www.psychiatrict imes.com/view/recovered-memory-lawsuit-sparks-litigation (accessed 15 January 2021). 76. Allegra R. P. Fryxell, ‘Psychopathologies of Time: Defining Mental Illness in Early 20th-Century Psychiatry’, History of the Human Sciences, 32(2), 2019, 3–31. 77. Ellis, Kendal, and Taylor, ‘Voices in the History of Madness’, 9. 78. Nuala Morse and Helen Chatterjee, ‘Museums, Health and Wellbeing Research: Co-developing a New Observational Method for People with Dementia in Hospital Contexts’, Perspectives in Public Health, 138(3), 2018, 152–159. Paul M. Camic, Sabina Hulbert, and Jeremy Kimmel, ‘Museum Object Handling: A Health-Promoting Community-Based Activity for Dementia Care’, Journal of Health Psychology, 24(6), 2019, 787–798. 79. John Turner, Rhodri Hayward, Katherine Angel, Bill Fulford, John Hall, Chris Millard, and Mathew Thomson, ‘The History of Mental Health Services in Modern England: Practitioner Memories and the Direction of Future Research’, Medical History, 59(4), 2015, 599–624. Quote from 601. 80. Ibid., 599–624. 81. Ibid., 616. 82. Ellis, London and Its Asylums 1888–1914. 83. MSA, 1895/77, A. H. L. Fraser and C. J. H. Warden, ‘Notes on Asylum Administration’. GoB, GD, 7 August 1894. For full reference, see Pinto’s chapter. 84. See, for example, Sarah Marks and Mat Savelli (eds.), Psychiatry in Communist Europe (Palgrave Macmillan, 2015). 85. Leonard Smith, ‘Madness, Memory and Delusion in Late-Nineteenth Century Barbados’, 143. 86. Ibid., 144. 87. Andrew Scull, ‘The Insanity of Place’, History of Psychiatry, 15(4), 2004, 417–436, 422. 88. See, for example, Barbara Brookes, ‘Pictures of People, Pictures of Places: Photography and the Asylum’, Coleborne and MacKinnon (eds.), Exhibiting Madness in Museums, 40–57; Susan Sidlauskas, ‘Inventing the Medical Portrait: Photography at the ‘Benevolent Asylum’ of Holloway, c.1885–1889’, Medical Humanities, 39(1), 2013, 29–37. 89. For example Barbara Brookes and James Dunk, ‘Bureaucracy, Archive Files, and the Making of Knowledge’, Rethinking History, 22(3), 2018,

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90.

91.

92. 93. 94.

95. 96.

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281–288; Cris Sarg, Cheryl McGeachan, and Chris Philo, ‘Asylum Records: Files, Notes, Casebooks, and Patient Registers’, Chris Millard and Jennifer Wallis (eds.), Sources in the History of Psychiatry from 1800 to the Present (London: Routledge, 2022), 13–30; Sally Swartz, ‘Asylum Case Records: Fact and Fiction’, Rethinking History, 22(3), 2018, 289–301. Holly Allen and Erin Fuller, ‘Beyond the Feeble Mind: Foregrounding the Personhood of Inmates with Significant Intellectual Disabilities in the Era of Institutionalization’, Disability Studies Quarterly, 36(2), 2016. Elizabeth Nelson, Emily Beckman, and Modupe Labode, ‘Surprise and Nostalgia: Staff Narrate the Closure of an American Psychiatric Hospital’, 213. Verusca Calabria, ‘An Exploration of the Function of Nostalgia in Oral Histories of Institutional Care’, 232. Ibid., 249. Angela McCarthy and Catharine Coleborne (eds.), Migration, Ethnicity and Mental Health, International Perspectives 1840–2010 (New York: Routledge, 2012); Majorie Harper (ed.), Migration and Mental Health. Past and Present (London: Routledge, 2016). Barbara Taylor, The Last Asylum: A Memoir of Madness in Our Time (London: Hamish Hamilton, 2014). Porter, ‘The Patient’s View’.

Governance

Carrying on with ‘Common-Sense’: Rebuffing Reform in Bombay’s Lunatic Asylums, 1894–1933 Sarah Ann Pinto

At the turn of the century, Bombay’s lunatic asylums were ‘lock-ups’ with a ‘great lack of intelligent supervision’ and in need of urgent reform.1 A majority of Bombay’s superintendents were non-specialist superintendents, who managed the asylum as an additional charge. Asylums under their management were sites of ‘communicative memory’ where common-sense treatment was the norm.2 However, this period saw the emergence of specialist superintendents in charge of large central asylums, who aimed to transform these asylums into ‘mental hospitals’—with strict psychiatric doctrine. This transformation would see the transition

Maharashtra State Archives [hereafter MSA], 1907/81 from B.B. Grayfoot, Lunatic Government of Bombay, Government of Bombay [hereafter GoB], General Department [hereafter, GD], 10 August 1904 S. A. Pinto (B) Independent Historian/Researcher, Wellington, New Zealand e-mail: [email protected]

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 R. Wynter et al. (eds.), Memory, Anniversaries and Mental Health in International Historical Perspective, Mental Health in Historical Perspective, https://doi.org/10.1007/978-3-031-22978-7_2

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of asylums into sites of ‘cultural memory’.3 Further, they hoped, this change would legitimise their profession and distinguish them from their non-specialist counterparts. This chapter, using the Bombay Presidency as a case study, argues that intra-professional rivalries between specialist and non-specialist superintendents thwarted asylum reform. Bombay’s asylums remained, for this period, sites of ‘communicative memory’. Lunatic asylums—like other British institutions in India—were byproducts of colonisation. The British East India Company established its first factory in Surat, India, in 1613.4 When the Company defeated the French in the Battle of Plassey in 1757, it became the paramount colonial power in India. However, after the Indian Uprising of 1857, the Parliament of the United Kingdom passed the Government of India Act of 1858 liquidating the Company and transferring all power to the Crown.5 The Indian colony consisted of the three presidencies (Bombay, Calcutta, and Madras), six provinces, and a few dependent territories. In these presidencies and provinces, a governor and his provincial council oversaw the management of institutions, including lunatic asylums.6 In 1894, Bombay had six asylums in Colaba, Poona, Ahmedabad, Ratnagiri, Dharwar, and Hyderabad (see Fig. 1).7 The Parsis (Persian Zoroastrians who migrated to India in the seventh century) played a pivotal role in funding some of these asylums. Asylum patients came mainly from lower socio-economic groups and from different religious backgrounds. The total number of patients within the Presidency in 1894 stood at 1,000 (808 males and 192 females).8 The same year, the Indian Hemp Commission Report into the use of the drug also investigated lunatic asylums, due to the large number of patients whose ‘insanity’ was linked to hemp.9 The Commissioners exposed the deteriorating conditions of these asylums, noting that: Entries would be laughable but for a fact they indicate[d] a lamentable absence of anything like the systematic treatment of mental disease by superintendents … we have found such flagrant abuses … which we are persuaded would not be permitted in any asylum managed on scientific lines.10 In the light of its findings, the Hemp Commission made recommendations for changes in the management of asylums. These recommendations included the proper training of medical staff, changing the superintendence from an additional charge to a full-time role, and the centralisation of asylums.11 However, instead of adopting these recommendations, a blame game ensued between the Government and medical staff, each accusing the

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Fig. 1 Lunatic asylums in the Bombay Presidency, 1894 (Edmund Cox, A Short History of the Bombay Presidency [Bombay: Thacker and Co., 1887]; Images in Map: Author’s Photographs, 2014)

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other of the deteriorating standards of Bombay’s asylums. The Government argued that superintendents lacked the expertise and had ‘failed to make a special study of insanity’.12 Medical staff countered these allegations by accusing the Government of poorly funding asylums.13 The Surgeon General of Bombay also called the Hemp Commission Report an ‘exaggeration by officers with no experience of asylums in India’.14 Such bureaucratic and intra-professional rivalries led to a lack of consensus about a comprehensive reform plan for Indian asylums. Besides, the Hemp Commission’s recommendation to specialise and centralise created a rift between specialists and non-specialists. By the early twentieth century, treatment practices in Bombay remained stagnant, as non-specialist superintendents resisted new methods of treatment and instead adhered to treating patients in what they described as the ‘common-sense’ way.15 Clothing, diet, and occupation were the pillars of their approach. Although moral treatment influenced their methods, they developed their own distinctive character due to local factors. Non-specialists staunchly defended their treatment methods since they found it acceptable to patients, familiar to subordinate staff, convenient for superintendents, and inexpensive for the government. Their defence of such hybrid treatment practices indicates a shift in their perception of British psychiatry as the yardstick of modern treatment. The mid nineteenth-century enthusiasm in implementing British psychiatry in India dwindled in the early twentieth century. This change led to a majority of Bombay’s superintendents distinguishing themselves from their British counterparts by laying claim to inventing this common-sense approach, based on their personal knowledge of Indian asylums acquired through their everyday interactions with patients.16 Their negotiations with patients in treatment practices made asylums sites of communicative memory.17 However, specialist superintendents wanted to change the rubric by modelling Bombay’s asylums on the metropole, transforming them into sites of cultural memory requiring ‘specialists’.18 The term ‘specialist’ superintendents appeared in official records in India during the end of the nineteenth century.19 One such specialist was Dr Major W. S. J. Shaw, Superintendent of the Yerawada Central Asylum. He campaigned for systemic change, including in the designation ‘lunatic asylum’.20 He argued in his petition to the Surgeon General of Bombay that after the establishment of the Alienist Department in 1906, ‘asylums were to be hospitals after the European and American pattern’.21 Such attempts

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at reform would transform asylums into sites of cultural memory. Jan Assmann observed that ‘cultural memory has an inherent tendency to elitism; it is never strictly egalitarian’.22 This elitism is evident in their attempts to distinguish themselves from non-specialist superintendents. By asserting their role as specialists, they could justify the need for the establishment of new, large, centralised institutions under their exclusive care. This chapter argues that non-specialist superintendents disagreed with specialist superintendents’ vision for reform, and ultimately such intraprofessional rivalries thwarted asylum reform. Resistance to reform is analysed through two instances in the Bombay Presidency: the Governments’ proposal in 1904 to introduce central asylums and bring in a specialist from England; and Major Shaw’s campaign to change the nomenclature of ‘lunatic asylum’ to ‘mental hospital’. This chapter also analyses the agency of non-specialists from 1894, after the publication of the Hemp Commission Report, to 1933, the date of the last available records for Bombay’s asylums for the colonial period.23 This period also witnessed a growing nationalistic fervour. Such an unfavourable political milieu interrupted Major Shaw’s vision for reform. For instance, the Alienist Department, established in 1906, remained a nominal body because of the Government of India Act of 1919 under which provincial governments continued to manage health institutions.24 However, dissent was more complex than colony versus coloniser, as evident in the intra-professional rivalries between asylum superintendents. Their refusal to mould Bombay’s institutions after a European or American model prevented asylum reform. This trend contrasts with the developments in psychiatry in other parts of the world—and even in India (Ranchi)—where new therapies were introduced including psychotherapy, the use of insulin or kardiazol injections, the administration of electroshocks, and malaria pyrettherapy.25 These ‘new styles of dynamic psychiatry were launched and won support’.26 This study juxtaposes Anoushka Bhattacharyya’s argument that colonial asylums transformed into ‘archetypal colonial institutions, strict with psychiatric doctrine and filled with western-trained Indian doctors who entertained no alternate belief systems’.27 Similarly, Waltraud Ernst argued that the treatment of the insane became ‘gradually more subjected to the narrow dictates of medical expertise and new scientific paradigms’.28 However, her work examines the Ranchi Mental Hospital— an exception. At Ranchi, Superintendent Dr Dhunjibhoy, a Parsi doctor,

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transformed his hospital by using modern forms of treatment on par with hospitals in Europe and America.29 Furthermore, Ernst postulated that after 1920, ‘the colonial hegemony of British medicine in India was replaced by the hegemony of universal science’.30 However, in Bombay this subversion of British psychiatry happened towards the end of the nineteenth and early twentieth century. Non-specialist superintendents heralded this subversion, by refusing to accept British psychiatric developments, as the standard for psychiatric development in India. Even though superintendents had knowledge of European methods, they believed that ‘what [was] suitable for Europeans [was] not required in native asylums’. They even asked the Government to appoint as a specialist ‘a man who knows India and natives and has specialised lunacy as a hobby’.31 They considered the experience of working in Indian asylums, as more important than expertise in modern psychiatry. While Dr Dhunjibhoy ‘professionally-reoriented’ psychiatric practice at Ranchi by using ‘science-based’ psychiatry, which was free from nationalistic links, Bombay’s non-specialist superintendents chose the ‘common-sense’ approach.32 Specialist superintendents tried to re-establish British psychiatry in colonial asylums, but they were restricted by a lack of staff and resources. While Bhattacharya and Ernst focus on treatment practices to assess the shift from ‘colonial psychiatry’ to ‘modern psychiatry’, James Mills focuses on the change in lunacy laws and the increase in asylum buildings as signs of reform. Mills labelled the period 1914–47 as the ‘expansionist phase of modern psychiatry’ in India, caused by the ‘demand driven by Indians for asylum space’. However, no asylums were built during this period in Bombay. Even the new Yerawada Central Asylum, built in 1913, served as a replacement for the Colaba and Poona Asylums. The new beds increased the capacity to 385, yet 386 patients needed beds in the new asylum. The Annual Report for 1914, pointed that ‘it is a pity that it [was] built on such a small scale’ since in terms of accommodation, ‘the net gain [was] therefore nil’.33 Yet there was no major public demand for asylum space. In 1932, Major Shaw lamented the lack of public interest on asylum matters that he perceived as the ‘chief obstruction’ to modern psychiatry.34 Mills, nevertheless, provides us with a comprehensive overview of the history of psychiatry in India but his macro history of Indian asylums fails to take into account local factors.35 For example, Parsi philanthropy played a major role in establishing and funding some of Bombay’s asylums. Furthermore, the Government of

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India Act of 1919 transferred matters of public health to provincial governments, making them responsible for their local asylums.36 A study of local factors, therefore, is crucial in understanding the asylum system in India, since provincial governments were responsible for them. Historians like Shilpi Rajpal and Shruti Kapila have recognised some local factors that impacted asylum reform. Rajpal rightly argued that the modernisation of colonial psychiatry was ‘faulty and uneven’. Even so, Rajpal largely focuses on the role of legislation and of the Government’s ‘amateurish schemes’ in the retardation of psychiatry’s development in India.37 Similarly, Kapila concluded that colonial governmentality made colonial psychiatry more of a ‘medicine of order than a medicine of the mind’. She also postulated that fiscal priorities limited the Government’s commitment to reform. However, she does not identify the multiplicity of colonial motivations in asylum matters.38 Both Rajpal and Kapila fail to account for intra-professional rivalries among superintendents. In the early twentieth century, when the Government signalled openness to reform, superintendents began contesting over the professional expertise of Indian insanity. While such rivalries put a halt on any major reforms, so did rising political tensions. Increasing nationalistic fervour, led to the Government of India Act of 1919—a small step towards self-governance. As mentioned earlier, the passing of the Act indefinitely postponed the establishment of a central directorate for asylum management.39 The centralisation of asylum management in India never came to fruition. In an increasingly volatile political environment, specialist superintendents attempted to reestablish some western practices in Indian asylums. However, they failed, and treatment practices in Bombay remained largely unchanged. In analysing the agency of non-specialist superintendents in resisting reform, this chapter makes its arguments in three sections. The first section titled, ‘The Tale of the “Veritable Cinderella”’, provides an overview of the establishment of the asylum system in Bombay and its progress until the end of the nineteenth century. The second section, ‘The Elusive Glass Slipper of Reform’, analyses the early twentieth-century superintendents’ resistance to the central government’s plan for reform. The final section, ‘A New Name for Cinderella’, examines the opposition from non-specialists’ to the proposal to change the nomenclature of lunatic asylum to mental hospital. The intra-professional rivalry led to disagreements between specialists and non-specialists regarding the pathway to reform. Their lack of consensus deprived Bombay’s asylums

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of reform, and they remained sites of communicative rather than cultural memory.

The Tale of the ‘veritable Cinderella’40 This branch of public service has been so starved as to make it the veritable Cinderella of the [colonial institution] family ... The conscience of the Government has never been smitten by the blow of a great mortality or a great scandal, and so all these long years the system, such as it is, was carried on in a spirit that seemed to grudge everything except good food, and so our asylums have all the poverty-stricken bareness of a barrack room or godown [warehouse] with no hospital equipment, nurses, sick accommodation, special drugs, &c. To remedy all this it is not enough to add another patch to the existing ones, but to take up the whole matter in a large spirit and bring it under the rules of system and common sense.40

So wrote the Surgeon General, Superintendent Barry to the Government in 1904, lamenting the lack of coherence in the management of asylums. The establishment of asylums in the Bombay Presidency happened in a rather haphazard and slow manner. In 1793, the East India Company laid the foundation of the asylum system in the Bombay Presidency, when it sanctioned the first exclusive accommodation for mentally ill people. A set of five apartments in the seaman’s barracks at Butcher’s Island was constructed.41 During the first half of the nineteenth century, in most parts of the mofussil, civil hospitals had insane hospitals attached to them. By 1858, there were asylums in Colaba (1826), Poona (1823) and Ahmedabad (1849), and Dharwar (1851). The Colaba Asylum accommodated both European and Indian patients. After Sindh was annexed, the Government established the first asylum there at Larkana in 1861. The asylum was an old fort belonging to the Kalhora dynasty. In 1871, using the donation of Sir Cowasji Jehangir, the Government built a new asylum in Hyderabad. In 1902, a new asylum was built at Naupada, Thana, replacing the Colaba Asylum for Indian patients (except for Parsis and Jews). In 1913, the Government opened the first central asylum of the Presidency at Yerawada, Poona. Colonialism thrived through the establishment of institutions, which the Government managed through the creation of hierarchies. Lunacy administration too had a hierarchical structure. Once the East India Company achieved political hegemony, it established medical institutions

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and services.42 The Bombay government established a Hospital Board in the Presidency in 1787, and in 1796 they rechristened it as the Medical Board.43 The Medical Board came under the authority of the Governor and his Council. After the passing of the Queen’s Proclamation in 1858, the Crown took over all services of the East India Company. With the transfer of power to the Crown in 1858, the Government set up Bombay’s Public Works Department (PWD) and assigned it with the construction of asylum buildings. However, its work was ‘complicated since Supreme government kept financial direction’.44 The transfer of power also led to legislative changes. The First Lunacy Act for British India was passed in 1858. Anoushka Bhattacharyya has argued that the Act simply borrowed from the English Lunacy Act and was meant ‘to echo the psychiatric infrastructure of nineteenth century Britain’. However, the Act failed to ‘produce a watershed moment in public imagination’.45 Even Major Shaw complained in 1930 that Indians lacked a public opinion on asylums. Moreover, despite the Act providing for the building of asylums, meagre funding restricted a roll out of lunatic asylums. The Bombay government constructed asylums largely because of the donations received from Bombay’s elite, especially the Parsees.46 The Act, however, made certain bureaucratic provisions for managing Indian Asylums. It established a Committee of Visitors who were responsible for supervising the asylum system. The Committee included officers from the penal, judicial, and medical departments. Furthermore, it gave authority to penal and judicial authorities to detain, certify, and facilitate the admission of patients. Superintendents came under the authority of the Medical Board of each Presidency. The Indian Medical Service (IMS) replaced the Medical Board in 1897.47 A Director General headed the IMS and each presidency had its own Surgeon General under him.48 Superintendents came under the leadership of their Surgeon General. Civil Surgeons were given asylum superintendence as an additional charge. They managed asylums with the assistance of Indian doctors qualified in India,49 and they relied mostly on Indian and a few European subordinate staff to manage the asylum. However, superintendents did not undergo any formal or specialised training. In Bombay, the Grant Medical College appointed a Professor of Psychiatry only in 1936. Subordinate staff too learned on the job. Superintendents were highly dependent on the untrained subordinate staff they employed because it was difficult to get ‘attendants from a good class’. Even overseers

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were ‘elderly men with their best energies gone’ and forced to work out of necessity.50 Patients featured on the lowest rungs of the asylum hierarchy.51 In the view of the Hemp Commissioners and specialist superintendents, despite having these hierarchies, non-specialist superintendents managed asylums in a rather non-institutional way. Non-specialist superintendents challenged the efficacy of western treatment practices and actively resisted them. They instead practised ‘common-sense’ treatment. As one superintendent explained: ‘The native lunatic wants to be wellclothed, fed, treated when ill, amused in airy day wards, to be occupied in a garden and allowed to see his friends and have much freedom as possible; to have attendants who speak his language and understand his ways’.52 Bombay’s asylums, therefore, were sites of ‘communicative memory’. Assmann defined communicative memory as ‘non-institutional; it is not supported by any institutions of learning, transmission, and interpretation; it is not cultivated by specialists and is not summoned or celebrated on special occasions; it is not formalized and stabilized by any forms of material symbolization; it lives in everyday interaction and communication’.53 Since treatment practices were ‘non-institutional’ and superintendents acquired their knowledge of what worked best for Indian patients through ‘everyday interaction’, Bombay’s asylums were sites of ‘communicative memory’.54 The Hemp Commission Report had a scathing review of nonspecialists management of asylums and treatment methods. The Report berated them for their lack of expertise, noting that such superintendents approached mental diseases with a ‘superficial spirit’.55 Their findings stated: ‘Everywhere (in Indian asylums) there is evidence of the want of care and attention’. The ‘defects of the system’, they argued, only made the situation worse. Moreover, they concluded that one of the ‘great defects of the present system is [was] the want of centralisation’. They recommended that large central asylums replace small local ones. Such central asylums would facilitate the systematic and clinical teaching of mental disease.56 Taking note of their recommendations, the central government decided to establish a new central directorate to regulate lunacy administration. This decision would have enabled the transformation of asylums into sites of cultural memory. In 1905, on the recommendation of the Secretary of State for India, Sir John Morley, the Government established the Alienist Department. The central government intended that eventually ‘additional charge’ asylums

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would be abolished and asylums would be managed by specialists who would work under the authority of the central government. However by 1919, only nine central asylums had specialists appointed, compared to thirteen asylums that were held under additional charge. That year, the passing of the Government of India Act ‘altered the future of the Alienist Department … by depriving it of a prospective central directorate, and indefinitely postponing a provincial one’ after which it remained a nominal one.57

The Elusive Glass Slipper of Reform As discussed in the previous section, the central government recognised the necessity for reforming the asylum system. Taking the Hemp Commission Report into cognisance, the Government intended to bring about reform: firstly, by closing smaller asylums and opening large central asylums; and secondly, by appointing full-time specialist superintendents to manage them. The Government believed that the conditions of lunatic asylums could be improved by ‘introduc[ing] as soon as possible a trained agency into [their] supervision and management’. They therefore made a suggestion to W. McConaghy, the Surgeon General of Bombay, about ‘employing a specialist [from Europe] to supervise the management of all the asylums of the Presidency … or to engage specialist nurses’.58 However, the central government’s hopes for asylum reform came to a grinding halt when Bombay’s superintendents refused to jump on board with the plan. As argued in this section, the central government’s emphasis on centralisation and specialisation created an atmosphere of distrust between the government and non-specialist superintendents. It also led to professional rivalry between specialists and non-specialists. This unreconciled rivalry came at the price of reform. In 1904, the Governor in Council Lord Lamington asked McConaghy for his opinion regarding the appointment of specialists. In his response, McConaghy admitted that Bombay’s asylums were ‘same as when [they were] first established’ and they needed ‘radical changes’. However, he defended the work of his superintendents as he explained that they had made the best of the means at their disposal. He rejected the idea of bringing in British specialists. He justified his stance noting that medical officers with Indian experience were far more capable of ‘the study and management if all questions connected with the insane’, and his superintendents had experience that was ‘fresh and actual’.59

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Superintendents across the Presidency echoed Surgeon General McConaghy’s views about the employment of a specialist from Europe. They doubted that their European counterparts possessed any special expertise. Andrew Scull has argued that in Victorian England even medical men entering the field of psychiatry had little formal training. New psychiatrists trained on an apprenticeship basis and the subject ‘had virtually no presence in universities’.60 They essentially were ‘caretakers of custodial dumping institutions’, who ‘identified themselves as men of common sense’.61 Scull notes how asylum doctors admitted to their inability to properly classify mental illness. Charles Hill, the President of the American Medico-Psychological Association even described ‘our therapeutics are a pile of rubbish’.62 Asylums gave psychiatrists their legitimacy as experts of mental illness.63 Colonial superintendents too were aware of this fact. Major Grayfoot, who superintended the Dharwar Lunatic Asylum, strongly believed that while psychiatry appeared to be making progress in England, those who claimed to be specialists in lunacy had only provided a more complex classification of mental illness. He noted that he had attended lectures in London and always tried to discover if they got better results in cures compared to India. He laboriously ‘read books written by such experts’ and found that while they offered an improved classification for insanity, they provided little in terms of proper treatment. Therapy merely included ‘treating symptoms, gentle discipline and good nursing’. He added that an ‘expert at home is considered so in virtue of his … years in charge of a lunatic asylum … there are many in India when judged by this rule’.64 Moreover, Bombay’s superintendents were ‘officers of experience, who [made] a special study of Psychiatry’.65 British men, whatever the intention, wanted a local praxis—administrative memory was adapted and even overlaid by personal experience. Superintendents believed that their experience with Indian patients made them experts of Indian insanity compared to their European counterparts. An expert from England would take years to understand the ‘languages, habits and ways of the people before he could put his knowledge to any use’.66 In Superintendent Barry’s experience, Indian patients wanted ‘attendants who speak his language and understand his ways’.67 The presence of a European nurse, explained doctor W.G.H. Henderson of the Poona Lunatic Asylum, would ‘act as an irritant instead of a sedative’.68 The officer appointed, therefore, should have ‘experience of

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the habits and customs of the Natives of India’.69 Bombay’s superintendents felt that the ‘present craze for experts’ to treat Indian lunacy was ‘wholly unnecessary’,70 as the ‘common-sense’ treatment of Indian insanity was a method acceptable to patients, familiar to subordinate staff, and convenient for superintendents. Based on their experience Bombay’s superintendents also claimed that what was ‘suitable for Europeans is not required in native asylums’; therefore they insisted on using common-sense treatment practices.71 For example, Henderson, who worked in Indian asylums for twenty-six years, felt that Indian asylums did not need padded rooms. The most violent patients could be managed with well-trained warders, sedatives, and a pair of muff handcuffs.72 The cost-ineffectiveness and high maintenance of padded rooms caused their exclusion and scant use as an architectural feature of Bombay’s asylums.73 Some superintendents even opposed the building of central asylums, since ‘the extra comfort in living and small benefits they get from treatment by and expert … does not outweigh the discomfort they and their friends feel being in a strange country … away from … their homes’.74 Superintendent J.W.T. Anderson of the Ahmedabad Lunatic Asylum argued that any innovation introduced by the new specialist during his first five years of service would have to be undone ‘after he acquired the necessary local experience’.75 Waltraud Ernst asserted that such arguments, based on the premise of ‘lack of personal knowledge of Indian conditions’, were a ‘long tradition’ and used ‘whenever interest groups in Britain questioned the continuation of British colonial rule or the ways the empire was run by their compatriots on the ground in India’.76 Bombay superintendents’ resistance to accept a specialist from Europe or developments in western psychiatry in their asylums provides an interesting contrast to the Ranchi Asylum superintended by Dr J.E. Dhunjibhoy. From 1920 to 1940, Dr Dhunjibhoy experimented with new forms of treatment that he had learnt through his travels in Europe and the United States, and also through his reading of the latest psychiatric literature. In Bombay, then, superintendents perceived their psychiatric practice as existing ‘in its own terms and in its own right’ rather than a derivative from psychiatry in western countries’.77 In 1933, Superintendent M. Taylor of the Yerawada Mental Hospital boasted that the mean rate of recoveries to admission at the hospital was 38.8% and those discharged ‘improved’ stood at 21.5%. Such remarkably good figures, he added, ‘had not been exceeded in any mental hospital in India or in the

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United Kingdom’.78 Colonial psychiatrists perceived themselves as equal to, and even better than their European counterparts in the management of asylums. They were ‘self-confident of their discipline’ and ‘dismissive of criticism’.79 And by virtue of their experience, Bombay’s superintendents both specialists and non-specialists made a claim to the professional expertise of Indian insanity. While non-specialists argued that they were experts in their own right, they were aware that they were not providing a ‘cure’ for insanity, but rather acting as custodians of unmanageable mentally ill people. As Doctor Grayfoot noted, ‘In India, we [superintendents] do not pretend to be experts but treat lunacy in a common-sense way; our methods are the same and our results I think, [and] just as good’.80 But such treatment forms, they believed, were necessary because of the lack of means at their disposal and it led to them neglecting the ‘real treatment of the mind’. Moreover, the ‘antiquated’ Bombay Asylum General Rules noted that asylums staff were responsible for the ‘the proper care and custody of the inmates’; the word cure or treatment was absent.81 For Bombay’s non-specialist superintendents their asylums were ‘simply places of confinement’.82 However, diverging from this stance, specialists at central asylums, perceived asylums as a hospital for the ‘treatment in mental disease’.83 Specialist superintendents made a claim of providing specialist care to distinguish themselves from non-specialists. After the whole controversy about appointing a European specialist, the Government finally appointed Major Shaw as a specialist at the Yerawada Central Asylum. He had considerable experience of working in Indian asylums in Punjab, Lahore, and Rangoon, but no formal training in psychiatry. He attempted to align Bombay’s colonial asylums with its European counterparts, based on the principles of western psychiatry. While he perceived his asylum as an ‘institution that [was] in fact a hospital’, Annual and Triennial Asylum Reports show that feeding, clothing, and occupying patients remained the main form of treatment at Yerawada.84 Bombay’s Asylum or Mental Hospital Reports show no evidence of reform, unlike some of the other Indian asylums that started experimenting with new forms of treatment including hydrotherapy, glandular therapy, and psychotherapy.85 Specialists, despite their claims to the expertise of Indian insanity, failed to ‘evolve into a “profession” of mental therapeutics’.86 However, in order to emphasise their professional superiority, they published articles and books as advice to non-specialist superintendents.

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Assmann described cultural memory as ‘a kind of institution. It is exteriorized, objectified, and stored away in symbolic forms that … are stable and situation-transcendent’.87 Specialist superintendents’ publications served the purpose of institutionalising western psychiatric treatment and transferring it to the colony. Through these publications, they also asserted their role as ‘guardians’ of western psychiatry.88 Major Shaw wrote articles in the Indian Medical Gazette on the construction and administration of asylums, and even authored The Clinical Handbook of Mental Diseases in 1925.89 While his publications show the influence of European ideas, such as suggestions to incorporate German ornamental and curved designs on window bars, he tailored his advice to be specifically ‘necessary in this country’.90 In 1913, A. W. Overbeck-Wright, Superintendent of the Agra Central Asylum, published Mental Derangements in India as a ‘guide to students and practitioners in India’. This textbook received a very critical review in the Indian Medical Gazette for excluding the ‘new science’ of normal and abnormal psychology. In his defence, he explained ‘The students and practitioner in India have no time to go into the niceties and theories of this subject and even though au fait with all the vagaries of psychoanalysis how many among them would have the time and energy to spare for all that is involved’.91 Specialist superintendents like Major Shaw and Captain OverbeckWright, while claiming to provide treatment for mental disease, mainly worked to alleviate patients’ physical ailments. Such superintendents found themselves in a conflict between ‘biology (psychology) and physical science’ and sided with physical science—‘supreme in the hierarchy of sciences’—as a premise for their treatment methods.92 However, their claim to professional expertise would soon be challenged by the emergence of western-trained Indian doctors, who comfortably employed both psychology and physical science in treating patients.93 Western-trained Indian psychiatrists debunked specialists’ claims of expertise based on Indian asylum experience, since they possessed both the knowledge of international trends in psychiatry and personal knowledge of India.94 For instance, when Major Shaw’s published a controversial study in the British Medical Journal (BMJ ) about Parsis and dementia praecox, he received stark criticism for it. In the article, he argued that the Parsi community had a higher prevalence of dementia praecox (schizophrenia) compared to Hindus or Muslims as a result of heredity and ‘inbreeding’. English doctor Arthur Brock challenged his

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conclusions on the grounds that they were merely based on his ‘conjecture and highly selective observations’. Dr Brock instead attributed the high rates of dementia praecox to ‘western education’.95 However, Major Shaw retaliated by asserting that Dr Brock lacked ‘personal knowledge of India’ to draw such conclusions. Finally, Dr Dhunjibhoy, Ranchi’s Superintendent, countered Major Shaw’s arguments by asserting that dementia praecox prevailed in western nations, though ‘inbreeding’ was not practised. As a result of Dhunjibhoy’s response, the BMJ refused to publish Shaw’s final report. Even so, he published it years later in another British journal.96 Despite his claim of possessing specialist knowledge and providing specialist treatment, Major Shaw, like his non-specialist colleagues, could only claim expertise based on his experience of working in Indian asylums. As stated earlier, no major changes occurred under his superintendence at the Yerawada Asylum, and asylums throughout Bombay. Bombay’s asylums took partly ‘the nature of a prison’ and ‘partly the nature of a general hospital’.97

A New Name for Cinderella: The Asylum Nomenclature Controversy In 1914, Dr W.S. Jagoe Shaw, Superintendent Yerawada Asylum, recognised that the public image of the asylum was hindering its use.98 Dr Shaw believed that changing the nomenclature of ‘Lunatic Asylum’ to ‘Mental Hospital’99 would bring about a change in public perception of the pagal khana (local term for lunatic asylum): The days when it was considered a visitation of God or a possession by the devil have gone for some time, but the name ‘Lunatic Asylum’ for the place in India in which persons were imprisoned for the safety of the public, remains, as also, in the public mind, the ideas associated with the name. So vivid are these associated ideas, that it is a common occurrence for persons bringing in a patient, to ask that they may send him certain patent medicines, and surprise is expressed when it is explained that treatment is provided and that the institution is in fact a hospital. I have also been frequently asked by relatives of incoming patients whether any hospitals for such patients exists in India, and I know that this is a provision for which there is a persistent demand on the part of the more educated classes of India.100

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Shaw rightly understood that over the nineteenth and early twentieth centuries, locals had come to perceive the asylum as a mere place of confinement for incurable ‘lunatics’, rather than a hospital for their treatment. However, he hoped that just as public attitudes towards asylums changed in Europe, with voluntary self-admissions ‘eagerly’ availed at the institution, the same would happen in India since ‘what has happened in Europe generally must happen in India’.101 He believed his proposition was in line with practices in England where the word ‘lunacy’ was ‘falling out of official use in the early twentieth century’.102 Scull argued, that this trend of relabelling asylums in Britain ‘did little to disguise an increasingly grim reality’ of the failure of asylums as curative institutions.103 But Shaw had set his mind on abolishing the term lunatic asylum. His proposal was an attempt to ‘actively forget’ the reality of lunatic asylums as custodial institutions, and to ‘remember’ them as hospitals.104 However, his efforts were met with significant opposition from non-specialists. This section argues that their reluctance to change the nomenclature demonstrates a resistance to reforming Indian asylums after an English model. Major Shaw persistently campaigned for several years, but his proposal faced considerable opposition. He raised the matter with the central government three times (with the support of the Bombay government) and consultations began. The second time the heads of the medical departments and superintendents were consulted. Shaw clashed with most superintendents, not only in the Bombay Presidency, but also all over the Indian colony over the matter.105 The opposition to the change in nomenclature came from his non-specialist colleagues. He noted how the Government consulted ‘superintendents of asylums—specialists and nonspecialists indiscriminately’. To start with, many superintendents argued that the change of nomenclature would ignore the Lunacy Act of 1912, which made provision for the custodial detention of those who threatened public safety.106 It would therefore lead to overcrowding of patients who were ‘neither violent nor dangerous’. Furthermore, they insisted that asylums were merely places of detention and ‘could not be considered hospitals, as no lunatics ever recovered!’ Additionally, the Lunacy Act of 1912 was the first to make a statutory reference to the word ‘treatment’.The Civil Surgeon of the Agra Asylum, who was officiating for the Superintendent, explained that changing the ‘European nomenclature will in no way change the Indian term of “Pagal-Khana”’, he asked that the idea be ‘abandoned immediately’ since if asylums were called hospitals

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the Government would require to provide ‘a hundred times the present occupation’.107 Shaw ridiculed his opponents, labelling them ‘non-specialists’. Their objection, he added, was based on a ‘wrong premise’ since the ‘general modern conception was that asylums … [were] hospitals for the treatment of mental disease’.108 He then put forward the memorandum a third time. He finally succeeded in 1920, after five years, to bring about the change in the nomenclature with the support of the Director General of the IMS.109 The change led to the amendment of the Lunacy Act of 1912 contained in Act VI of 1922.110 Act VI also insisted on ‘curative treatment’ in all government institutions. However, changes in legislation had little impact on treatment practices in Bombay’s institutions. As discussed in the previous section, Bombay’s superintendents adhered to a common-sense treatment regime. The controversy over the designation ‘lunatic asylum’ provides evidence that superintendents themselves perceived asylums as places of confinement rather than cure. In the opinion of superintendents, then, there was no justification for changing the designation of ‘lunatic asylums’ to ‘mental hospitals’. Despite Shaw deriding his fellow colleagues calling them ‘non-specialists’ for opposing him, in 1932 he too admitted that, ‘treatment even now is very inadequate’. But such an admission failed to change his view of specialists. He asserted, ‘We must continue to depend on the influence and energy of the few and scattered provincial specialists for the enlightening of politicians in the methods of civilization, during the continued absence of central supervision’.111 Shaw hoped that specialists like himself would herald the movement for change in Bombay’s asylums. While blaming non-specialist superintendents for obstructing asylum reform, specialists also condemned the poor public response for the state of Bombay’s asylums. Shaw called the lack of public opinion on asylum matters as the ‘chief obstruction to psychiatry in India’. The beginning of the religious revivalist movement in the 1920s, which contended that ‘colonial policies [were] detrimental to Indian science and medicine’, also caused a setback to the progress of psychiatry in India. Superintendent J. Shaw complained that ‘the noisy section of the population led by M. K. Gandhi prefers the Ayurvedic and other indigenous systems to our modern methods of treatment. These so-called “systems” are based on very primitive ideas of anatomy and physiology, and are even more out-of-date than that of Galen’.112 Moreover, after 1919, Bombay city became increasingly the

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arena for popular nationalism that ‘reterritorialized’ it as a nationalist space.113 Yet, Shaw continued to claim in 1932 that changing the nomenclature of asylums to mental hospitals had changed the public perception of mental hospitals. Among voluntary patients and their friends, he explained, ‘the word “hospital” [was used] very naturally’. However, the Yerawada Mental Hospital Annual Report in 1929 notes that even among the educated and affluent classes patients admitted had been ill from one to four years and they still held ‘strong prejudices’.114 The change in nomenclature did little to reform Bombay’s asylums or change the perception of the ‘veritable Cinderella’.

Conclusion Despite having the opportunity to reform Bombay’s asylum system, the Government and asylum medical staff failed to bring about much needed reform. The Government believed that bringing in a specialist could help reform the asylum system. Their initial suggestion to appoint a European specialist met with objection, and they eventually appointed specialists from the IMS. The appointment of such specialists failed to usher in an era of modern psychiatry in Bombay since specialist and non-specialist superintendents contested over the professional expertise of Indian insanity. For non-specialists, asylums were ‘non-institutional’ sites of ‘communicative memory’ where common-sense treatment practices were the norm. However, specialist superintendents wanted to implement western psychiatric treatment as the norm and transform the asylum into sites of ‘cultural memory’. This vision was to be achieved through centralisation and specialisation. Specialists like Major Shaw tried to implement this vision through various means including changing the nomenclature of lunatic asylums to mental hospitals. Further, they tried to assert their role as specialists by publishing books and articles that would store away in public form the knowledge of western psychiatry in India. However, non-specialists rebuffed their vision for reform and claims to expertise. Their intra-professional rivalries thwarted asylum reform in Bombay. Acknowledgements Thanks to the editors Dr Rob Ellis, Dr Rebecca Wynter, and Dr Jennifer Wallis for persisting with this publication despite the challenges of the pandemic. Most importantly, to my husband, Ashwin Nazareth, thank you for being my constant through the highs and lows of writing and of life.

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Notes 1. MSA, 1905/55 From the Surgeon General with the Government of Bombay to the Secretary to the Government, Government of Bombay, GoB, GD, 5 November 1904; ‘Lunatic Asylums in the Bombay Presidency’, The Hospital, 33(84), 1902, 102–103. 2. This chapter uses Jan Assmann’s definitions/concept of communicative and cultural memory. See Jan Assmann, ‘Communicative and Cultural Memory’, Astrid Erll and Ansgar Nünning in collaboration with Sarah B. Young (eds.), Cultural Memory Studies. An International and Interdisciplinary Handbook (Berlin and New York: de Gruyer, 2008), 109–118. 3. Anouska Bhattacharyya, Indian Insanes: Lunacy in the “Native” Asylums of Colonial India, 1858–1912 (PhD thesis, Harvard University, 2013), iii. 4. Om Prakash, ‘The English East India Company’, H. V. Bowen, Margarette Lincoln and Nigel Rigby (eds.), The Worlds of the East India Company (London: Boydell Press, 2002), 3. 5. Sekhar Bandyopadhyay, From Plassey to Partition: A History of Modern India (India: Orient Blackswan, 2004), 44, 179–180. 6. Richard Burn (ed.), The Imperial Gazetteer of India, Volume 4, 1908– 1931 (Oxford: Clarendon Press, 1909), 46–47. 7. Sarah A. Pinto, Lunatic Asylums in Colonial Bombay: Shackled Bodies, Unchained Minds (Cham, Switzerland: Palgrave Macmillan, 2018), 66. 8. National Library of Scotland [hereafter NLS], Annual Administration and Progress Reports on the lunatic asylums in the Bombay Presidency [hereafte, APR], 1894, 2. 9. The Hemp Drugs Commission was set up in 1893 to conduct an enquiry into the Indian use of Hemp in order to regulate its use. The enquiry was intended to primarily focus on hemp use in Bengal, but it was extended to the whole of India. It consisted of ‘written and oral examination of 1193 witnesses’ who included ‘civil and medical officers, European and native medical practitioners, farmers, traders and missionaries’ and hemp users. See Oriana Kalant, ‘Report of the Indian Hemp Drugs Commission, 1893–94: A Critical Review’, The International Journal of the Addictions, 7(1), 1972, 77–78. 10. MSA, 1895/77, A.H.L Fraser and C.J.H. Warden, ‘Notes on Asylum Administration’, GoB, GD, 7 August 1894. 11. Ibid. 12. Superintendents failed to make a ‘special study of insanity’. National Archives of India [hereafter NAI] Medical Proceedings–August, Simla

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13.

14.

15. 16. 17.

18. 19. 20. 21.

22. 23.

24. 25.

26. 27. 28.

29. 30. 31. 32.

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Records 4, Home Department, 1897, Nos. 188–232 From the Government of Bengal to the Home Department, Government of India, Administration of Lunatic Asylums in India, 25 August 1896. MSA, 1907/81, From Lt. Col. J.P. Barry, Superintendent, Colaba Lunatic Asylum to the Personal Asst. to the Surgeon General with the Government of Bombay, GoB, GD, 25 June 1904. NAI, Nos. 188–232 From the Surgeon General with the Government of Bombay, 18 July 1895, Simla, Records 4, Home Department, Medical Proceedings, August 1897. From B. B. Grayfoot, 10 August 1904. Assmann, ‘Communicative and Cultural Memory’, 114. ‘Communicative memory is not formalized and stabilized by any forms of material symbolization; it lives in everyday interaction and communication’. See Assmann, ‘Communicative and Cultural Memory’, 111. Ibid., 114. NLS, APR 1898, 9. W. S. Jagoe Shaw, ‘The Alienist Department of India’, British Journal of Psychiatry, 78, April 1932, 331–341. MSA, 1922/2257-B From the Superintendent, Central Lunatic Asylum, Yerawada, to the Surgeon General with the Government of Bombay, GoB, GD, 26 May 1922. Assmann, ‘Communicative and Cultural Memory’, 116. After 1933, asylum records in Bombay were meant to be available at the Thana Mental Hospital. However, a few years ago the hospital destroyed those records due to lack of space. Shaw, ‘The Alienist Department’, 334. Heinz-Peter Schmiedebach, ‘Psychiatry in Germany in the Early Twentieth Century’, Neurology, Psychiatry and Brain Research, 22(2), 2016, 32. At the Ranchi Indian Mental Hospital Dr Dhunjibhoy implemented many ‘cutting edge’ practices. See Waltraud Ernst, ‘The Indianization of Colonial Medicine: The Case of Psychiatry in the Early-TwentiethCentury British India’, NTM International Journal of History & Ethics of Natural Sciences, Technology and Medicine, 20, 2012, 64–65. Roy Porter, Madness: A Brief History (New York: Oxford University Press, 2002), 187. Bhattacharyya, Indian Insanes, iii. Waltraud Ernst, ‘Crossing the Boundaries of ‘Colonial Psychiatry’, Reflections on the Development of Psychiatry in British India, c.1870– 1940’, Culture, Medicine and Psychiatry, 35(4), 2011, 543. Ernst, ‘The Indianization of Colonial Medicine’, 61–89. Ernst, ‘Crossing the Boundaries’, 539. B. B. Grayfoot, 10 August 1904. Ernst, ‘Crossing the Boundaries’, 538, 539.

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33. ‘Annual Reports: Lunatic Asylums in Bombay’, Indian Medical Gazette, October 1914, 408. 34. Shaw, ‘The Alienist Department’, 334. 35. James Mills, ‘The History of Modern Psychiatry in India, 1858–1947’, History of Psychiatry, 12(48), 2001, 431–458. 36. Shaw, ‘The Alienist Department’, 337. 37. Shilpi Rajpal, ‘Psychiatrists and Psychiatry in Late Colonial India’, The Indian Economic & Social History Review, 55(4), 2018, 517. 38. Shruti Kapila, The Making of Colonial Psychiatry, Bombay Presidency, 1849–1940 (PhD thesis, University of London, 2002), 2, 87–88. 39. Shaw, ‘The Alienist Department’, 337. 40. Lt. Col. J. P. Barry, 25 June 1904. 41. Pinto, Lunatic Asylums in Bombay, 65–66. 42. Muhammad Umair Mushtaq, ‘Public Health in British India: A Brief Account of the History of Medical Services and Disease Prevention in Colonial India’, Indian Journal Community Medicine, 34(1), 2009, 6– 14. 43. D. G. Crawford, A History of the Indian Medical Service, 1600–1913 (London: W Thacker and Co., 1914), 25. 44. S. M. Edwardes, ‘District Administration in Bombay, 1858–1919’, H. D. Dodwell (ed.), The Cambridge History of the British Empire, 1497– 1858, Vol. VI, 2nd edn (London: Cambridge University Press, 1932), 263; Sir Wilson William Hunter, Bombay 1885–1890: A Study in Indian Administration (London: H. Frowde; Bombay, B. M. Malabari, 1892), 275, 316. 45. Bhattacharyya, Indian Insanes, 52, 64. 46. Pinto, Lunatic Asylums in Bombay, 156. 47. Crawford, A History of the Indian Medical Service, 293. 48. MSA, 1862–64/15 Lunacy Act XXXVI of 1858, GoB, GD, 1858; MSA 1812/336 From the Acting Clerk, Petty Sessions, to the Chief Secretary to the Government of Bombay, PDD, 14 June 1812. 49. Shaw, ‘The Alienist Department’, 336. 50. Pinto, Lunatic Asylums in Bombay, 73; MSA, 1907/81 From A. F. W King, Superintendent of Ratnagiri to the Personal Asst to the Surgeon General with the Government of Bombay, GoB, GD, 11 July 1904. 51. Amna Khalid, ‘Subordinate Negotiations; Indigenous Staff, the Colonial State and Public Health’, Biswamoy Pati and Mark Harrison (eds.), The Social History of Health and Medicine in Colonial India (New York: Routledge, 2009), 45; Shilpi Rajpal, ‘Colonial Psychiatry in Mid-Nineteenth Century India: The James Clark Enquiry’, South Asia Research, 35(1), 2015, 75. 52. From B. B. Grayfoot, Superintendent, Lunatic Asylum, Dharwar, to the Personal Asst. to the Surgeon General with the Government of Bombay, 10 August 1904, GoB, GD, 1907/81, MSA.

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53. Assmann, ‘Communicative and Cultural Memory’, 111. 54. Pinto, Lunatic Asylums in Bombay, 93–95. 55. NAI, Simla Records Nos 97 to 99 A. H. L. Fraser and C. J. H. Warden, ‘Proposed Improvement in the Administration of Lunatic Asylums in India’, Medical, Home Department, March 1895. 56. MSA, 1895/77, A. H. L. Fraser and C. J. H. Warden, ‘Notes on Asylum Administration’, GoB, GD, 7 August 1894. 57. Shaw, ‘The Alienist Department’, 336, 337. 58. MSA, 1907/81 From J. Sladen, Esq., I.C.S., Acting Secretary to the Government to the Surgeon General with the Government of Bombay, GoB, GD, 13 June 1904. 59. MSA, 1907/81 From W. McConaghy, Surgeon General of Bombay to the Secretary to Government, GoB, GD, 5 November 1904. 60. Andrew Scull, Psychiatry and Its Discontents (Oakland: University of California Press, 2019), 62. 61. Janet Oppenheim, “Shattered Nerves”: Doctors, Patients, and Depression in Victorian England (New York: Oxford University Press, 1991), 29, 55; Andrew Scull, ‘Mad-doctors and Magistrates: English Psychiatry’s Struggle for Professional Autonomy in the Nineteenth Century,’ European Journal of Sociology, 17(2), 1976, 283, 303. 62. Scull, Psychiatry and Its Discontents, 62. 63. Andrew Scull, Museums of Madness: The Social Organization of Insanity in Nineteenth Century England (London: Trinity Press, 1979), 15, 48. 64. B. B. Grayfoot, 10 August 1904. 65. MSA, 1907/81 From K H Mistri, Superintendent Narotamdas Madhavdas Lunatic Asylum, Naupada to the Personal Asst. to the Surgeon General of Bombay GD, GoB, GD, 5 November 1904. 66. W. McConaghy, 5 November 1904. 67. B. B. Grayfoot, 10 August 1904. 68. MSA, 1907/81 From Lt. Col. W. G. H. Henderson, Superintendent, Poona Lunatic Asylum, to the Personal Asst. to the Surgeon General with the Government of Bombay, GoB, GD, 18 July 1904. 69. MSA, 1907/81 From Lt. Col. J. W. T. Anderson, Superintendent, Ahmedabad Lunatic Asylum, to the Personal Asst. to the Surgeon General with the Government of Bombay, GoB, GD, 10 July 1904. 70. B.B. Grayfoot, 10 August 1904. 71. Ibid. 72. Lt. Col. W. G. H. Henderson, 18 July 1904. 73. Pinto, Lunatic Asylums in Bombay, 133. 74. Lt. Col. W. G. H. Henderson, 18 July 1904. 75. Lt. Col. J. W. T. Anderson, 10 July 1904. 76. Ernst, ‘The Indianization of Colonial Medicine’, 77.

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77. Waltraud Ernst and Thomas Mueller, ‘Introduction’, Waltraud Ernst and Thomas Mueller (eds.), Transnational Psychiatries: Social and Cultural Histories of Psychiatry in Comparative Perspective c. 1800–2000, ed. (Newcastle: Cambridge Scholars Publishing 2010), xx, xxi. 78. NLS, APR Appendix, Annual Report of the Central Hospital for Mental Diseases, Yeravada, 1933, 6. 79. Kapila, The Making of Colonial Psychiatry, 30. 80. B. B. Grayfoot, 10 August 1904. 81. Lt. Col. J. P. Barry, 25 June 1904. 82. MSA, 1907/81, From Lt. Col. H. W. Stevenson, Superintendent, Hyderabad Lunatic Asylum to the Personal Asst. to the Surgeon General with the Government of Bombay, GoB, GD, 14 July 1904. 83. Shaw, ‘The Alienist Department’, 331. 84. Pinto, Lunatic Asylums in Bombay, 90. In 1928, Bombay’s superintendents complained about limited facilities for occupational therapy. They requested the government to provide funds ‘for adequate staff for instruction and supervision’ so that patients could be employed more effectively. See NLS, APR, 1928, 6. 85. Ibid., 155; MSA, 1922/2257B From the Superintendent, Central Lunatic Asylum, Yerawada, to the Surgeon General with the Government of Bombay, GoB, GD, 16 July 1920; Schmiedebach, ‘Psychiatry in Germany’, 20. 86. Kapila, The Making of Colonial Psychiatry, 29. 87. Assmann, ‘Communicative and Cultural Memory’, 111. 88. Ibid., 114–115. 89. ‘Notes on Books’, British Medical Journal, 2(3374), 1925, 386. 90. W. S. Jagoe Shaw, ‘Some Generalizations on the Scope, Construction and Administration of Central Asylums in India’, The Indian Medical Gazette, 49(11), 1914, 426. 91. A. W. Overbeck-Wright, ‘Mental Derangement in India: A Reply to a Criticism’, The Indian Medical Gazette 48(7), 1913, 285–286; ‘Mental Derangements in India: A Criticism (Communicated)’, The Indian Medical Gazette, 48(6), 1913, 240–242. 92. ‘Mental Derangements in India: A Criticism’, 242. 93. Ernst, ‘The Indianization of Colonial Medicine’, 62. 94. Shruti Kapila argues that during this time, Indian psychiatrists took a keen interest in psychoanalysis and busied themselves to give it a ‘scholarly and institutional position’. See Kapila, The Making of Colonial Psychiatry, 230. 95. Arthur J. Brock, ‘Dementia Praecox in Parsees’, British Medical Journal 2(6 October 1928), 634–635; W. S. J. Shaw, ‘The Heredity of Dementia Praecox,’ British Medical Journal 2(29 September 1928), 566; W. S. J. Shaw, ‘Demetia Praecox in the Parsees’, British Medical Journal 2(20 October 1928), 728.

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96. 97. 98. 99. 100.

101. 102.

103. 104.

105. 106.

107.

108. 109. 110. 111. 112. 113. 114.

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Ernst, ‘The Indianization of Colonial Medicine’, 75–78. Lt. Col. J.P. Barry, 25 June 1904. Shaw, ‘The Alienist Department’, 331. Ibid., 338. From the Superintendent, Central Lunatic Asylum, Yerawada, to the Surgeon General with the Government of Bombay, 16 July 1920, GoB, GD, 1922/2257B, MSA. Shaw, ‘Some Generalizations’, 424. Janet Weston, ‘Managing Mental Incapacity in the 20th Century: A History of the Court of Protection of England and Wales’, International Journal of Law and Psychiatry, 68, 2020, 3. Scull, Psychiatry and Its Discontents, 62. Remembering and forgetting are part of the dynamics of cultural memory. See Aleida Assmann, ‘Canon and Archive’, Astrid Erll and Ansgar Nünning in collaboration with Sarah B. Young (eds.), Cultural Memory Studies. An International and Interdisciplinary Handbook (Berlin and New York: de Gruyer, 2008), 97–98. Shaw, ‘Some Generalizations’, 424. Muhammad Mudasir Firdosi and Ahmad Zulkarnain, ‘Mental Health Law in India: Origins and Proposed Reforms’, British Journal of Psychiatry International, 13(3), 2016, 65. MSA, 1922/2257-B From the Superintendent, Central Lunatic Asylum, Yerawada, to the Surgeon General with the Government of Bombay, GoB, GD, 26 May 1922. Ibid. Shaw, ‘The Alienist Department’, 338–339. The 1912 Act was only replaced in 1987. Shaw, ‘The Alienist Department’, 334, 341. Ibid. Prashant Kidambi, ‘Nationalism and the City in Colonial India: Bombay, c.1890–1940’, Journal of Urban History, 38(50), 2012, 950–951. NLS, APR Appendix, Annual Report of the Central Hospital for Mental Diseases, Yeravada, 1933, 5.

The New Socialist Citizen and ‘Forgetting’ Authoritarianism: Psychiatry, Psychoanalysis, and Revolution in Socialist Yugoslavia Ana Antic

Introduction In the aftermath of the Second World War, the socialist revolution which unfolded in Yugoslavia (and the rest of Eastern Europe) radically changed all aspects of political, social, and cultural life. The resistance movement, led by the Communist Party of Yugoslavia, successfully liberated the country in the spring of 1945 and went on to turn its victory into immense social and political capital. Following the traumatic ideological split with the Soviet Union and the Cominform (the leading organisation of the international communist movement in late Stalinism) in 1948, the country eventually moved away from the Soviet model and sought to define its own unique version of socialism. The overall effect of these changes on Yugoslav society was enormous, and various scientific and medical disciplines developed new paradigms and theoretical frameworks.

A. Antic (B) University of Copenhagen, Copenhagen, Denmark e-mail: [email protected]

© The Author(s) 2023 R. Wynter et al. (eds.), Memory, Anniversaries and Mental Health in International Historical Perspective, Mental Health in Historical Perspective, https://doi.org/10.1007/978-3-031-22978-7_3

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Psychiatry and other ‘psy’ disciplines were deeply affected, sometimes in surprising ways. The socialist period proved to be a golden age of the Yugoslav ‘psy’ sciences, and of psychoanalysis and psychotherapy in particular.1 Not unlike other European countries, social psychiatry rose to prominence, benefiting from both the overall focus of Marxist practitioners on socio-economic factors and their increasingly dynamic international collaboration. Moreover, psychoanalysis and psychoanalytically informed psychotherapy gradually became influential clinical models in psychiatry. This was highly unusual: nowhere else in socialist Eastern Europe was psychoanalysis practised so openly and awarded such a prominent clinical and intellectual position. In recent years, many historians have revised the proposition that East European psychiatry was fully subservient to the Soviet diktat, and developed within the rigid constraints of the materialist-organic and neurological Pavlovian framework.2 Even though such biological approaches persisted in different parts of the Eastern bloc, the picture gradually became more nuanced, with psychotherapeutic and psychodynamic clinical practices gaining strength in the decades after Stalin’s death in 1953. In Yugoslavia, the traditional biomedical paradigm certainly survived the war, and soon after the end of the Second World War influential medical circles devised plans to initiate a full-blown ‘Stalinisation’ of Yugoslav medicine.3 These were cut short by the country’s dramatic break with the Soviet Union, which left Yugoslavia determinedly socialist but relatively free to formulate its own social, political, and medical responses. Because of this unique constellation of political events, the move away from and ‘forgetting of’ the biological paradigm was particularly effective in Yugoslavia, where social psychiatry and psychoanalytic approaches thrived to an unprecedented extent when compared to other socialist societies.4 This was partly also because Yugoslav psychiatry became thoroughly internationalised and by the 1960s the country had the most developed and vibrant psychoanalytic and psychotherapeutic profession in Eastern Europe.5 Yugoslavia’s psychiatry and psychoanalysis, I will argue, experimented with revolutionary concepts and practices in a genuinely unique manner, and ‘psy’ practitioners saw themselves as important carriers of revolutionary progress. This chapter focuses on the importance of revolution and ideas of radical reform for the development of socialist psychiatry. I will look at how the experience of social and political revolution transformed the clinical practice and intellectual frameworks of Yugoslavia’s ‘psy’

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disciplines, but also how the concept of revolution and reform was worked into psychiatric theories and initiatives. On the one hand, external socio-political circumstances significantly changed the face of Yugoslav psychiatry: in the interwar period, mainstream psychiatry was almost exclusively shaped by the Central European biomedical model. Following the war, psychiatrists started paying more attention to the role of broader social factors in causing and exacerbating mental pathology. The Yugoslav discourse of socialist psychiatry was marked by unique revolutionary political references. By the 1960s and 70s, Yugoslav psychiatrists’ theorisation of the interplay between broader societal influences and individual psyche developed in a direction much more radical than mainstream social psychiatry in western Europe had ever seen. On the other hand, in addition to reshaping psychiatry, the revolution became one of its central themes. Yugoslav psychiatry dedicated significant efforts to describing, interpreting, and treating psychological consequences of the socialist revolution. The history of Yugoslav psychiatry has so far received little scholarly attention, and researchers have not yet fully examined the significance of the socialist revolution for the development of the country’s psychiatric profession.6 Moreover, the broader history of East European ‘psy’ sciences remains rather under-explored: while recent research has demonstrated that the region’s psychiatry was far from monolithic or irrelevant,7 the role of Eastern Europe in European or global psychiatric knowledge production has been completely neglected. This research is the first to shed light on the contribution of East European psychiatrists to post1945 transcultural psychiatry and to global decolonisation debates. Moreover, it offers the first detailed exploration of transnational exchanges of psychiatric ideas between Eastern and western Europe in the Cold War. I will argue that socialist psychiatrists’ faith in the therapeutic potential of revolutionary changes rested on their belief that both the profession and society at large needed to ‘forget’ their authoritarian past and psychological dispositions, as well as their early links to Soviet psychiatric practice. This also applied to a transnational context: Yugoslavia’s transcultural psychiatrists argued that decolonising societies needed to forget and eliminate the oppressive social and psychological structures of colonialism in order to achieve mental health and stability. Reformed socialist psychiatry was in the service of struggling against authoritarianism in both Eastern Europe and the decolonising world.

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As I will demonstrate, psychiatrists’ relationship to the multiple disruptions caused by the revolution was ambivalent. In the immediate aftermath of the war, a rapidly growing number of ‘war neurotics’ among the victorious partisan resisters caused major concern for both the Communist political leadership and the psychiatric profession. Mental health professionals linked the outbreak of war hysteria to the disruptive potential of the revolution itself, and clearly lacked faith in the positive outcome of the reform and radical social change they were experiencing. In the subsequent decades, the Yugoslav version of socialism developed in the direction of workers’ self-management and radical political decentralisation. In their search for an alternative political model following the country’s exit from the Soviet bloc, the most important ideologues of Yugoslav Communism developed their doctrine of socialist workers’ selfmanagement, which was partly based on Engels’ notion of the ‘state that withers away’, on Marx’s early writings and analysis of the Paris Commune, on Gramsci’s theories, and partly inspired by the Yugoslav Communists’ wartime experiences of popularly elected and popularly responsible committees/councils. Such reforms ultimately helped build a more pluralistic society.8 The Yugoslav political and intellectual elite thus promoted this concept of humanist, democratic Marxism in contradistinction to the authoritarian Stalinist model, and it required a new type of socialist citizen—one characterised by independence of mind, autonomy, and self-initiative instead of blind political obedience. Such a dramatic ideological change opened up new possibilities for the psychiatric profession in the early 1950s. A new generation of socialist psychiatrists stopped worrying about the revolution’s disruptive potential and became the most ardent promoters of radical political change and reform, increasingly preoccupied with notions of individual emancipation. Heavily influenced by the Frankfurt school, and by psychoanalytic thinkers such as Erich Fromm, Igor Caruso, and Karen Horney, they developed original ideas about revolutionary psychiatry and psychoanalysis, which primarily aimed to undermine—to forget—lingering authoritarian structures in social institutions (including the family), and to aid patients on their road to personal liberation and emancipated authentic existence as democratic Marxist citizens. Finally, Yugoslav socialist psychiatrists were the only ones in Eastern Europe to get involved in transcultural psychiatric discussions and research and to travel to a variety of countries in the Global South as part of technical assistance missions and exchange programmes. This

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cross-cultural global context offered them an opportunity to reflect on the psychiatric, social, and political meaning of revolutions in different cultural settings. In the 1960s, they drew parallels between African and Yugoslav experiences of revolutionary war, resistance, and liberation. They also radically redefined the role of social and political conflicts in causing mental illness and focused on their positive reformist potential. As Greg Eghigian argued in relation to psychiatry in the German Democratic Republic, Yugoslav psychiatrists imagined the socialist subject as a psychiatric and psychotherapeutic project—and this meant that the profession as a whole came to participate wholeheartedly in the development of this new type of personality.9 By the 1960s, the psychiatric ideal of non-conformist, revolutionary personality was shaped by a combination of international psychoanalytic and psychotherapeutic theories and the specific characteristics of Yugoslavia’s self-managing socialism. The profession moved from critiquing and pathologising the revolutionary dislocation in 1945 to fully adopting the project of radically reforming social structures and individuals in their own consulting rooms. For socialist ‘psy’ practitioners, the possibility of reforming the discipline along Marxist lines meant new hope for a previously marginalised profession and renewed faith in their ability to bring about effective therapy, recovery, and progress for their patients and for society at large.

Socialist Revolution and ‘Reactionary’ Biological Psychiatry In the aftermath of the 1948 break, Yugoslav psychiatry quickly moved away from the organicist framework. This radical transformation could not have been solely due to the growing international connections of Yugoslav psychiatrists, and the strong influence exerted upon them by the British and American social psychiatry movements. The increased interest in broader social and environmental contexts of mental illness was in evidence well before 1948 and conditioned to a large extent by the experiences of war, resistance, and postwar socialist revolution. In 1946, at the first postwar conference of Yugoslav psychiatrists and neurologists in Zagreb, leading psychiatrist Nikola Nikolic called for a ‘new type of social doctor, prophylactic doctor, therapist—a neuropsychiatrist’, who would be able to help cure those illnesses that ‘had their roots in social and economic conditions, and which could be treated with

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social and economic measures.’10 Nikolic argued that new socialist psychiatry could seamlessly become a part of the radical social medicine turn and that it was the ‘backward socio-economic system’ inherited from the pre-war Yugoslav regime that led to the most serious forms of psychiatric damage, as much as the wartime suffering did. A reactionary and ‘backward’ interwar regime also produced a reactionary psychiatric profession, which completely ignored such damning social and economic factors, and focused exclusively on organic, neurological, and physiological causes of mental illness, thereby making it impossible to hold the regime (and the broader social system) to account. A wholesale political and social revolution, as implemented by the new Yugoslav regime, was needed to reduce the rate of psychiatric illnesses. The sheer brutality of the Second World War on Yugoslav soil further accelerated these trends. One of the core characteristics of the interwar psychiatric paradigm in Yugoslavia (and Central Europe as a whole) was its disinterest in the notion of psychological traumatisation, and in the influence of external factors on the origins and development of mental illness. In 1946, the speech of Bosko Niketic, the first officer for mental hygiene of the Yugoslav Committee for the Protection of People’s Health, announced a dramatic change in this respect. For Niketic, the postwar socialist government’s most formidable mental health challenge was dealing with the consequences of the psychological scarring caused by the war and the occupation. The crimes committed on Yugoslav soil by the occupying powers, as well as the heroic sacrifices of the resistance movement, became central to the foundational ideological narrative of the new state, but within the framework of biological psychiatry they would have likely been marginalised or forgotten. Unlike interwar clinicians, the new revolutionary psychiatric profession could hardly write the wartime suffering out of the country’s and its own history. As Niketic noted, the ‘fascist criminals’ caused the Yugoslav population immeasurable ‘sorrow, worries, unbearable uncertainty and fears, psychological suffering, insults, and humiliations.’11 A renewed and reformed psychiatric service had to address this. The revolutionary nature of these proclamations cannot be overemphasised: this was the very first time that any mainstream psychiatric professionals—let alone a state-funded national conference of psychiatrists—in Yugoslavia and Eastern Europe discussed broader social and environmental factors in the origins and development of mental illness, and accorded them such a large role in their interpretive framework.

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These new psychiatric approaches were explicitly linked to the political programme and revolutionary language of the new socialist Yugoslavia and legitimated with direct reference to the Marxist ideological framework (and its socio-economic concerns). This rejection of the view that heredity was the sole factor in the aetiology of mental illness became one of the cornerstones of Yugoslavia’s new Marxist psychiatry. In a 1949 article, the head of one of the largest psychiatric hospitals in the country, Dezider Julius, emphasised the harmful effects of earlier ‘biologizing tendencies,’ which were both ideologically reactionary and also the reason for pre-war psychiatry’s general methodological and epistemological crisis: ‘We need to finally relinquish that bourgeois belief in definitively pre-constituted personalities, in an inevitable, fateful role of heredity. This perspective ignores completely important effects of societal factors, and leads in the final analysis to educational nihilism and desperation.’12 For Julius, the ideological tenets of socialism required a radically reformed psychiatry, one in which the socio-economic conditions of human upbringing were not being sidelined in favour of purely organic considerations. Marxist societies were in the business of developing a new socialist consciousness in all their citizens, and this educational task could not be accomplished without psychiatrists’ careful attention to the multitude of ways in which social and historical developments altered the human psyche. Towards the end of the war, another set of events occurred which pushed psychoanalytic and psychotherapeutic approaches to the fore: the victorious resistance army was hit by an unusual predicament, a sudden outbreak of a unique type of ‘partisan neurosis’. In this acute political crisis, it was two Vienna-educated psychoanalysts, Stjepan Betlheim and Hugo Klajn, who were appointed and given resources by the new government to handle the illness.

A Moment of Fear and Ambivalence In 1945, the Communist Party-led Yugoslav People’s Army, having faced and triumphed over numerous formidable wartime challenges, was plagued by an internal problem which appeared impossible to resolve or even fully understand: a virtual epidemic of war neurosis, which did not show any signs of subsiding after the end of fighting.13 This was a disorder

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that bore no resemblance to war traumas in other nations that participated in the conflict: it did not manifest itself in the form of an urge to withdraw from the frontlines, as was the case in the British and US armies, where battle exhaustion, anxiety, and demoralisation emerged as the most popular diagnoses by 1944.14 Rather, Yugoslav war neurotics demonstrated a heightened willingness to fight, as their new disorder consisted of violent and potentially harmful epileptiform seizures which simulated wartime battles and attacks.15 The seizures could occur at any moment and under any circumstances, usually when there was audience— in the middle of a conversation, at lectures or meetings, while driving a car, or in front of superiors. Crucially, the Yugoslav form of war neurosis apparently most frequently affected the uneducated, socially immature, and emotionally less sophisticated—in some reports even ‘primitive’16 —members of the partisan troops, who were given important political responsibilities but experienced severe trauma and anxiety due to their own inadequacy and unpreparedness. Because of this, and in a highly volatile and disruptive broader social context, ‘partisan hysteria’ became an opportunity for psychiatric professionals to express their anxiety over, and even open disapproval of, increasing upward social mobility and socio-political transformation following the socialist revolution of 1945, and to criticise the effects of the creation of a new political and military elite from the ranks of workers and peasants. Given the greater visibility and social authority of the urban and rural poor from 1945 on, ‘partisan hysteria’ gave psychiatrists an opportunity to define this new source of social instability, and devise ways to solve it—through education, control, or limits on upward social mobility. In other words, witnessing a true social revolution outside the hospitals, Yugoslav psychiatrists found it very difficult to shed their long-time beliefs about the volatile nature of the ‘masses’ and pathologised the upward mobility and other revolutionary societal changes of the new Yugoslav socialist republic. At this early stage in the revolution, even progressive psychiatrists struggled to embrace the social (and medical) reform, and ‘forget’ the hierarchies of the old political system. Klajn, who was the most prolific in dealing with partisans’ war neurosis, concluded that the illness was a ‘sign of a certain slowdown in development, certain infantilism’, or an ‘underdevelopment of character.’17 But for him, the problem was not the incapacity itself. The original conflict was actually determined by the patients’ desire to fulfil their new tasks,

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and by their exceptional ambition for professional and political advancement and recognition in a revolutionary context. The unique nature of the partisan army organisation and postwar Yugoslav society was that it offered an unprecedented opportunity for people from the lowest sectors to achieve high-ranking, responsible, and socially prestigious positions. Their capacity to succeed in their new tasks was doubted by virtually everyone: the Party, psychiatrists, and, finally, themselves. For Klajn, this was one of the main sources of neurotic reactions: this ‘need to make independent decisions in a number of tasks, and thereby take personal responsibility for their solutions’ had a particularly strong ‘pathogenic effect’ on those soldiers with ‘immature characters’, who were ‘perhaps also intellectually and otherwise less than developed’.18 In addition, the very possibility of achieving professional and social success stimulated many partisan soldiers extraordinary ambition and a very powerful desire to be rewarded. When peacetime circumstances made the achievement of that recognition more difficult or even impossible, it was argued, soldiers resorted to hysterical seizures as (immature) forms of protest, or as a roundabout strategy for realising their goals. In fact, Klajn highlighted the ‘wish for being recognised’ as the single most important psychological factor in the development of partisan neurosis: this also explained why so many new cases were registered after 1944 and 1945. The distribution of officer ranks, distinctions, and status rewards within the victorious army in the spring of 1943 was held responsible for the seizure of many ‘incompetent’ and overly ambitious partisans, who found themselves in lowly positions within the hierarchy: these changes ‘incited envy and awoke ambition and desire for rewards among the partisans, especially in uneducated, young and psychologically immature soldiers’. When advancement was denied or jeopardised, ‘the wish emerged in immature and vain partisans to vent their anger and receive what they thought was a deserved award’.19 Therefore, in the final analysis, partisan neurosis was the typical mental condition of a highly socially mobile revolutionary community. This idea was perhaps expressed most clearly in Klajn’s description of the case of Misa M., a 20-year-old non-commissioned officer, who in 1945 started suffering seizures while attending a radio-telegraphic course in which his results were unsatisfactory, and also had one ‘at a political class when a comrade criticised his statements. He is very ambitious, and wants to remain a political official.’20 In that sense, Klajn’s work criticised the

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wartime radical politics and social mobility of the partisan units, which were being translated into a postwar social system. The expectation that this created in unstable and immature persons frequently drove them to aggression and indiscipline. This became particularly clear to Klajn and Betlheim while they were involved in a failed attempt to treat around 100 partisan war neurotics at the Military Psychohygienic Institute in Kovin in northern Serbia. In his descriptions of his experiences in Kovin, Klajn indicated the potential social danger of strong ambition being awoken in the lower classes. In Klajn’s account of some patients’ behaviour, the anticipation of an imminent eruption was clearly present: Niko N. ‘is permanently dissatisfied, walks around with a stick, threatens and stirs up others … he leaves the Institute on his own, does not recognise the commissar as his superior’21 ; Jovan O. is ‘undisciplined, leaves without permission and returns late … he broke a window. … Threatens the superintendent and the clerks.’22 Klajn also explained how the ‘fighting spirit’ that, according to his interpretation, characterised this particular neurosis, made the patients ‘very unpleasant’, inclined to act violently, attack the medical and administrative staff at the facility where they were placed for treatment, behave extremely disobediently, participate in beatings, and become destructive. Klajn reported that five particularly undisciplined soldiers even threatened to murder all members of the Institute’s management. He remained resolute in his claim that the issue of partisan neurosis was a social problem much larger than ‘neuropsychiatry itself, and which also falls within the scope of social psychology and politics, pedagogy, military discipline, military court system, and even criminology.’23 In other words, the source of the neurosis was to be found in some of the most widespread social circumstances. Klajn’s and Betlheim’s disconcerting experiences in the microcosm of the Military Psycho-hygienic Institute demonstrated partisan hysterics’ potential to permanently upset social order and to develop into uncontrollable factors in a larger social setting.This image of destruction and chaos that resulted from the fear of the lower classes taking over thus persisted after 1945: the social revolution had apocalyptic potential. Still, the psychiatric profession maintained that they were best placed to deal with its consequences. Yugoslav ‘Partisan hysteria’ turned out to be a major political issue, not least because its expression was so theatrical and because it affected the celebrated heroes of the resistance movement. As we saw above, Klajn and Betlheim diagnosed it as a sign of

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‘primitivism’, emotional immaturity, infantilism, and lack of education in very young peasant soldiers, and offered ‘pedagogical therapy’, ‘enlightenment’, and re-education as a solution. These were to be delivered by sympathetic but authoritative teacher-psychiatrists, whose attitude was to be that ‘of a mature educator towards an immature pupil’.24 They thus inserted themselves directly in broader political and social debates about the revolutionary changes and the population’s seeming unpreparedness to take part in them. In other words, the issue of the socialist revolution propelled the psychiatric profession to the centre of the political stage, and they used the crisis as an opportunity to reassert their significance beyond the asylum. Following the first few years of the war, a new generation of psychotherapists and psychoanalysts started thinking about the revolution (and their role in it) in more complex terms and worked on reconciling Yugoslavia’s unique form of Marxism with the ‘psy’ disciplines.

Building an Activist Psychoanalysis As the immediate postwar period was coming to a close, a new generation of socialist psychiatrists and psychotherapists emerged, which redefined their profession’s relationship with and role in political and social revolution. For these young and ideologically committed clinicians, the idea of revolution and reform was not automatically tied to disruption, aggressiveness, or harmful insubordination; on the contrary, the revolutionary ideals of Yugoslavia’s ‘humane socialism’ provided important new avenues for reforming and reinvigorating the psychiatric profession. The new generation of socialist ‘psy’ practitioners had genuine faith in the significance of constructing new democratic Marxist citizens in Yugoslavia, and their faith was closely linked with their vision of a radically transformed socialist psychiatry. This reformed profession was to play a pivotal role in the revolutionising of Yugoslav citizens’ minds, and in the collective effort to weed out traditional authoritarian mentalities and social structures. The ‘Westernisation’ of Yugoslav psychiatry and psychoanalysis was a complex and layered process, and mental health practitioners often reframed the concepts and techniques of British and French psychoanalysis to respond to the pressing social and cultural problems of building democratic socialism and revolutionising society. In this extraordinary case of transnational borrowing and adaptation, West European psychoanalytic experiences and insights were used to help raise Marxist children and construct proper Marxist families in Yugoslavia, and Yugoslav child

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psychoanalysts hoped to employ a psychoanalytic approach both inside and outside the clinic to revolutionise patriarchal, authoritarian and hierarchical social relations. This was to be a revolutionary and activist psychoanalysis, which was meant to contribute to broader discussions in Yugoslavia about constructing a society based on genuine Marxist collective and individual emancipation, an alternative to both Stalinist state socialism and western capitalism/liberal democracy. This was truly unique: in most East European countries psychoanalysis was confined to various degrees of underground existence, and informally integrated in a series of therapies and approaches labelled as ‘dynamic’ or ‘psychotherapeutic’.25 Moreover, as Christine Leuenberger pointed out with regard to the GDR, psychoanalysis was more likely to be perceived as ‘politically subversive’ and to ‘[offer] an alternative conception of human nature’ than the one promoted by orthodox Marxism-Leninism or Pavlovian approaches.26 It was arguably only in Yugoslavia that the clinical and theoretical aims of psychoanalysis aligned quite closely with the political revolutionary agenda of workers’ self-management, so that psychoanalysis became directly involved in the process of overhauling social and psychological conditions in order to build a democratic socialist person. Moreover, Yugoslav psychoanalysts styled themselves not only as perceptive social critics and subversive intellectuals but also as direct revolutionaries in their everyday clinical practice. Even though they participated in broader social and political discussions, their primary field of political action and involvement was the consulting room, where they proposed to directly transform archaic social relations and promote self-management by undoing traditional Yugoslav patriarchal and authoritarian families. In his commentary on Marxist psychoanalyst Igor Caruso’s work, one of socialist Yugoslavia’s leading psychiatrists Vladimir Jakovljevic put forward the concept of ‘engaged psychoanalysis’, and treated it as identical—or at least highly comparable—to revolutionary Marxism in its emancipatory potential: ‘just like revolutionary Marxist praxis, engaged psychoanalytic practice aims to help individuals become freer creators of their own and social history, shedding light on the conditions and forms of their alienation and on possibilities for overcoming it.’27 According to Jakovljevic, it was a natural mission of psychoanalysis—in its ‘anthropological’ and activist guise—to play a central role in developing authentic personalities and deepening consciousness. The discipline’s potentials for constructing authentic citizens and a free society were virtually unlimited, and this form of Marxist and anthropologically minded psychoanalysis

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was indispensable for achieving socialist revolution on both personal and societal levels. Other practitioners, too, tended to draw direct parallels between psychoanalysis and Marxist revolution (and radical reform), and even between Freud and Marx themselves as personalities who intervened in modern history in forceful ways.28 Both Marx and Freud, the ultimate believers in Reason as a substitute for God, drew attention to core conflicts and struggles: between the conscious and the unconscious in the case of Freud, and between different social structures in a historical process in the case of Marx. In this way, psychoanalysis yet again became a tool for revolutionary Marxist praxis in the sphere of individual consciousness, which Yugoslav mental health specialists seemed to embrace wholeheartedly as much for therapeutic as for political reasons. The Yugoslav path to socialism turned out to be significantly different from the Soviet model: very soon after the break, the Yugoslav political leadership began searching for an alternative ideological and political basis for legitimation, which would move away from Stalinist totalitarianism without endangering the socialist essence of the Yugoslav revolution. In 1949, the Communist Party’s leading ideologue, Edvard Kardelj, suggested that socialism meant ‘such an organisation of a people’s community which would represent a mutual cooperation of equal, free people’ and would eliminate ‘a uniformity imposed from above and hierarchical subordination to the centre.’29 The political image of an ideal citizen of this novel system, consequently, changed quite significantly. Yugoslav socialism now rested on a very complex set of ideas centred around workers’ self-management and ‘withering away of the state,’ and inspired by Marx’s early writings. The new Yugoslav self-managing worker needed to possess robust assertiveness, independence of mind, and a host of other critical psychological and intellectual qualities in order to sustain the political experiment. He or she would also need to leave behind dogmatic, authoritarian, or subservient frames of mind which characterised previous models of social relations.30 Central to this was forgetting one’s authoritarian upbringing in a traditional Yugoslav family. The increasingly dynamic psychiatric and psychotherapeutic profession offered to participate in the project of building this new type of democratic revolutionary person. A social institution which, according to psychiatrists, presented the most serious obstacle and required immediate restructuring was family: according to leading child psychoanalyst Vojin Matic, Yugoslav (traditional) family remained one of the last ‘niches of

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coercion’ in a rapidly revolutionising society, and it was within traditional families that deeply harmful violent and dictatorial structures needed to break first in order to allow for the development of truly liberated humanist Marxist individuals. Throughout psychiatric discussions, patriarchy and authoritarianism were marked as the authentic cultural traits of the Yugoslav family and social structure. One of the central characteristics of the Yugoslav family was that ‘expressions of disobedience and resistance to parents, teachers and other adults, especially if they were higher up on the hierarchical scale, were condemned and punished, while obedience and submissiveness were encouraged. Parents and adults were sacred beings who may not be called in question or disputed.’31 Patriarchal parents were guilty of producing automatons and weak personalities, who would only be capable of fulfilling other people’s orders. On the contrary, the fledgling Yugoslav society of self-managers needed independent young people, ‘who thought with their own heads’.32 From the 1960s, then, the Yugoslav psychiatric profession proposed to liberate and revolutionise society by revolutionising the traditional Yugoslav family. It was, in particular, psychoanalysis which was to become the intellectual tool for making families and parent–children relationships more socialist, egalitarian and self-managing. In 1950s and 60s Yugoslav child psychiatric circles, psychoanalysis was seen as ‘a democratic, liberating psychotherapy, which stands for independence and personal liberties of individuals’.33 As psychotherapist Vladeta Jerotic later confirmed, psychoanalysis coupled with self-analysis presented a unique way to achieving unsurpassed human autonomy, self-actualisation, and educational growth: unlike traditional psychiatry, it educated without relying on authoritarianism, and, by increasing patients’ self-knowledge, ‘created pre-conditions for the constitution of a mature and autonomous personality’ and for attaining the ‘freedom of self-development.’34 For Jerotic, the ethics of psychoanalysis required that practitioners shun any attempts at manipulation or indoctrination, and focus on advancing a democratic dialogue with the patient. For these reasons, a society of true socialist self-managing workers was impossible without psychoanalytic guidance. Many of the Yugoslav child psychotherapists proposed original ideas regarding an activist psychoanalysis, which might abandon its ‘aristocratic’ position in the cabinet and get involved in proper social change. They often criticised western psychoanalysis for its failure to focus more on collective than individual freedoms, and to take detailed theoretical

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account of the numerous economic, political, racial, or religious pressures in modern societies: ‘the psychoanalyst… most frequently closes his eyes before the social and political issues of his time.’35 What they had in mind for their profession was radically different, and it involved changing society by revolutionising family relationships and structures through clinical practice. Such an unusually activist stance might be one of the defining features of East European (socialist) psychoanalysis, and it was founded on the ideas of self-management and its continuous implementation in both families and society at large. In her book on psychopathology and youth, Nevenka Tadic drew a direct parallel between a ‘patriarchal family’ and ‘bureaucratised social’ relations, equating non-democratic familial arrangements with dictatorial political structures, and concluding that youth needed to liberate itself from both in order to realise its own authentic emotional, cognitive, and social capacities.36 Family became yet another experimental site in which hierarchical relations were to be gradually unravelled and patients were to be encouraged to replace them with more egalitarian and self-managing structures. Importantly, while in western Europe or the US such clinical experiences primarily aimed to advance the individual transformation and emancipation of child patients, Yugoslav therapists placed these personal psychological goals explicitly in a political context: human freedom and its relationship to authoritarianism came to the very centre of the psychiatric understanding of child and youth psychotherapy. Tadic used very peculiar terminology to describe the position of a child psychotherapist who was asked to treat a patient by parents or a state agency: ‘a psychotherapist must be aware of a trap, in which they often fall, to become a protector and advocate of the interests of the family and of the society, and to serve their interests uncritically.’ This was particularly important because it was most often the case that the decision regarding psychotherapy was not made by patients themselves, but by their parents, schools, or psychological centres, who ‘should take responsibility for their part in the development of mental disturbances in children and youth.’ Furthermore, sending a child to a therapist could be ‘the last and most decisive pressure and enslavement.’37 Clinical contexts thus became arenas for political experimentation and activism: ‘The therapist should not act like a person who offers freedom to the enslaved while smiling at and encouraging the enslaver,’ but should instead increase the political awareness and liberation potential of the enslaved.38 Speaking of relationships inside the consulting room, Vojin Matic stated that ‘a child, with his individuality,

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already attained the right of citizenship in medicine’, and this attainment, a new realisation of the psychological essence of children’s personalities, should now be the first step towards a transformed political subjectivity.39 Although she did not directly refer to them, Tadic’s critical proclamations about the role of psychiatry in perpetuating societal oppression echoed some of the most important principles of radical psychiatry, a contemporaneous and mainly western movement that emphasised alienation, hierarchy, inequality, and social coercion in modern societies as the core causes of mental suffering. As Claude Steiner, the movement’s founder and one of its most prominent theorists, wrote in an influential 1971 article, ‘[p]sychiatry has a great deal to do with the deception of human beings about their oppression,’ and it is precisely this collusion that Tadic’s vision of activist psychoanalysis attempted to unravel: by proclaiming their ‘neutrality’, psychiatrists in fact became ‘[enforcers] of the domination and [their] lack of activity becomes essentially political and oppressive.’40 On the other hand, radical psychiatrists (as well as Tadic and her colleagues) sought to counter the deception, make patients aware of their own oppression, and enact liberation through an explicitly politicised therapeutic process. Tadic and Matic appeared to closely follow Herbert Marcuse’s injunction—that psychiatry should be a ‘subversive undertaking’ which would ‘prepare the mental ground for [the struggle against society]’, that any action to tackle psychological illness would need to take place on a political level, and that psychiatrists should act as political saboteurs of any oppressive elements within the social order, preventing their patients from ‘[collaborating] in their own repression’.41 As per the advice of the Massachusetts-based Radical Psychiatry collective, Tadic invited her colleagues to see their (child) patients ‘as oppressed people who must be liberated’ rather than ‘“sick people who [needed] “treatment”’.42 In socialist Yugoslavia, therefore, psychiatry and psychotherapy became directly engaged in discussing crucial questions about shaping and reshaping political minds, and building, as the Communist Party called it, a genuine democracy.

‘Revolutionary Personality’: Psychiatry of Non-Alignment In Vladimir Jakovljevic’s Marxist interpretation, psychoanalysis was both non-conformist as a discipline and primarily focused on non-conformist,

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potentially revolutionary or disruptive, personalities: ‘from Freud to Fromm … psychoanalysis always viewed individuals as potential rebels of sorts, who strove to overcome dominant models of the society in which they had developed.’43 In this reading of psychoanalysis, therefore, the discipline becomes a handmaiden of revolutionary thinking: an intellectual framework which both explains and enables the development of rebellious personalities and sows the seed of social revolution. Jakovljevic’s research into revolutionary psychology and behaviour was greatly advanced through his involvement in global transcultural psychiatry networks and research in the 1960s. As a representative of a non-aligned country and as part of Yugoslavia’s technical assistance missions to a range of decolonising countries, Jakovljevic travelled to Guinea, a former French colony in western Africa, to help establish local psychiatric services and organise education for local mental health staff.44 He practised psychiatry in Guinea for over three years and also engaged in extensive anthropological research of local conceptualisations of mental illness and normality. As a result of his psychiatric-anthropological work in Guinea, Jakovljevic produced the only explicitly Marxist publications in transcultural psychiatry, which explored the complex relationships between socio-economic, cultural, and individual psychological factors in the onset of mental illness. Even more importantly, he drew direct comparisons between revolutionary experiences in Guinea and Yugoslavia, arguing that there existed significant parallels between Guinea’s anticolonial struggle and decolonisation, and Yugoslavia’s recent history of anti-fascist resistance and socialist revolution. In line with his interest in the notion of non-conformism in psychoanalysis, he developed a theory of revolutionary personalities, which was much more optimistic about the possibility—and psychological cost—of reform and transformation in underdeveloped societies. This was a new platform for Marxist psychiatry and psychoanalysis, and it radically redefined the role of social conflict in causing mental illness. Jakovljevic emphasised the revolutionary (rather than only pathological) potential of conflicts between individuals and their (‘backward’ or underdeveloped) social environment: ‘socially caused conflicts might constitute a progressive factor in the development of a society’ and lead to revolutionary resistance against the social organisation or structure.45 While a discord or conflict between an individual and their social environment (which traditional psychoanalysis tended to see as the core origins of neurotic disorders) might lead to mental pathology, pathogenic

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socio-cultural factors did not necessarily cause psychological disorders, if a robust individual in an ‘abnormal’ society found ways to overcome their circumstances. In fact, such intra-psychic conflicts need not lead to mental illness at all, and might even result in the ‘growth of personality and society, which happens precisely as a consequence of ever more complex internal conflicts and new solutions built into that society by the personality [in question]’. On the contrary, a ‘conformist adaptation of an individual to an abnormal social environment might lead to an even more fundamental form of [psychological] abnormality.’46 In that sense, what Jakovljevic defined as a ‘non-conformist’ personality was a phenomenon critically different from a mentally ill individual, although it emerged from a similar structural setting. In fact, the ‘non-conformist personality’ was the healthiest type of individual in any reactionary or ‘anachronistic’ society. Jakovljevic articulated his theory of revolutionary personality following his work in Guinea but based it on his research findings in both Africa and Yugoslavia. It was in this context of non-conformist and revolutionary personalities that Jakovljevic implicitly recognised one of the strongest connections between Eastern European and Guinean/African experiences of dramatic social change. While revolutionary activity in wartime and postwar Yugoslavia established the foundations of the new state, Guinea had undergone comparable political experiences, primarily in the course of its recent decolonisation struggle which produced different forms of anticolonial cultural and political expressions. The Guinean and Yugoslav experiences demonstrated that ‘pathogenic’ social and political situations were not necessarily destructive. On the contrary, certain personalities might be ‘stimulated [by such illness-inducing settings] to develop creatively new forms of reacting (such as the creation of novel political forms in the context of fighting colonialism instead of conformist subordination)’.47 This creative potential allowed both Yugoslavia and Guinea to turn possible psychological disorders into reformist and progressive political behaviour. It was in this theory of revolutionary personality and its complex relationship to mental illness that the original contribution of Yugoslavia’s postwar Marxist psychiatry lay. And since Jakovljevic’s ‘revolutionary personality’ was a universal concept drawn from his transnational research, it was as applicable to the Yugoslav revolutionary situation. In fact, Tadic’s and Matic’s visions of radical psychotherapy, discussed in the previous section, seemed in large part grounded in similar theoretical and clinical tenets. For Yugoslav

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psychotherapists—and for child psychoanalysts in particular—raising nonconformist, revolutionary individuals remained a key political preoccupation and a precondition for building a truly free society. For this reason, authoritarian and backward-looking social structures needed to be unravelled and ‘forgotten’ through psychotherapeutic work. In Jakovljevic’s research, the situation in Yugoslavia was linked to the revolutionary conditions in Guinea, where non-conformist individuals were needed to reform the old structures and establish a new post-colonial socialist society.

Conclusion The experience of socialist revolution affected Yugoslav psychiatric profession in a number of ways: it started influencing clinical practice immediately after the Second World War ended, while the concept of political and psychological revolution radically transformed the theoretical landscape of Yugoslav psychiatry and psychotherapy. The first meaningful change was to move away from the reductive organicism of traditional psychiatry, and to consider the role of sociological, cultural, and political factors in patients’ personal histories. For Marxist practitioners, this was of the utmost ideological and clinical importance: a psychiatric framework that reduced psychological conflicts to biological, chemical, or neurological explanations removed any potential for social critique or engagement, and undermined Marxist psychiatrists’ ability to relate their work to broader socio-political trends and objectives.48 As the case of ‘partisan hysteria’ demonstrated, mental health practitioners used crisis situations to engage in a broad political discussion about the state of Yugoslav society and emphasised their own role in addressing unprecedented social dislocation. Following this turbulent period in which revolutionary changes were often seen to lead to volatile and dangerous situations, a new generation of psychiatrists started conceptualising ‘revolution’ in more positive ways and even embraced it as one of their profession’s most important goals. By the 1960s, psychiatrists and psychotherapists actively sought a major role for themselves in the realisation of the revolution of individual psychological and family planes. This was a profession many of whose members were increasingly committed to a radical social/political agenda, and whose most prominent representatives aimed explicitly to reconcile revolutionary Marxist worldview with psychotherapeutic and psychiatric practices. They

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aimed to develop their own version of revolutionary and activist psychoanalysis and psychotherapy. Many used overtly political language to frame their professional aims and experiences and turned their consulting rooms into revolutionary sites. Historians have already showed that, in the Eastern bloc, a variety of psychodynamic approaches was allowed to develop, while the Cold War did not prevent socialist psychiatrists’ involvement in transnational collaboration with western colleagues. Such historical analyses argue that East European psychiatry was perhaps ‘socialist by default’—i.e. shaped by necessity by the socialist context—but not deeply grounded in socialist ideology and therefore not fundamentally different from its West European or North American counterparts.49 However, as the Yugoslav case demonstrates, East European ‘psy’ disciplines could become radically reformed as a result of their interpenetration with Marxist intellectual frameworks, and informed by broader socialist or revolutionary principles. This was by no means always a sign of political authoritarianism and professional subordination: Marxist psychiatry in its Yugoslav version developed original emancipatory approaches, even on the global level, and engaged in innovative and experimental projects. This was then a specifically socialist psychiatry, although it was not necessarily abused by the Communist Party: rather, it was meant to participate in the broader political project precisely by raising a new generation of non-conformist citizens. Moreover, it would be useful to reconsider the role of Eastern Europe in the history of ‘psy’ disciplines. If we look more closely at the Yugoslav case, it becomes clear that socialist psychiatry was neither a helpless political handmaiden nor a mere imitation of western psychiatric techniques. Instead, it was only in Eastern Europe that a truly radical and revolutionary psychiatry received full state support instead of existing on the social and political margins, and it was practised in a range of mainstream state-funded clinical establishments. The consulting room became a revolutionary field, in which broader social, cultural, and political changes played out. In that sense, this East European socialist experiment, in which a new activist psychotherapy became the norm, remains central to understanding the ‘psy’ disciplines as a tool for socio-political critique and activism in the second half of the twentieth century.

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Notes 1. Matthew Savelli, ‘The Peculiar Prosperity of Psychoanalysis in Socialist Yugoslavia’, Slavonic and East European Review, 91(2), 2013, 262–288. 2. Christine Leuenberger, ‘Socialist Psychotherapy and Its Dissidents’, Journal of the History of the Behavioural Sciences, 37(3), 2001, 261–273; B. Buda, ‘Psychotherapy in Hungary During the Socialist Era and the Socialist Dictatorship’, European Journal of Mental Health, 4(1), 2009, 67–99; Matthew Savelli, ‘“Peace and Happiness Await Us:” Psychotherapy in Yugoslavia, 1945–1985’, History of the Human Sciences, 31(4), 2018, 38–57. 3. See, for instance, Nikola Nikoli´c, ‘Vladimir Ilji´c Lenjin i Zaštita Narodnog Zdravlja’, Medicinski Glasnik, 1, 1947, 5; G. Nikoli´c, ‘Oktobarska Revolucija i Razvoj Sovjetske Medicine’, Vojno-Sanitetski Pregled, 4, 1947, 11–12; V. Stojanovi´c, ‘Velika Oktobarska Revolucija i Zaštita Narodnog Zdravlja u SSSR,’ Medicinski Glasnik, 2, 1947, 2, Nikola Nikoli´c, ‘Razvi´ce Sovjetske Medicine’, Medicinski Glasnik, 1, 1947, 9. 4. Savelli, ‘The Peculiar Prosperity of Psychoanalysis in Socialist Yugoslavia’, 262–288. 5. Ana Antic, ‘The Pedagogy of Workers’ Self-Management: Terror, Therapy, and Reform Communism in Yugoslavia After the Tito-Stalin Split’, Journal of Social History, 50(1), 2016, 179–203. 6. For an argument about the limited relevance of socialism for the development of Yugoslav (and East European) psychiatry, see Savelli, ‘Beyond Ideological Platitudes: Socialism and Psychiatry in Eastern Europe’, Palgrave Communications, 4(45), 2018, https://doi.org/10. 1057/s41599-018-0100-1; for in-depth studies of Yugoslav psychiatry, see also Savelli, ‘Diseased, Depraved or Just Drunk? The Psychiatric Panic Over Alcoholism in Communist Yugoslavia’, Social History of Medicine, 25(2), 2012, 462–480; Heike Karge, ‘Making Sense of War Neurosis in Yugoslavia’, Peter Leese, and Jason Crouthamel (eds.), Psychological Trauma and the Legacies of the Great War (Basingstoke: Palgrave Macmillan, 2016), 217–235; Ana Antic, Therapeutic Fascism: Experiencing the Violence of the Nazi New Order (Oxford: Oxford University Press, 2017). 7. Sarah Marks, and Matthew Savelli, ‘Communist Europe and Transnational Psychiatry’, Sarah Marks, and Matthew Savelli (eds.), Psychiatry in Communist Europe (London: Palgrave MacMillan, 2015), 1–27. 8. Marie-Janine Calic, Geschichte Jugoslawiens im 20. Jahrhunert (Munich, 2010), 240. 9. Greg Eghigian, ‘The Psychologization of the Socialist Self: East German Forensic Psychology and Its Deviants, 1945–1975’, German History, 22(2), 2004.

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10. Nikola Nikoli´c, “Drugovima neuropsihijatrima!, Narodno zdravlje: Organ Komiteta za zaštitu narodnog zdravlja F.N.R.J., 1946, 3, 1. 11. Boško Niketi´c, “Otvaranje konferencije,” Narodno zdravlje: Organ Komiteta za zaštitu narodnog zdravlja F.N.R.J., 1946, 3, 4. 12. Dezider Julius, ‘Pitanja socijalne psihopatologije’, 5. 13. Arhiv Sanitetske sluzbe Ministarstva odbrane, R-19, ‘Neuropatija (slicna histeriji)’, 1–2. 14. Ben Shephard, ‘Pitiless Psychology: The Role of Prevention in British Military Psychiatry in the Second World War’, History of Psychiatry, 10, 1999, 491–524; Edgar Jones and Stephen Ironside, ‘Battle Exhaustion: The Dilemma of Psychiatric Casualties in Normandy, June–August 1944’, Historical Journal, 53, 2010, 109–128. 15. Isak Alfandari, ‘Ratna neuroza’, Vojno-Sanitetski Pregled (VSP), 4(5), 1944, 119–122. 16. See, for instance, Josip Dojˇc, ‘Inozemstvo-Mania, nova zarazna bolest!’, Arhiv Sanitetske sluzbe Ministarstva odbrane, R-202; Dojc, ‘O biti zivcanih napadaja u ratu (ratna neuroza)’, Vojno-Sanitetski Pregled (VSP), 1946, 3, 118. 17. Hugo Klajn, Ratna neuroza Jugoslovena (Belgrade: Tersit, 1995—reprint, originally published in 1955), 84. 18. Ibid., 88–89. 19. Ibid., 17–18. 20. Ibid., 81–82. 21. Ibid., 78. 22. Ibid., 82. 23. Ibid., 149. 24. Klajn, Ratna neuroza Jugoslovena, 151. 25. See Greg Eghigian, ‘Was There a Communist Psychiatry? Politics and East German Psychiatric Care, 1945–1989’, Harvard Review of Psychiatry, 10(6), 2007, 364–368. 26. Christine Leuenberger, ‘Socialist Psychotherapy and Its Dissidents’, Journal of the History of the Behavioural Sciences, 37(3), 2001, 268. 27. Vladimir Jakovljevic, ‘Predgovor za knjigu I. Karuza: Drustveni aspekti psihoanalize’, Prilozi sa socijalnu patologiju (Belgrade: Sloboda, 1984), 257–259. 28. Muradif Kulenovic, ‘Izgnanstvo i smrt u tudjem gradu’, Psihoterapija, 6(2), 1976, 196. 29. Radovan Radonjic, Sukob KPJ s Kominternom I drustveni razvoj Jugoslavije, 1948–1950 (Zagreb, 1979), 281. 30. Kardelj, Borba, 14 January 1950. 31. Tadic, Psihijatrija detinjstva i mladosti (Belgrade: 1989, reprinted), 30. 32. Pesic, Vladimir Jakovljevic (1925–1968), 25. 33. Tadic, Psihijatrija detinjstva i mladosti, 20.

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34. Vladeta Jerotic, ‘Psihoanaliza, autoanaliza i autonomija licnosti,’ Psihoterapija, 2, 1975, 215–217. 35. Tadic, Psihijatrija detinjstva i mladosti, 19. 36. Ibid., 18–19. 37. Ibid., 19. 38. Ibid., 20–21. 39. Vojin Matic, ‘Dete u bolnici: Dusevno-higijenski osvrt’, Medicinski Glasnik, 7–8, 1954, 275–277. 40. Claude Steiner, ‘Radical Psychiatry: Principles’, The Radical Therapist (New York, 1971), 16–17. 41. Herbert Marcuse, Negations: Essays in Critical Theory (Boston, 1967). 42. Rough Times Collective, ‘Introduction’, The Radical Therapist (London, 1974), 8–9. 43. Vladimir Jakovljevic, ‘Da lie je psihoanaliza neuspela’, Harry Wells (ed.), Neuspeh psihoanalize (Belgrade: Kultura, 1967), 5–51. 44. Vladimir Jakovljevic, Kulturna sredina i psihiˇcki poreme´caji liˇcnosti: transkulturno-psihijatrijsko prouˇcavanje u Afriˇckoj Gvineji, unpublished doctoral dissertation, University of Zagreb, 1967, 4. 45. Vladimir Jakovljevic, ‘Transkulturno-psihijatrijska proucavanja u Gvineji’, Neuropsihijatrija, 11(1), 1963, 21–36; Vladimir Jakovljevic, ‘Prilog proucavanju sociopsihogeneze neurotickih poremecaja licnosti’, Sociologija, 2, 1959, 76. 46. Jakovljevic, ‘Prilog Proucavanju Neurotickih Poremecaja’, 76–77. 47. Jakovljevic, Prilozi za Socijalnu Patologiju, 163. 48. Stjepan Betlheim, ‘Kakav je stav lekara prema psihoanalizi’, Nas Vesnik, 204, 1956, 3. 49. Matthew Savelli, ‘Beyond Ideological Platitudes: Socialism and Psychiatry in Eastern Europe’, Palgrave Communications, 4(45), 2018, https://doi. org/10.1057/s41599-018-0100-1

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Open Access This chapter is licensed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/ by/4.0/), which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made. The images or other third party material in this chapter are included in the chapter’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the chapter’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

Practitioners

Appropriating Wilhelm Griesinger’s Asylum Reform Legacy (1868–2018): Some Reflections on Historiographic Narratives of Failure Eric J. Engstrom

Introduction: Griesinger’s Contested Legacies In accounts of the history of nineteenth-century psychiatry in Germany, Wilhelm Griesinger (1817–1868) is unique in the laudatory praise heaped upon his work. Numerous authors have scripted his legacy in transformative and paradigmatic terms. According to the German psychiatrist and historian Klaus Dörner, Griesinger all but single-handedly constituted the first ‘integral theoretical and practical paradigm of psychiatric science in Germany’ and became for Germany what William Battie had been for England and Philippe Pinel for France.1 For Griesinger’s biographer Alexander Mette, he was nothing less than the ‘founder of modern psychiatry in Germany’.2 According to the renowned neuropsychiatrist Karl Leonhard, he was a ‘psychiatric vanguard’ who had ‘paved the way

E. J. Engstrom (B) Department of History, Humboldt University, Berlin, Germany e-mail: [email protected]

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 R. Wynter et al. (eds.), Memory, Anniversaries and Mental Health in International Historical Perspective, Mental Health in Historical Perspective, https://doi.org/10.1007/978-3-031-22978-7_4

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out of speculative philosophy and into a natural science of medicine’.3 The Dutch philosopher Gerlof Verwey, by contrast, has extolled his work as a psychiatric humanist and lauded his profound synthesis of anatomic localism and biological functionalism.4 That work has also been interpreted as a precursor to psychodynamic psychiatry because of its attention to ego psychology and the subjective experience of patients.5 And more recently Griesinger has also been lauded for his multidimensional understanding of causality that accommodated biological, psychological, biographical, developmental and constitutional interpretations.6 Indeed, numerous scholars have come to view his legacy as a synthetic, integrating force within the history of psychiatry.7 The authors of one recent survey of psychiatric history have gone so far as to describe his work as the ‘Magna Charta of psychiatry’.8 And so, across a rather broad range of historical literature, there exists today—although for vastly different and often antithetical reasons—a generally favourable consensus about Griesinger’s seminal contribution to psychiatry. Most of the vast scholarly literature on Griesinger relies heavily on his textbook The Pathology and Therapy of Mental Illness, first published in 1845.9 Woven through the depictions of this work are several common strands, among them the maxim that ‘mental illness is brain disease’,10 the rejection of natural philosophical interpretations of insanity in favour of physiological ones grounded in neurocerebral reflex action, the unity of psychiatry and neurology, and the theory that all psychiatric symptoms are manifestations of but one underlying disease or ‘unitary psychosis’.11 But I intend to leave Griesinger’s textbook aside and focus instead on another strand of his legacy, one that can be traced back to an article he wrote in 1867 ‘On Mental Asylums and their Further Development in Germany’.12 The article was a programmatic statement designed to fundamentally reform and reorganise psychiatric care in Germany. Many histories of psychiatry have written off this reform programme as a failure; and as a result, it has rarely figured prominently in the historical literature.13 In English language textbooks, its elision has been especially profound, thanks mainly to a mix of language barriers and ignorance. Some histories, however, have been less dismissive of Griesinger’s asylum reform legacy and have even argued that its impact was transformative. This chapter examines these widely divergent historiographic interpretations of Griesinger’s asylum reform legacy. I ask whether, when and why historians have narrated that legacy and examine how they have sometimes elided, appropriated, or valorised it. Specifically, I illustrate how

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that legacy—if not ignored entirely—has most often been rendered in narratives of failure. To these ends, this chapter first briefly summarises Griesinger’s reform programme and reviews the obituaries published upon his death in 1868. It will then turn to several anniversaries and other pivotal junctures in order to reflect on how his reform legacy was appropriated (or not) over the course of the twentieth century. The conclusion will summarise some of the historiographic forces that have contributed to the elision and denigration of asylum reform narratives.

A Synopsis of Griesinger’s Reform Programme Wilhelm Griesinger understood his asylum reform agenda to be part of an evolutionary development proceeding from the earlier ‘great reforms’ of the 1820s. In a nutshell, he proposed creating two distinct kinds of psychiatric hospitals: one located in urban settings for short-term, acute cases; and another located in the countryside for long-term, robust, chronic patients that was designed to provide them with less restrictive forms of care. A Table can best summarise the differences between Griesinger’s urban and rural asylums (Table 1): For many of Griesinger’s alienist colleagues, his reform ideas were professional dynamite. Indeed, they threatened to obliterate numerous well-established alienist assumptions and practices.14 A few examples can help illustrate this point. (1) Alienists viewed separate asylums as a throwback to an earlier era when asylums had been built either for curable or incurable patients rather than modern asylums that were constructed for both. (2) Admissions criteria based on length of stay (acute vs chronic) threatened to completely upend the entire notion of curability, a cornerstone of nineteenth-century asylum planning that was embedded in countless institutional statutes and other legal frameworks. (3) Urban settings contradicted long-held assumptions that patients needed to be removed from the madding civic crowd, away from their familial relations in order to reconstitute their social relations within the asylum’s artificial, patriarchal family order—an order that required that the superintendent live and work on site. (4) Alienists believed that observation wards harkened back to a pre-asylum era when patients were thrown together in one bedlamic room rather than segregated into groups and distributed across the asylum’s architecture. (5) Psychiatric training, in the view of most alienists, needed to be undertaken in situ—in the asylums where patients lived—rather than in university lecture halls.

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Table 1

Griesinger’s reform agenda

Urban Asylum

Rural Asylum

Urban locale Short-term, acute, ‘fresh’ cases Easy admission No spatial segregation by class No surrounding grounds, fields, or gardens Director off site 80–150 beds 1–1½ year maximum stay High frequency of admission & discharge

Rural locale Long-term, chronic cases Restricted admission Class distinctions Large grounds Director on site 400–600 beds Unlimited maximum stay Low frequency of admission and discharge Repository for robust chronic cases Decentralised, ‘freer’ forms of care (Agricola colonies, family care) Lower and middle classes No lecture hall No clinical instruction

Easy discharge of chronic cases Admission/observation ward

Urban bourgeois patients Lecture hall Clinical instruction and demonstration

Griesinger was fully aware of how controversial his ideas were. Indeed, the reform agenda was a meticulously executed, full-frontal assault on existing alienist practice, designed to break open alienists’ ‘guild-like seclusion’.15 Griesinger was spoiling for a professional fight, and he got one: his agenda became the target of truly withering alienist criticism. Alienist efforts to professionally ostracise him and reinforce established asylum practices are reflected in the resolutions of the psychiatric section of Germany’s pre-eminent Society of German Naturalists and Physicians in 1868. The resolution stipulated that: (1) New asylums should provide for both acute and chronic forms of insanity and retain their character as so-called ‘mixed asylums’; (2) New asylums should be located outside of cities; (3) Asylum superintendents should live and work on site.16 It is this resolution that informs many historiographic claims that Griesinger’s reforms ‘failed’. And yet, what belies this claim of abrupt ‘failure’ is the rapid emergence of university psychiatric clinics and polyclinics throughout Imperial Germany in the late-nineteenth century.17 These institutions were modelled on Griesinger’s urban asylums and differed in fundamental ways from traditional asylums. Narratives of reform failure have often

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and confusingly subsumed university clinics under the rubric of custodial psychiatry (Verwahrpsychiatrie) and therefore obscured what came to be one of the defining characteristics of German institutional psychiatry post1870: the division between academic and alienist psychiatry.18 More than anyone else, it was Griesinger’s reform agenda that laid the foundation for this dynamic and often divisive relationship.

The Obituaries of 1868/69 Griesinger’s early death in 1868 robbed his proposals of their most able protagonist. Given the acrimonious and highly-polemical debate surrounding his reform programme, it is hardly surprising that Griesinger’s obituaries addressed it.19 His colleague and friend, Carl Wunderlich (1815–1877), described the reform agenda as ‘epochal’ and assured his readers that its ‘humanitarian’ impetus would eventually deliver ‘victory’ in a fundamental restructuring of the asylum system.20 Another friend, the philosopher and psychologist Moritz Lazarus (1824– 1903), pronounced that in spite of his death, Griesinger’s fight for reform would continue and his arguments would emerge victorious thanks to their deep philosophical and psychological underpinnings.21 Another obituary written by Carl Westphal (1833–1890) was far less invested in a narrative of progressive inevitability. Westphal had been passed over when Griesinger was hired in 1865 and would soon inherit his chair in psychiatry at the university in Berlin. Westphal merely cited Griesinger’s firsthand experience visiting asylums around Europe and corresponding with American doctors; these far-flung contacts had spurred on Griesinger’s enthusiasm for ‘freer forms of care’.22 By contrast, one of Griesinger’s most trenchant critics, Carl Friedrich Flemming (1799–1880), underscored that it was precisely his reform programme—and not his medical views or his calls for more humane treatment of patients—that had sparked the dispute with alienists and seen Griesinger abandon his otherwise ‘quiet and dispassionate demeanour’.23 For Flemming, there was no narrative of progress or inevitability associated with Griesinger’s vision of urban and rural asylums.

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The 25th Anniversary of Griesinger’s Death (1893) and the Early Twentieth Century By several accounts, Griesinger’s reform programme was ignored immediately after his death.24 And indeed, in the reform debates of the 1870s and 1880s it was often completely silenced. Most authors focused solely on his textbook, in part because a new revised edition had been published.25 The republication was savaged by Alfred E. Hoche (1865– 1943) as hopelessly outdated and essentially useless in contemporary practice.26 A prominent alienist, Carl Pelman (1838–1916), noted the textbook’s decades-long dominance, but judged it ‘unsatisfactory’ for its lack of clinical method and its merely ‘schematic’ nosology: since Griesinger’s death, psychiatry had moved on, thanks mainly to the study of ‘hereditary degeneration’.27 But if we turn our attention to Griesinger’s reform legacy, we find greater interest, especially in academia. In the early 1890s, in the face of a metastasising public relations scandal over patient abuse and illegal internment, his ideas were revisited upon the 25th anniversary of his death. In 1893, Robert Sommer (1864–1937) published an article on ‘the implementation of Griesinger’s programme’ in which he argued that no other contemporary writer could grasp the needs of psychiatry more profoundly than Griesinger had 25 years before.28 Sommer saw him as a ‘towering figure’ whose spirit needed to be sustained and cultivated. To this end, Sommer’s article contained extended excerpts from his writings on the relationship between university psychiatric hospitals and urban asylums. Sommer argued cryptically that Griesinger had set the standard by which to measure current reform efforts, but that his convictions needed to be ‘extracted in a specific way’ for them to comprise the ‘correct backdrop’ to contemporary questions.29 In response to the challenges raised by psychiatry’s critics, it was not his outdated ideas, but his model of the university psychiatric clinic that could still reap great rewards. No doubt Sommer’s invocation of Griesinger had something to do with the fact that in Würzburg, where Sommer worked, teaching and research were still being conducted on the wards of the local charity hospital, the Juliusspital. Sommer was appropriating Griesinger’s legacy to advocate for the construction of Würzburg’s own university psychiatric hospital. Efforts to rehabilitate Griesinger seem to have widened after the turn of the century. On the initiative of several neurologists (not alienists), a bust of Griesinger was erected at the Charité Hospital in Berlin,

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Germany’s pre-eminent university hospital.30 And in 1904, upon the inauguration of the Munich psychiatric clinic headed by Emil Kraepelin (1856–1926), an American observer hailed it as the culmination of Griesinger’s reforms.31 One study about urban asylums published in 1901 by Adolf Dannemann (1867–1932) provides another important window onto Griesinger’s legacy.32 In his introduction, Dannemann defended himself against critics who argued that Griesinger’s ideas had become anachronistic, out of date, and inapplicable to present-day needs. Dannemann disagreed. He found that many of the problems Griesinger faced (rapid, unbureaucratic hospitalisation; easier resocialisation; university training; better public relations) still confronted psychiatric practice. The motives behind Griesinger’s reform agenda were now just as important as they had been more than 30 years earlier. Above all, and in the face of rapid population growth, the need for urban asylums to address problems of nervousness, alcoholism and crime was greater than ever. Taking stock of the current state of psychiatric care in urban centres, Dannemann pointed out that numerous urban asylums had been built since the 1860s and that no one doubted their usefulness or believed that their urban location was harmful. Furthermore, Griesinger’s conviction that chronic patients in large rural asylums benefited from therapeutic work and ‘freer’ forms of care had become widely accepted. Dannemann’s assessment was repeated shortly after the First World War. An influential two volume collection of biographies of German psychiatrists published in 1921 argued that Griesinger’s dispute with the alienists had been overcome and was now of only ‘historical interest’: his views and aims had ‘essentially won the day’.33

The 60th Anniversary of the Berlin Society for Psychiatry and Nervous Diseases (1927) The next milestone of reflection about Griesinger’s reform legacy occurred at a meeting of the Berlin Society for Psychiatric and Nervous Diseases in 1927. The Society had been founded by Griesinger in 1867 and to commemorate its 60th anniversary organisers sponsored four lectures about him, one of which was delivered by the alienist Clemens Neisser (1861–1940). In a rhetorical jab at Griesinger’s opponents, Neisser argued that it was no exaggeration to claim that ‘all progress in the development psychiatric practice’ had been along the lines laid down

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by Griesinger.34 Neisser cited the creation of psychiatric and neurological wards in Berlin’s Charité (i.e. an urban asylum!) as evidence that his views had emerged ‘victorious’.35 Increasingly, few large cities could manage without urban asylums and non-restraint policies had been widely adopted shortly after his death. His work had ‘transformed the entire complexion of our discipline’, allowing psychiatry to achieve ‘a degree of legitimacy and influence in public life … practically unmatched by any other medical discipline’.36 Psychiatry had moved way beyond simply treating institutionalised populations and had become a pillar of all efforts to support and maintain public mental health. Strikingly, however, Neisser’s historical retrospective does not seem to have been echoed in the actual reform debates of the 1920s. Indeed, one symptom of Griesinger’s disappearance is reflected in the fact that even prominent advocates of more open forms of psychiatric care and ‘social psychiatry’ in the Weimar Republic ignored him and did not explicitly frame their reforms as part of his legacy. Some of this reticence had to do with the First World War and its aftermath: reformers in the postwar era were loath to associate their initiatives with the old Imperial monarchy. But that reticence was no less a reflection of how deeply Griesinger’s reforms had become the norm in German psychiatry. Far from failing, they had become so matter-of-fact that they barely warranted any discussion at all.

The Elision of Griesinger’s Reform Legacy in the Mid Twentieth Century It seems that psychiatrists working under the Nazi regime showed little interest in Griesinger’s reform agenda. Indeed, it was hardly compatible with the larger biopolitical aims of the regime. But two accounts help illustrate the transition away from a recognition of his deep and lasting impact. First, in 1940 Karl Bonhoeffer (1868–1948) penned a history of the psychiatric clinic at Berlin’s Charité Hospital—the clinic which Griesinger had founded more than 70 years earlier. The father of dissident Lutheran pastor Dietrich Bonhoeffer (1906–1945) who was later executed by the Nazi regime, Karl Bonhoeffer had served as director of the psychiatric clinic in Berlin since 1912. Nearing retirement, he recounted a history that seemed designed to preserve institutional traditions threatened by the Nazi regime’s racial hygiene policies. For Bonhoeffer, Griesinger had

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‘revolutionized the entire system of psychiatric care in Germany’ and in spite of early criticisms, subsequent developments had entirely vindicated him.37 His most important achievement had been to draw ‘psychiatry into clinical medicine and its empirical, natural scientific methods’ and take up the ‘struggle against the autarky and rural isolation of the asylums’.38 For Bonhoeffer, Griesinger’s lasting accomplishment had been the institutional differentiation of urban academic clinics and rural asylums in German psychiatry. A second, more illustrative example of mid twentieth-century assessments is that of Friedrich Panse (1899–1973). His massive study of psychiatric hospitals was not published until 1964,39 but Panse had been a member of the Nazi party and deeply implicated in the notorious T-4 programme that saw thousands of psychiatric patients murdered in the interests of racial cleansing. He had also been Bonhoeffer’s student in Berlin. Panse believed that German psychiatry had progressed further because Griesinger’s reforms had not succeeded. The concerns of Griesinger’s detractors had been wholly justified and they had successfully defended traditional alienist culture. Griesinger’s programme would have degraded that culture, transforming asylums into custodial institutions and thwarting a long tradition of asylum-based medical research. Had Griesinger succeeded, urban asylums would have lacked access to asylum patients and progress in psychiatry would have been stunted. Panse believed that Griesinger’s ideas had been too early for their time and efforts to implement them inevitably disruptive. In this vein, and strikingly, Panse never once mentioned Griesinger in his chapter on the development of nineteenth-century asylums.40 Following the Second World War, Griesinger’s wider legacy witnessed a significant bifurcation. In the 1950s, an effort to appropriate his work for the history of psychoanalysis emerged in Switzerland. Both Ludwig Binswanger (1881–1966) and Roland Kuhn (1912–2005) sought to place Griesinger in a Freudian lineage traced back to Johann Friedrich Herbart (1776–1841).41 A similar elision of that reform legacy can be found in postwar neuropsychiatric discourse, where recourse to Griesinger’s name focused exclusively on the evolving relationship between psychiatry and neurology.42 Neither of these psychoanalytic and neuropsychiatric renderings of Griesinger’s legacy paid serious attention to his asylum reform programme. And so it seems that this strand of his legacy mostly disappeared in the mid twentieth century. Not until the late 1960s and ’70s did it re-emerge.

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1967/68: The Triple Anniversaries and a Griesinger ‘Renaissance’ In 1967/68, psychiatrists in Germany commemorated Griesinger’s 150th birthday, the 100th anniversary of his death, and the 100th anniversary of the founding of the Berlin Society for Psychiatry and Neurology. These three anniversaries were commemorated in East Germany in several publications, but none of them addressed the legacy of Griesinger’s reform programme.43 Only a later biography published in 1976 by the prominent East German historian of medicine Alexander Mette cited his advocacy of non-restraint and freer forms of treatment, although Mette only briefly described the asylum reform programme and alienists’ resistance to it. Griesinger was portrayed as battling for the ‘progress of humanity’ and of science, but—like many others in the bourgeoisie—as someone who ultimately underestimated the ‘tenaciousness of the inhuman forces of reaction’.44 In West Germany, however, the anniversaries elicited renewed interest in Griesinger’s reform legacy. Especially noteworthy is a lecture given by the psychiatrist Gerhart Zeller on the occasion of the 100th anniversary of the Berlin Society for Psychiatry and Neurology. For Zeller, Griesinger’s vision of an urban asylum had been effectively and ‘tragically’ snuffed out by his detractors in 1868, but that vision remained the prototype of ‘community treatment centres’.45 Directly countering the interpretation of Panse, Zeller maintained—albeit decades later—that the failure to fully implement his programme had led to mass institutionalisation that in turn spawned widespread ‘therapeutic pessimism’ and calls for eugenic interventions (such as sterilisation and euthanasia).46 The most substantial reevaluation of Griesinger’s legacy in terms of psychiatry opening to society and overcoming the asylum’s geographic ‘isolation’ was undertaken in a series of articles in 1967/68 by the medical historian Martin Schrenk.47 Schrenk argued that Griesinger’s promotion of extramural forms of care (agricultural colonies, family care) was a consequence of his somatic conception of mental illness. However, a paradox lay at the heart of Griesinger’s work: the very success of the somatic paradigm had undercut his asylum reform programme. Only by evolving beyond a neuropsychiatric paradigm could a truly social psychiatry emerge.48 The case of Griesinger had demonstrated to Schrenk that mere institutional reform could not guarantee the evolution of social psychiatry.49 Griesinger’s coupling of the humanitarian impulses of early

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alienists with the ethos of medical science had failed to spark the development of a social psychiatry.50 Schrenk attributed this failure to the pervasively ‘authoritarian’ and patriarchal character of the doctor-patient relationship in the nineteenth century.51 Griesinger had taken ‘important steps’ towards reducing psychiatry’s isolation, but he never attempted to implement ‘radically’ open forms of care that deviated from traditional alienist practice. What is striking about Schrenk’s articles, however, is that he associated ‘rural seclusion’ of asylums with the ‘ivory tower’ seclusion of medical science. This allowed him to sustain the notion that psychiatry had remained isolated from society in spite of the construction of numerous urban hospitals and polyclinics from the 1870s onward. Schrenk’s account was symptomatic of how reform debates in West Germany in the 1960s revived interest in Griesinger and spawned a socalled ‘Griesinger Renaissance’. The most prominent representative of this renaissance was the psychiatrist Klaus Dörner. In his monograph Madmen and the Bourgeoisie (1969),52 Dörner portrayed Griesinger as the first fully paradigmatic figure in German psychiatric science (comparable to Battie and Pinel), in the sense that he represented a wholesale negation of the theoretical and practical assumptions of mid nineteenth-century psychiatry. He had provided essential components not just of subsequent institutional and therapeutic developments, but of ‘all subsequent theoretical trends’. Most importantly, Griesinger had made it possible to think about community-based psychiatric services, aftercare, halfway houses and day clinics (even if such facilities were not yet fully realised). Although marginalised during the National Socialist regime, since then his legacy had blossomed into a ‘Griesinger Renaissance’.53 Dörner’s reading of Griesinger as a progressive social psychiatrist was largely adopted by two historians of medicine, Hans-Georg Güse and Norbert Schmacke, albeit with more explicitly political aims in mind. Their book Psychiatry Between Bourgeois Revolution and Fascism (1976)54 interpreted Griesinger as the high watermark of progressive reform. In place of the exclusionary logic of alienism, Griesinger had tried to create a ‘special social space’ for people labelled insane and to build bridges for their resocialisation. Hitherto warehoused lunatics became incorporated into a differentiated therapeutic system. For Güse and Schmacke, Griesinger’s work was imbued with the optimism of progressive, bourgeois science. And yet, dating from Griesinger’s death in 1868, Güse and Schmacke then proceeded to recount a narrative of psychiatry’s inexorable

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decline into the catastrophe of National Socialism. This teleological narrative of decline set the stage for much historical research from the 1980s onward.55 Perhaps the pinnacle of Griesinger’s West German renaissance was reached in the mid 1970s with the so-called psychiatric EnquêteCommission. The Enquête-Commission was a sweeping initiative that inaugurated the reform of psychiatric facilities throughout West Germany. Its origins can be traced back to individual state initiatives in the mid 1960s, the dogged efforts of a conservative politician named Walter Picard (1923–2000), the new social-liberal federal government under Willy Brandt (1913–1992) in 1969, and the formation of numerous advocacy groups.56 The commission published a preliminary report in 1973 that found grievous abuses in psychiatric hospitals and, in its final report in 1975, called for major reforms.57 In effect, the reforms expanded the two existing pillars of psychiatric care (public hospitals and private practitioners) with a third pillar of complementary and rehabilitative facilities (halfway houses, before- and after-care units, communal living facilities). In Germany, there was no radical deinstitutionalisation like that undertaken in the US or in Italy. Numerous commentators have suggested that the EnquêteCommission was ‘inspired’ by Griesinger.58 But the role of his legacy in these psychiatric policy debates has yet to be systematically investigated.59 What is certain, however, is that the euphoric reform initiative of the early 1970s soon gave way to infighting between various stakeholders, including large state asylums, biological psychiatrists, social psychiatrists, neurologists in private practice, as well as public welfare and medical insurance agencies. It took years to implement watered-down measures. By the 1980s, many of the reformers had become deeply disillusioned and saw the ambitious reform initiatives of the 1970s ‘in ruins’.60

Evolving Narratives of Failure: Griesinger’s Reform Legacy After the Psychiatrie-Enquête While some viewed Griesinger as the historical poster child of reform in the 1970s, others took a less sanguine view of his legacy. One of the most striking accounts to appear in the midst of those debates was published in 1976 by the director of the university psychiatric clinic in Freiburg and member of the Enquête-Commission, Rudolf Degkwitz. Its title, ‘Progress? Retreat?’, harked back to Heinrich Laehr’s blistering riposte

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to Griesinger’s reform programme, which Laehr had published in 1868 under the title ‘Progress? Retreat!’61 In the article, Degkwitz outlined two visions of institutional care: the traditional alienist model of a single institution responsible for all types of mental illness (‘Einstufigkeit ’), and Griesinger’s model of multiple institutions responsible for specific forms of treatment and care. Degkwitz recognised the profound influence that Griesinger’s reform model had had on Germany psychiatry: far from withering in the 1860s, it had for decades provided a ‘relatively balanced system of care’ until the mid twentieth century when university clinics mostly abandoned their ‘therapeutic responsibilities’.62 Once the balance between academic and asylum psychiatry had been lost, admissions to large rural asylums had ballooned. In other words, for Degkwitz the ‘long night’ of custodial psychiatry had really only begun post-1945 and not with the ‘failure’ of Griesinger’s reforms in the nineteenth century.63 Nevertheless, Degkwitz criticised the EnquêteCommission for rehabilitating Griesinger’s model and the ‘technocratic solution’ it entailed, suggesting that the older alienist model of full-service psychiatric hospitals, envisioned by Griesinger’s opponents, also needed to be rehabilitated.64 Degkwitz’s critique paled in comparison to other more strident voices. The main spokesman of the Heidelberg Socialist Patient Collective (SPK), Wolfgang Huber, criticised the institutional divisions embodied in Griesinger’s reforms as a ‘two-class medical system’.65 Along similar lines, and no less heavily invested in anti-psychiatric discourse, another study vehemently disputed Griesinger’s paradigmatic status as proclaimed by Klaus Dörner. According to Gunter Herzog, Griesinger had failed to dislodge the ‘carceral regime of psychiatry’ and remained ‘trapped in the categories of the asylum tradition’.66 As such, Griesinger had been essentially no different than his detractors, belonging to a common alienist tradition guided not by natural science, but by ‘conventional notions of deviance’.67 The medical historian Heinz-Peter Schmiedebach was far less categorical. For him, Griesinger’s reforms had a ‘seemingly modern ‘socialpsychiatric’ hew’ and were based on ‘humanitarian principles’ rather than any social exclusion of the mad.68 However, it was not so much the therapeutic agenda per se that was new, but rather its infusion with bourgeois social and economic norms.69 It was these norms that governed Griesinger’s plans to reorganise the traditional asylum regime and undergirded any prospect of rehabilitating patients. Schmiedebach concluded

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that what distinguished Griesinger was not just his neuropsychiatric paradigm, nor simply his incorporation of psychological perspectives, but his political liberalism. However, by the end of the nineteenth century, the balance between the norms of economic and social liberalism had been lost: in psychiatry, as in society, economic liberalism eclipsed social liberalism and unleashed a ‘tendency to social delegitimation’.70 In other words, the failure of liberalism in Germany undid Griesinger’s reforms. Schmiedebach effectively framed Griesinger’s reform legacy within the classic historiographic trope of illiberalism and a German Sonderweg, i.e. within much broader and widely debated historical questions in the 1970s and ’80s about the strength and political viability of liberalism in pre-1914 German politics and society. One of the historiographic consequences of this rendering of reformist failure qua political failure, was that there could be no bridge for Griesinger’s reform agenda across the abyss of the Nazi era. Other studies, however, pushed back against these narratives of failure and decline, specifically for having over-relied on political explanations rather than narrower psychiatric ones. These narratives have allowed for greater nuance and ambiguity in the assessments of Griesinger’s reforms, conceding their success while also suggesting that their consequences were sometimes dire. The psychiatrist Ursula Gast described Griesinger as the ‘first sociopsychiatrist’ and rebutted the claims of Güse and Schmacke about a ‘continuity of failure’, arguing that they had dealt only with conceptual issues and ignored ‘psychiatric practice’.71 Gast sought a more comprehensive perspective that could also reveal ‘healthy aspects’ of psychiatry’s history.72 Likewise eschewing political explanations, Bernd Wengler maintained that Griesinger’s reform programme had certainly been characterised by ‘humanitarianism and care’, but at the same time had contributed to ‘a growing exclusion of chronic patients’ and thus become part of a ‘disastrous history of martyrdom’ during the Nazi regime.73 Wengler criticised Güse and Schmacke for trying to protect Griesinger’s legacy (i.e. for claiming that the divide between rural and urban asylums had arisen only after his death). Instead, the inherent logic of Griesinger’s reforms meant that ‘over time chronic patients necessarily had to be marginalised’.74 Taking this argument a step further, and agreeing that Griesinger’s reforms prefigured many elements of the late twentieth-century community-based models of psychiatric care, Wulf Rössler attributed the

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failure of Griesinger’s reforms in part to the very institutional dichotomy that he himself had actively promoted.75 By this interpretation, and in contrast to Schrenk, there was no need to appeal to patriarchal nineteenth-century doctor-patient relationships to explain the failure. Nor was there any need to invoke the rise of new anthropological and psychotherapeutic paradigms to explain a putative emergence of social psychiatry after the Second World War. Instead, by Rössler’s reading, psychiatry had been social ever since Griesinger and was merely thwarted by institutional arrangements and overcrowding. Some observers have remained still more willing to hail Griesinger’s legacy of community-based care and social reintegration. Gerald Detlefs has argued that Griesinger’s reforms were at least ‘partly implemented’ and that his urban asylum ‘corresponds’ to and was a model for the ‘community based facilities’ advocated by social psychiatrists in the 1960s and seventies.76 Detlefs takes issue with Herzog’s carceral argument, insisting that the urban asylum was ‘neither prison, nor correctional institute, but a civic facility with some characteristics of a hospital’.77 Similarly, Paul Hoff has lamented that the significance of Griesinger’s ‘social psychiatry’ has been ‘massively underestimated’; Griesinger’s reform programme was an ‘extraordinarily modern’ model of psychiatric care that anticipated ‘current decentralization efforts’, as well as today’s ‘complementary facilities’ and aftercare.78 In psychiatric historiography, however, such voices have been few and far between.

Conclusion: Moving Beyond Narratives of Failure Evidence that narratives of reform failure persist can be seen most recently in Cornelia Brink’s history of asylum psychiatry in Germany published in 2010.79 The book’s first chapter, ‘The Decision for the Carceral Asylum’, culminates in the claim that Griesinger’s reform programme of the late 1860s ‘floundered’ on the rocks of alienist resistance, which ‘laid the groundwork’ for ‘a purely custodial psychiatry (reine Verwahrpsychiatrie)’.80 In Brink’s telling, Griesinger’s 1868 vision of freer forms of care failed utterly and that failure inaugurated an era of institutional psychiatry so benighted that ‘in the ensuing 120 years’ nothing better than the mid nineteenth-century custodial asylum ever evolved.81 Brink’s findings echo much recent historiography on psychiatric asylums—historiography that is powerfully inflected by the pejorative image we have come to associate with psychiatric hospitals since the 1960s. By reducing the history

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of psychiatry’s raison d’être to mere criticism, such studies often read like one long finger-wagging at those who built, expanded, maintained, or failed to eliminate psychiatric asylums. Against this backdrop, histories of reform have not found much traction other than as histories of failure. In the case of Germany, a number of forces have been at work that have privileged the elision of asylum reform narratives, or indeed of any notion of asylum reformability. Consider the following trends and their implications: 1) Psychiatry’s critics in the 1960s were looking to close asylums and build community care networks, rather than reform them like Griesinger suggested. This contemporary psychiatric agenda, if it did not altogether foreclose dispassionate analysis of Griesinger’s reform vision and legacy, certainly made that legacy appear more ambiguous. Of course, it is anachronistic to judge Griesinger by the standards of the 1960s; he could not have envisioned twentieth-century deinstitutionalisation. But those standards were historiographically useful for narrating a story of social psychiatry emerging not post-1868, but post-1945 out of medical anthropology and psychotherapy. The standards of the 1960s certainly provide one, but not necessarily the best measure by which to judge Griesinger’s legacy. And indeed, Klaus Dörner explicitly rejected this rendering, citing Bonhoeffer as Griesinger’s legitimate heir and above all emphasising Griesinger’s natural scientific ethos which proved better able to resist National Socialism than psychiatrists with an ‘idealistic-anthropological view of human nature’.82 2) The rise of social historical perspectives within medical history interpreted Griesinger’s legacy in the context of (often pejoratively valenced) bourgeois norms and practices of social marginalisation and exclusion. These views were further influenced by the Sonderweg thesis—specifically its notion of dysfunctional reform (‘Reformstau’)—which could a priori truck no reformist narratives rooted in Imperial German society before the First World War. Eager not only to bolster historically the claims of psychiatry’s critics in the 1960s and seventies, but also to situate those critics as the fons et origio of meaningful asylum reform, they tended to fashion narratives that precluded any notion that Griesinger’s reforms could have succeeded. Earlier reforms evolving out of the pre-1914 Kaiserreich were incompatible with the Sonderweg thesis; at best, reforms

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needed to be interpreted as having originated from the short-lived and ill-fated Weimar Republic in the 1920s. 3) Since the 1970s, the rise of research on Nazi psychiatry and its sometimes categorical emphasis on historical discontinuities has tended to background or discount reformist legacies and to reinforce narratives of reform ‘failure’.83 4) A more general shift in the biographic research on Griesinger emphasised his philosophical, medical, and putative anthropological accomplishments as a mid nineteenth-century synthetic thinker, thus tending to background his institutional reform agenda. 5) Long-standing and ideologically freighted discourses pitting psychoanalysis against biological psychiatry have tended to obscure the internal professional politics of asylum care from historical narratives. Both biologically and psychodynamically invested narratives have lacked both the incentive and the means to examine asylum reforms. 6) More recently, the rise of biological psychiatry has privileged the notion that pharmaceutical innovations obviated much of the need for asylums. These accounts have appeared to make debates about asylum reform less pressing or, if not entirely moot, mere derivatives of Griesinger’s somatic legacy. Given all of these trends, one can well ponder the price paid (and purpose served) by reducing the history of reform to one of failure. Notwithstanding the very real merits of this historiography, one of the things it does rather poorly is to explain why, in the nineteenth century, asylums were viewed as viable solutions to pressing psychiatric needs, and why—if they were indeed as odious as many have suggested—families apparently rendered their relatives up to them in such numbers.84 Studying the history of faith in reform, its ebb and flow over time, can help us recover important aspects of asylum culture and overcome similarly important historiographic blind spots. As Oliver Sacks reminded us not long before his untimely death, there had once existed a ‘conceptualization of the asylum as a place of refuge and a sanatorium as a place of peaceful pursuits’ at a time when the paternalistic and ‘protective responsibility of the state’ drove asylum management and when ‘residents were occupied with interesting and meaningful activities’ as part of a ‘self-reliant, self-sustaining’ institution.85 Today it is easy to cynically pooh-pooh these notions as nothing

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but patriarchal alienist ideology. But historians cannot afford to recklessly discount the efforts of nineteenth-century reformers. For to do so is not only to concede that one is unable to explain why those efforts appeared so promising in the eyes of many contemporaries, but also to neglect the vital relevance of contingency for historical scholarship. Not that one must always be parroting the rhetoric of alienism’s ‘humanity’, but nor should one be doggedly narrating histories of failure and abuse around the scandals that subsequently engulfed the asylum. At the very least, historians should be more cognisant and forthcoming about what is liable to get lost in the telling of these histories of failure.

Notes 1. Klaus Dörner, Bürger und Irre: Zur Sozialgeschichte und Wissenschaftssoziologie der Psychiatrie, 2nd ed. (Frankfurt/M: EVA, 1984), 288 and 305. 2. Alexander Mette, Wilhelm Griesinger: Der Begründer der wissenschaftlichen Psychiatrie in Deutschland (Leipzig: BSB B.G.Teubner Verlagsanstalt, 1976), 5. 3. K[arl] Leonhard, ‘Vorwort’, Wissenschaftliche Zeitschrift der Humboldt Universität zu Berlin, Math.-Nat. Series 17 (1968): 1. 4. Gerlof Verwey, Wilhelm Griesinger: Psychiatrie als ärztlicher Humanismus (Nijmegen: Arts & Boeve, 2004); idem, Psychiatry in an Anthropological and Biomedical Context: Philosophical Presuppositions and Implications of German Psychiatry, 1820–1870 (Dordrecht: Reidel, 1985). 5. Henri F. Ellenberger, The Discovery of the Unconscious: The History and Evolution of Dynamic Psychiatry (New York: Basic Books, 1970), 241. 6. See Heinz Schott and Rainer Tölle, Geschichte der Psychiatrie: Krankheitslehren, Irrwege, Behandlungsformen (Munich: Beck, 2006), 72–74; Bernd Wengler, Das Menschenbild bei Alfred Adler, Wilhelm Griesinger und Rudolf Virchow: Ursprünge eines ganzheitlichen Paradigmas in der Medizin (Frankfurt/M: Campus, 1989), 64–70. 7. See most recently Luigi Grosso and Heinz-Peter Schmiedebach, ‘L’intégration des dimensions neuroscientifique, psychologique et institutionelle dans l’oevre psychiatrique de Wilhem Griesinger’, Psychiatrie—Sciences Humaines—Neurosciences 16, no. 4 (2018): 7–20. 8. R[ainer] Tölle, ‘Wilhelm Griesingers magna charta der Psychiatrie’, Fortschritte der Neurologie und Psychiatrie 40, no. 11 (2002): 613–619. The phrase ‘magna charta of psychiatry’ was originally coined by Ludwig Binswanger, ‘Freud und die Verfassung der klinischen Psychiatrie’, in Ausgewählte Vorträge und Aufsätze, vol. 2 (Bern: Francke, 1955 [1936]), 81–104, here 84–85.

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9. Wilhelm Griesinger, Die Pathologie und Therapie der psychischen Krankheiten, 2nd ed. (Stuttgart: Krabbe, 1861; Reprint edition, Amsterdam: Bonset, 1964). 10. This phrase was never used by Griesinger. Verwey rightly insists that it must be read as a ‘working hypothesis’ rather than any expression of materialist convictions. See Verwey, Psychiatry, 111. 11. Several studies have already addressed some of the different facets of Griesinger’s reception and legacy. See especially Ulf Jacobsen, ‘Wissenschaftsbegriff und Menschenbild bei Wilhelm Griesinger’ (Medical Dissertation, University of Heidelberg, 1986), 154–191; Hans-Georg Güse and Norbert Schmacke, Psychiatrie zwischen bürgerlicher Revolution und Faschismus, 2 vols. (Kronberg: Athenäum, 1976), Teil I, 81–100; Otto Marx, ‘Wilhelm Griesinger and the History of Psychiatry’, Bulletin of the History of Medicine 46 (1972): 519–544. 12. Wilhelm Griesinger, ‘Über Irrenanstalten und deren Weiter-Entwickelung in Deutschland’, Archiv für Psychiatrie und Nervenkrankheiten 1 (1868): 8–43. This narrow focus means that many important publications that rely mainly on Griesinger’s textbook will be backgrounded or ignored in this article. 13. See Kai Sammet, ‘Ueber Irrenanstalten und deren Weiterentwicklung in Deutschland’: Wilhelm Griesinger im Streit mit der konservativen Anstaltspsychiatrie 1865–1868 (Hamburg: Lit, 2000), 1; Paul Hoff and Hanns Hippius, ‘Wilhelm Griesinger (1817–1868)’, Der Nervenarzt 72 (2001): 885–892, here 889; and especially Rainer Tölle, ‘Suum cuique? Zur Griesinger-Rezeption’, Schriftenreihe der deutschen Gesellschaft für Geschichte der Nervenheilkunde 8 (2002): 323–331, here 326 and 328. 14. For a more extensive analysis of the reforms, including their institutional and political implications, see Eric J. Engstrom, Clinical Psychiatry in Imperial Germany: A History of Psychiatric Practice (Ithaca: Cornell University Press, 2003), 51–87; Sammet, ‘Über Irrenanstalten’; idem, ‘Akteure, Konflikte, Interessen’, Medizinhistorisches Journal 38, no. 3/4 (2003): 285–311. 15. Griesinger, ‘Über Irrenanstalten’, 23. 16. See Archiv für Psychiatrie und Nervenheilkunde 1 (1868): 742. 17. Historians have generally argued that Griesinger’s reforms were intended to facilitate the construction of university hospitals. See for example Ernst Köhler, Arme und Irre: Die liberale Fürsorgepolitik des Bürgertums (Berlin: Wagenbach, 1977), 173–174; Heinz-Peter Schmiedebach, ‘Mensch, Gehirn und wissenschaftliche Psychiatrie’, in Vom Umgang mit Irren: Beiträge zur Geschichte psychiatrischer Therapeutik, edited by Johann Glatzel, Steffan Haas, and Heinz Schott (Regensburg: S. Roderer, 1990), 83–105, here 93–94; Engstrom, 51–87. Griesinger devoted a large part (five pages) of his article to psychiatric instruction. Furthermore, the

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motives behind his departure from Tübingen in 1860 suggest that his aim was to create a university hospital. Indeed, as early as 1845 Griesinger had proposed creating a university clinic there. By 1900, most urban asylums in Germany were university clinics. For the most glaring example of this historiographic blunder, see Cornelia Brink, Grenzen der Anstalt: Psychiatrie und Gesellschaft in Deutschland 1860–1980 (Göttingen: Wallstein, 2010). Specifically on the obituaries, see Marx, 522–527 and Jacobsen, 161–164. Carl August Wunderlich, Wilhelm Griesinger: Biographische Skizze (Leipzig: Otto Wigand, 1869), 21. Moritz Lazarus, ‘Rede auf W. Griesinger’, Archiv für Psychiatrie und Nervenkrankheiten 1 (1868): 775–782, here 772. Carl Westphal, ‘Nekrolog’, Archiv für Psychiatrie und Nervenkrankheiten 1 (1868): 760–774. Carl Friedrich Flemming, ‘Drei Nekrologe und einige Anschuldigungen’, Allgemeine Zeitschrift für Psychiatrie und psychisch-gerichtliche Medizin 26 (1869): 265–270, here 267. Güse and Schmacke, Teil I, 83; Tölle, ‘Suum cuique?’, 324; Marx, 527. See Wilhelm Griesinger and Willibald Levinstein-Schlegel, Wilhelm Griesinger’s Pathologie und Therapie der psychischen Krankheiten für Ärzte und Studirende, 5th ed. (Berlin: Hirschwald, 1892). [Alfred Erich] Hoche, ‘Review of [W]. Griesinger’s Pathologie und Therapie’, Berliner Klinische Wochenschrift 29 (1892): 284–285. Carl Pelman, ‘Über die Entwicklung der Psychiatrie seit Griesinger’, Deutsche Medizinische Wochenschrift 19, no. 43 (1893): 1050–1051. Pelman’s review suggests that retrospective attempts to embed Griesinger in a larger tradition of degeneration theory do not reflect late-nineteenth century perceptions. For one such attempt, see Volker Roelcke, Krankheit und Kulturkritik: Psychiatrische Gesellschaftsdeutungen im bürgerlichen Zeitalter (1790–1914) (Frankfurt/M: Campus, 1999), 88–95. By contrast, Dörner rightly aligns Griesinger’s views with nineteenth century debates about child rearing and education rather than ‘hardened’ twentieth century racial tropes. Dörner, 300. Robert Sommer, ‘Die Ausführung des Griesinger’schen Programms’, Zentralblatt für Nervenheilkunde und Psychiatrie 16/17 (1893/94): 599–601, 105–112. Ibid., 599–601. See Psychiatrisch-Neurologische Wochenschrift 3 (1901/02): 290; Gerhart Zeller, ‘Hat das psychiatrische Reformprogramm Wilhelm Griesingers aus dem Jahr 1868 heute noch eine Bedeutung?’ in Jürgen-H[elmut] Mauthe (ed.), Rehabilitationspsychiatrie, (Stuttgart: Enke, 1998), 12–14. Stewart Paton, ‘The New Munich Clinic’, Science 22, no. 558 (1905): 313–315.

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32. Adolf Dannemann, Bau, Einrichtung und Organisation psychiatrischer Stadtasyle (Halle: Marhold, 1901). 33. Theodor Kirchhoff, ‘Wilhelm Griesinger’, in Deutsche Irrenärzte: Einzelbilder ihres Lebens und Wirkens, ed. Theodor Kirchhoff, vol. 1 (Berlin: J. Springer, 1921), 1–14. 34. Clemens Neisser, ‘Die Weiterentwicklung der praktischen Psychiatrie, insbesondere der Anstaltstherapie im Sinne Griesingers’, Monatsschrift für Psychiatrie und Neurologie 68, no. 6 (1927): 314–335, here 314. 35. Ibid., 317. 36. Ibid., 334 and 335. 37. Karl Bonhoeffer, Die Geschichte der Psychiatrie in der Charité im 19. Jahrhundert (Berlin: Springer, 1940), 12–22, here 18. 38. Ibid., 19. 39. Fr[iedrich] Panse et al., Das psychiatrische Krankenhauswesen: Entwicklung, Stand, Reichweite und Zukunft (Stuttgart: Thieme, 1964). 40. Ibid., 21–45. 41. Binswanger, 84–87; Roland Kuhn, ‘Griesingers Auffassung der psychischen Krankheiten und seine Bedeutung für die weitere Entwicklung der Psychiatrie’, Bibliotheca psychiatrica et neurologica 100 (1957): 41–67. Binswanger’s article was originally published in 1936, but its impact on debates in Germany was greatest after its republication in 1955. Jacobsen describes this article as a ‘precursor’ to the Griesinger ‘renaissance’ of the 1960s and ’70s and a bridge to psychoanalysis. See Jacobsen, 170. Dörner however rightly sees Binswanger positing Griesinger as the context from which both Kraepelin’s clinical psychiatry and Freud’s psychoanalysis emerged. See Dörner, 291. 42. Karl Leonhard, ‘Über die Geschichte der Nervenklinik der Charité’, Zeitschrift für ärztliche Fortbildung 54 (1960): 492–496; J[ürg] Zutt, ‘Psychiatrie und Neurologie’, Der Nervenarzt 33, no. 1 (1962): 1–6; R. Ch. Behrend et al., ‘Neurologie und Psychiatrie’, Der Nervenarzt 33, no. 1 (1962): 245–248; Fr[iedrich] Panse, ‘Psychiatrie, Neurologie und die Psychiatrischen Krankenhäuser’, Der Nervenarzt 33, no. 6 (1962): 242–245. 43. See Jacobsen, 183–184. In East Berlin, Griesinger’s legacy was also commemorated by renaming a local asylum after him. See D[ietfried] Müller-Hegemann et al., 75 Jahre Städtisches Krankenhaus WuhlgartenBerlin, 1893–1968 (Berlin: Direktion des Wilhelm-GriesingerKrankenhauses, n.d. [1968]). Although earlier East German reform initiatives (the so-called Rodewischer Theses of 1963) embodied the spirit of some of Griesinger’s reforms, they did not appeal to him by name. See ‘Rodewischer Thesen’, Zeitschrift für die gesamte Hygiene 11 (1965): 61–64. 44. Mette, 69–72, here 72.

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45. Gerhart Zeller, ‘Welcher psychiatrischen Schule hat Wilhelm Griesinger angehört?’ Deutsches Medizinisches Journal 19 (1968): 328–334, here 333 and 334. 46. Zeller, ‘Hat das psychiatrische Reformprogramm’, 11–13. 47. See Martin Schrenk, ‘Zur Geschichte der Sozialpsychiatrie’, Der Nervenarzt 38 (1967): 479–487; idem, ‘Sozialpsychiatrische Konsequenzen aus Griesingers Lehre von der Hirnkrankheiten’, Episteme 2 (1968): 147–155; idem, ‘Griesingers neuropsychiatrische Thesen und ihre sozialpsychiatrischen Konsequenzen’, Der Nervenarzt 39 (1968): 441–450. 48. See ibid. and cf. also Jacobsen, 181–183. 49. See Schrenk, ‘Griesingers neuropsychiatrische Thesen’, 448. 50. Unlike this negative view of the relationship between humanitarianism and medical science (i.e. that it blocked the development of social psychiatry), Schmiedebach saw it positively as a bulwark against both ‘social stigmatization and scientific objectification.’ Schmiedebach, ‘Mensch, Gehirn und wissenschaftliche Psychiatrie’, 95. This aligns with readings of Griesinger as a transitional figure mediating between romantic medicine and positivism. See Engstrom, 51; Marx, 542–543. 51. Schrenk, ‘Griesingers neuropsychiatrische Thesen’, 450. Cf. similarily H[elmut] Haselbeck, ‘Zur Sozialgeschichte der ‘Offenen Irren-Fürsorge’,’ Psychiatrische Praxis 12 (1985): 171–179, here 172. 52. Here, the only minimally revised 1984 German edition of Dörner, 279– 306, will be cited. 53. Ibid., 292. See also Jacobsen, 185–186. Dörner argues that the seeds of this renaissance could be traced back to Binswanger’s article. According to Asmus Finzen and Helmut Haselbeck, Griesinger’s reform legacy was appropriated as part of a ‘Renaissance of social psychiatry’ following the collapse of his nineteenth century ‘social-psychiatric paradigm’. See Ulrike Hoffmann-Richter, Helmut Haselbeck, and Renate Engfer, eds., Sozialpsychiatrie vor der Enquete (Bonn: Psychiatrie Verlag, 1997), 26 and 63–67. 54. Güse and Schmacke, Teil I, 45–100. 55. Cf. especially Brink, but also Zeller, ‘Hat das psychiatrische Reformprogramm’, 11–12. 56. See Brink, 461–468. 57. See Deutscher Bundestag, Enquête über die Lage der Psychiatrie in der Bundesrepublik Deutschland. Zwischenbericht der Sachverständigenkommission zur Erarbeitung der Enquête über die Lage der Psychiatrie in der Bundesrepublik Deutschland (1973), Drucksache 7/1124; idem, Enquête über die Lage der Psychiatrie in der Bundesrepublik Deutschland: Zur psychiatrischen und psychotherapeutischen / psychosomatischen Versorgung der Bevölkerung (1975), Drucksache 7/4200.

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58. Schott and Tölle, 78. The reform era overlaps broadly with what Jacobsen sees as an almost entirely favorable reception of Griesinger’s legacy between 1955 and 1985. See Jacobsen, 177. 59. On this question, see Marx, 543 and Gerald Detlefs, Wilhelm Griesingers Ansätze zur Psychiatriereform (Pfaffenweiler: Centaurus, 1993), 78–81. A superficial comparison with Griesinger’s reforms reveals some stark differences. For example, Griesinger was adamantly opposed to psychiatric wards in general hospitals, something envisioned by the Enquête’s concept of Einstufigkeit. 60. W[alter] Mende, ‘Entwicklungstendenzen in der forensischen Psychiatrie’, Münchner Medizinische Wochenschrift 123 (1981): 772–774, here 774. See also Asmus Finzen, ‘Von der Psychiatrie-Enquete zur postmodernen Psychiatrie’, Psychiatrische Praxis 14 (1987): 35–40. 61. Rudolf Degkwitz, ‘Fortschritt? Rückschritt?’ Spektrum der Psychiatrie und Nervenheilkunde 1 (1976): 40–43; Heinrich Laehr, Fortschritt?—Rückschritt! Reform-Ideen des herrn Geh. Rathes Prof. Dr. Griesinger in Berlin auf dem Gebiete der Irrenheilkunde, 2 vols. (Berlin: Oehmigke, 1868). 62. Degkwitz, 42. 63. See also Rechlin’s suggestion that the institutional crisis of psychiatry can be dated to the 1950s and 1960s. T. Rechlin and J. Vliegen, Die Psychiatrie in der Kritik: Die antipychiatrische Szene und ihre Bedeutung für die klinische Psychiatrie heute (Berlin: Springer, 1995), 7. In her account, Cornelia Brink badly misinterprets Degkwitz’s article. Because of her conviction that asylums were irretrievably carceral institutions and her failure to distinguish between asylums and university psychiatric clinics, she like Gunter Herzog can neither recognize nor explain the twentieth century influence of Griesinger’s reforms. This misinterpretation is all the more crippling because of Brink’s primary concern for long-term historical processes. 64. Degkwitz, 43. 65. See Christian Pross, Sonja Schweitzer, and Julia Wagner, ‘Wir wollten ins Verderben rennen’: Die Geschichte des Sozialistischen Patientenkollektivs Heidelberg, 1970–1971 (Cologne: Psychiatrie Verlag, 2016), 91. 66. Gunter Herzog, Krankheits-Urteile: Logik und Geschichte in der Psychiatrie (Rehburg-Loccum: Psychiatrie-Verlag, 1984), 149 and 161. 67. Ibid., 170. 68. Heinz-Peter Schmiedebach, ‘Wilhelm Griesinger’, in Berlinische Lebensbilder: Mediziner, edited by Wolfgang Treue and Rolf Winau (Berlin: Colloquium, 1987), 109–131, here 127 and 130. 69. Schmiedebach, ‘Mensch, Gehirn und wissenschaftliche Psychiatrie’, 95. This alignment of Griesinger with bourgeois liberal norms implicitly assumed that those norms were absent in alienism. Yet this contradicts

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81. 82. 83. 84.

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the results of Doris Kaufmann’s work which argues that early nineteenth century asylums were the very expressions of liberal bourgeois norms. As a result, Schmiedebach has difficulty explaining what was new about Griesinger’s reforms and what distinguished him from his alienist detractors. Ibid., 102. Ursula Gast, ‘Sozialpsychiatrische Traditionen zwischen Kaiserreich und Nationalsozialismus’, Psychiatrische Praxis 16 (1989): 78–85, here 79. Ibid. Wengler, 76–80. Ibid, 80. W. Rössler, ‘Wilhelm Griesinger und die gemeindenahe Versorgung’, Nervenarzt 63 (1992): 257–261. Along similar lines, see also Marx. Detlefs, 8 and 80. Ibid., 74. However Detlefs did see developments after Griesinger’s death ‘ultimately shifting toward large psychiatric institutions’. Ibid., 90. Hoff and Hippius, 889. More recently, Brink has again claimed that Griesinger’s reforms failed. http://hsozkult.geschichte.hu-berlin.de/tagungsberichte/id=5508 See (Accessed 9 August 2022). Brink, 82f. See also 103 and 478. To speak of the emergence of asylums in terms of a ‘decision’ being made belies not only the historical diversity of their arrangements and origins, but also Brink’s own insistence on analysing ‘long-term processes’ rather than ‘one-time snap shots’. Ibid., 18. Ibid., 478. Dörner, 292. See Roelcke, 68–79 and 88–95. For every depiction of asylums as ‘monstrous institutions’ (Brink, 120), there are numerous other (doubtless sometimes self-serving, but by no means only and always self-serving) accounts of their more salubrious effects. Beth R. Handler, ‘Review of Christopher Payne, Asylum: Inside the Closed World of State Mental Hospitals ’, H-Disability, H-Net Reviews. September, 2010. URL: http://www.h-net.org/reviews/showrev.php?id= 30037 (Accessed 9 August 2022).

Remodelling the Sigmund Freud Museum, Vienna: Memories, Museums, and Curatorial Considerations Daniela Finzi and Monika Pessler

We do not want to diminish our guilt: the fact that until today nothing more had been done for the memory of Sigmund Freud in Vienna and that not even this commemorative plaque was created on our initiative but had to be donated from abroad, is truly shameful for us. But the fact that psychoanalysis had such a hard time establishing itself in Vienna should be less surprising to us today; only now can we appreciate what a revolution it is for people’s mental and spiritual lives. Revolutionaries are unpopular at all times and in all places—but the laurels go to the victorious revolutionary.1

This quote, written by an anonymous author, is taken from an article that was published in the Austrian daily Arbeiter-Zeitung on 7 May 1954.

D. Finzi (B) · M. Pessler Vienna, Austria e-mail: [email protected] M. Pessler e-mail: [email protected]

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 R. Wynter et al. (eds.), Memory, Anniversaries and Mental Health in International Historical Perspective, Mental Health in Historical Perspective, https://doi.org/10.1007/978-3-031-22978-7_5

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Fig. 1 Plaque of the World Federation for Mental Health, (© Stephanie Letofsky, 2021)

The plaque, to which it refers as being an initiative from abroad, is nothing less than Sigmund Freud’s first official recognition in postwar Austria. The plaque was donated by the World Federation for Mental Health, stating in German (and omitting Freud’s persecution by the Nazi regime and his escape to London2 ): “In this house lived and worked/Professor Sigmund Freud/in the years 1891–1938/the creator and founder/of psychoanalysis/Donated by the 6th Annual/Assembly of the World/Federation for Mental Health” (Fig. 1). Sigmund Freud, the founder of psychoanalysis, who, like few others, with his ideas and insights, profoundly changed our understanding of human beings, spent 47 years in this building renting various apartments within it, and he would probably have spent the last days of his life at Berggasse 19, if it had not been the annexation of Austria to NaziGermany on 12 March 1938, the “Anschluss”: Freud, who was a Jew and whose books were burned in Berlin in 1933, was forced to flee his home country. With the assistance of influential foreign friends and colleagues, the Freuds’ emigration could be arranged, and already by the end of

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March 1938, Great Britain agreed to accept the family. Sigmund, his wife Martha, and daughter Anna left Vienna on the Orient Express on 4 June 1938. Following a stopover in Paris, they arrived in London on 6 June, living first on Elsworthy Road. In September 1938, after completing the purchase and renovation of the house (supervised by Freud’s son, Ernst), Sigmund, Martha, and Anna Freud moved into 20 Maresfield Gardens, which the family referred to as the “London Berggasse”. There, he passed away at the age of 83 on 23 September 1939. Back to the Vienna Berggasse, to Freud’s “everyday reality”—which of course finds its expression in his dreams and in his writings, especially in his most famous work and the founding document of psychoanalysis, The Interpretation of Dreams (1900),3 in which he elaborates the function of dreaming, that is to say the (disguised) fulfilment of a (repressed) wish. In one of his dream analyses, Freud interprets his jumping the staircase at Berggasse while being incompletely dressed, starting by explaining that “I occupy two flats in a house in a house in Vienna, which are connected only by the public staircase”.4 As a matter of fact, when the 35-yearold Freud moved in with his family at Berggasse 19 in 1891, he rented the left apartment, No. 5, on the mezzanine, which served as the family residence until 1938. During the years when he started to systematically note and interpret his dreams, Freud’s consultation rooms were located on the upper ground floor, below the family’s living quarters. As of 1908, the right mezzanine- apartment, No. 6, was the site of his practice, and as of 1923, of Anna Freud’s as well. At the time when the plaque as the first public trace of remembrance was unveiled, the house at Berggasse 19 served as nothing more than a modest apartment building. Until then, no hint of what has happened inside: It is at this address that Freud had his analytical practice and established a radical and innovative treatment, the “talking cure”, based on a wholly new form of “exchanging words”, whereby it is the patient who speaks, while the psychoanalyst listens. And it is here that he wrote nearly all his works and almost 20,000 letters, that he created with psychoanalysis a science of the unconscious that makes dreams, parapraxes, wishes, fantasies, and also memories the subject of investigation: “Memory traces”, “memory pictures”, falsification of memory”, “chains of memory”, “gaps in memory”, “sets of memories”, mnemic symbols”…—the high number alone of different terms used by Freud to consider memory phenomena gives an impression of the complexity of the

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subject. We will come back to Freud’s memory insights and their “transfer” into our curatorial work in detail later, but first we will continue to expound the history of the museum and its various phases. In 1968, moves began to honour in Austria the heritage of Sigmund Freud and create a memorial site in his former home, an external impulse once again became indispensable. The initiative of opening a museum at this address, the origin of psychoanalysis, was occasioned by a rather embarrassing question posed by the US-president Lyndon B. Johnson to the Austrian Federal Chancellor Josef Klaus during a visit to the White House: why was nothing being done for Freud in his former homeland?5 Klaus then commissioned the psychoanalyst and exiled Viennese Friedrich Hacker with founding the Sigmund Freud Gesellschaft: an association with the aim of making the life and work of Sigmund Freud, as well as research findings on the theory and application of psychoanalysis, accessible to a broad public. By doing so, “the myth of Vienna’s indifference and animosity should be refuted”,6 as can be read in the protocol of the constituent assembly in November 1968 under the chairmanship of the Chancellor himself. If every myth contains a grain of truth, this one contains the full bushel: in postwar Vienna, and in a country that still found itself in the comfortable self-deception of claiming to be Hitler’s first victim, psychoanalysis and Freud did not enjoy any scientific or broad interest.7 Once the Sigmund Freud Gesellschaft had been constituted, it did not take them long to found a museum: In 1971, after having exchanged many letters with Anna Freud, who had every reason to be sceptical, the association succeeded in opening a museum commemorating Freud at Berggasse 19, in the apartment of his former practice on the mezzanine level (No. 5). From the very beginning, absence was the central theme, which doomed conventional ideas of museums in writers’ homes based on the desire to create the illusion of an original ambiance to failure8 : Thanks to his international fame, Sigmund Freud was able to take his complete furnishings and personal items, packed into ten spacious cabin trunks, with him when he fled Austria in June 1938—a privilege not granted to other Jewish refugees. Be it books or pictures, his collection of antiquities, famous couch, desk, or the furniture from the family’s apartment—today all of these belongings are on display at the Freud Museum in London, the house where the family made their new home. As Marinelli and Traska observe, “[t]he expulsion of the Freud family left behind a site gutted

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of its material contents, whose emptiness formed a stark contrast to its symbolic charge.”9 When the rooms were opened to the public in 1971, the Sigmund Freud House, as it was then called, therefore only disposed of very few original items such as his mirror, his hat, and a walking stick, which were sent or brought to Vienna by Anna Freud or the former maid Paula Fichtl, who had emigrated to London with the Freud family. Totaling about 150 items, the remaining objects in this original permanent display by Harald Leupold-Löwenthal were photographs, some books by Freud, and documents from Austrian archives.10 Anna Freud had sent the furniture of the waiting room back to Vienna, so as to “restore at least one room to its old form”, as she wrote in a letter.11 As Fichtl and Anna Freud remembered a striped wallpaper in the waiting room, such a wall covering was hung there, forming, as it were, the scenery for the returned original furniture. Only when Edmund Engelman’s photograph of the waiting room appeared years later—more on this later—did it become apparent that this memory did not in fact correspond to the appearance of the room, which in 1938 had a floral wallpaper. This anecdote is revealing insofar as it directly refers to one of Freud’s important insights: Memories are not reproductions of past events, they are selective versions and constructions of the past that are bound to certain places; memory traces are permanent, but not unchangeable. In 1974, the museum’s inventory of memorabilia grew, mostly due to a successful visit to London by Lobner in 1974.12 Thanks to the support of the members of the Freud family, the itemised list of objects chosen for the Viennese museum included several dozen antiques, Freud’s cabin trunk, his reading glasses, the four copper engravings from the waiting room, and numerous smaller pieces of furniture and books from Freud’s estate. Fichtl was reported to have jokingly referred to this undertaking as a “foraging campaign”; or was it a raid?13 Loot, gifts, and relics—such objects, or rather concepts, that Krysztof Pomian proposes in his book Collectors and Curiosities: Origins of the Museum could easily apply to Vienna’s Sigmund Freud Museum and its collection.14 For Pomian, the real function of collections is the creation of relationships between the visible and the invisible—which was of course another major theme for those (including ourselves) who were tasked with remodelling the Museum 2019/2020: How could we stage or put on display Freud’s legacy, which consists of epistemological objects:

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concepts, insights, theory? How would we create links between the immaterial and the material? And which visions would be solicited by the way we were framing the objects?15 It was also in 1974 that a library first opened at Berggasse 19 in Anna Freud’s former consulting room and bedroom in apartment No. 5. It was her explicit wish to do so: creating a library, as she phrased it in an open letter to the members of the International Psychoanalytic Association asking them to donate copies or their own publications, ‘“would transform Berggasse 19, now a symbol of the past, into the representative of the living present of psychoanalysis and change it into a place to which followers and students of our discipline turn for reading, stimulation and enlightenment.’”16 The heart of this collection—which would go on to play an eminent role in creating the new permanent exhibition in 2020—resulted from gifts and generous donations by the psychanalysts Paul Federn and Gustav Bychowski, the botanist Arthur Tansley, and Anna Freud herself. Today, these copies no longer belong to the library, but are part of the archive’s book inventory. In 1985 the permanent exhibition in the rooms of Freud’s former practice was redesigned by Leupold-Löwenthal and Hans Lobner—and would go on to remain on display for more than three decades, until the closing of the exhibition rooms for the renovation project in 2019. The presentation consisted of panels and flat display cases on three levels along the walls of Freud’s former treatment room and study. On the upper level, there were facsimiled documents and photos depicting the course of Freud’s life and his intellectual biography; on the middle level some first editions and the few personal items such as his glasses or his pen, a napkin ring: knowing that these “items left behind” (‘Hinterlassenschaften’, Peter Geimer17 ) would have belonged to and been used by Freud, they easily become signifiers, trigger ideas, associations, and narratives, provoke desires and fantasies, whether in 1985 or in 2020. The lower level showed a sort of panorama of historical photos of the respective room: Taken in May 1938 by the young photographer Engelman, this unique documentation in black and white depicted the ambiance of Freud’s working and living environment before he had to leave Vienna for good, and at the same time created “a space of absence and exile”.18 “I wanted to see things the way Freud saw them, with his own eyes, during the long hours of his treatment sessions and as he sat writing”, Engelman wrote in his memoirs.19

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“Space may be the projection of the extension of the psychical apparatus”,20 Freud noted in a disconnected paragraph in August 1938, after his arrival in London. The space of Berggasse 19, isn’t it all at once an abstract, a symbolic, and a concrete space? Through all the years of the museum’s history, this questioning has been underlying the curational work, provoking new answers especially when additional exhibition space became available. Indeed, with the acquisition of Sigmund Freud’s family apartment (No. 6) in 1986, a new phase of the museum’s transformation under the secretary general and later director Inge Scholz-Strasser was launched. Between 1988 and 1997 and in close cooperation with the architect Wolfgang Tschapeller and the artists Werner Feiersinger and Peter Sandbichler, numerous modifications were made and—on the premises of the newly acquired apartment—a functional modern exhibition space was created. Whereas three major temporary exhibitions were curated by the former scientific director Lydia Marinelli, the permanent exhibition in Freud’s practice rooms remained untouched.21 Also, the continuing cooperation with American conceptual artist Joseph Kosuth started in 1989, when he created the Zero & Not installation on the walls of the family apartment to commemorate the fiftieth anniversary of Freud’s death.22 Other artists such as John Baldessari, Pier Paolo Calzolari, Georg Herold, Jenny Holzer, Ilya Kabakov, and Franz West each donated one work to the museum.23 Visitors who entered the Museum in search of material traces of the “Father of Psychoanalysis” were confronted with the artistic intervention in the former family apartment which played with the place’s constitutive absence in its own way: Kosuth used excerpts from the original German version of The Interpretation of Dreams, silkscreened the text on paper and applied it as wallpaper to the rooms of the family apartment. The text was struck through by black masking tape, but the words still remained legible, […] this alternation [of the text as figure and of ground], and the discursive implications of it bring to mind the terms of Jacques Derrida, wherein the Freud text is put under erasure; struck out, made seemingly absent, and yet is still present in its trace. Because the text is both legible and illegible, this artwork offers us an interpretation of how language and meaning are reliant on the on the flow of words and their relationship to one another.24

When the art historian and former director of the Frederick and Lillian Kiesler Private Foundation, Monika Pessler, became the museum’s new

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director in January 2014, her mission was evident. The Sigmund Freud Museum at Berggasse 19 was in need of extensive renovation: more than 100,000 annual visitors walking through the 280 m2 of Freud’s latenineteenth-century apartments had inevitably left their mark and damaged the historical structure of the building. Also, neither the museum nor the library was accessible, the service facilities were inadequate for the rising visitor numbers, and last but not least the exhibition areas including the permanent display from the mid 1980s no longer met current needs or modern-day elemental international museum standards. Furthermore, this somehow anachronistic display could not attract all our potential visitors with their different backgrounds and levels of knowledge. While the museum served in the first phase as a site consulted mostly by experts and Freud aficionados, from the mid 1980s onward, the audience became more diversified, which was partly a result of the hype around fin-de-siècle Vienna that began at that time (and continues to endure today). In the 2010s an increasingly-international public from more than 110 countries visited Berggasse 19; among these visitors, many had extensive expertise in psychoanalytic theory and/or practice, but we had to acknowledge that there were also many tourists who simply came on the recommendation of their travel guides or hosts, from countries where psychoanalysis has not historically played a major role in mental health discourse. It was thus obvious from the outset that the new museum and the new permanent exhibition must reach out to experts and amateurs alike by means of a multi-layered display. Also clear from the beginning was that the new design had to incorporate the museum’s genius loci, i.e. the specific atmospheric quality that lends this place its very unique character, the knowledge that here it happened: This is where psychoanalysis originated. It is precisely this circumstance that gives the Sigmund Freud Museum its justification, and also brings the question of authenticity into play. Given the fact that a museum as an institution is primarily defined as a place where, in order to enable encounters between yesterday and today, original things are exhibited, where the “real” is collected and preserved, the concept and topos of authenticity remain a primary value. In the case of Berggasse 19, all the commemorative site has to offer is, as already pointed out, the empty, authentic location.25 This authenticity of the place—these were our curatorial considerations—can be best experienced by walking the same paths as the Freud family and their guests once navigated. Thus, in a certain sense the historic staircase with etched windowpanes that leads

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up to Freud’s rooms on the mezzanine actually forms the first exhibition space. Many of our visitors, mostly those from abroad, may never enter an original apartment building dating from the high period of Vienna’s late-nineteenth-century Gründerzeit and discover its typical elements if not during their visit to our museum, including high ceilings, herringbone parquet, wooden box windows, and double doors. However, in its new incarnation Berggasse 19 was to be presented not only as the birthplace of psychoanalysis, but also as a memorial site that commemorates the atrocities that resulted from the National Socialist reign of terror. Even though Freud managed to flee to exile in London so as “to die in freedom”,26 his sisters Rosa, Marie, Pauline, and Adolfine stayed in Vienna where they were deported to the Nazi extermination camps of Theresienstadt and Treblinka. At Sigmund Freud’s former address, the Nazis installed six “Sammelwohnungen”—group apartments in which Jews were forced to live together in extremely cramped conditions. From the fall of 1939 to the spring of 1942, there is evidence of seventy-five Jewish men and women and one boy living at Berggasse 19 for several weeks or months. Most of them did not survive deportation and were murdered in Nazi concentration camps. Commemorating the occupants of Berggasse 19 and fostering an awareness of history, both for present-day Austria and for its future generations, was an imperative aim of the renovation from the very beginning. Consequently, by taking the new staircase, today’s visitors discover a fragmentary timeline on the walls: “Berggasse 19: History and Occupants 1880–2020”, mostly based on calendar entries and letters written by Freud. Whether walking up or down the stairs, it is impossible not to see the names of the seventy-six displaced Viennese Jews in relatively large adhesive letters, their respective dates of birth, deportation dates, and last known locations. A separate section in the gallery of the foyer is dedicated, not only to Freud’s successful flight into exile in London with his closest family, but also to his brother Alexander who, like Sigmund, was able to escape from Vienna, as well as to the tragic fate of their four sisters. In contrast to all previous adaption processes––most of which could only take place when an apartment in the house at Berggasse 19 became vacant and thus available to the museum—from the outset we had the benefit of being able to consider the renovation project and the approach to the emptiness on a large and comprehensive scale: in charge of the museum since 2006, the Sigmund Freud Foundation now owns the entire building. Therefore, we have at our disposal all three of Freud’s former

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apartments, as well as further—vacant—ones in the building. Not only would it now be possible to open to the public the apartment on the upper ground floor, where Freud had his office from 1896 to 1908, and present selected works from the museum’s aforementioned collection of conceptual art, but the exhibition space on the mezzanine level could be extended from 280 m2 to approximately 400 m2 (the entire floor). This meant that for the first time all private rooms once occupied by the Freud family could now be opened to the public. In the years before, parts of our library had been installed in the rooms of apartment No. 5, such as Freud’s bedroom, the bathroom and wardrobe, and the Herrenzimmer (gentlemen’s salon), and was thus not open to regular museum visitors. Within the renovation project “Sigmund Freud Museum 2020”, a whole floor, the bel étage, was available for the museum’s Library of Psychoanalysis, with all of its books open access for the first time. To gain publicity and raise funds, the commitment of international personalities like Judith Butler and Siri Hustvedt or the International Psychoanalytic Association was certainly helpful. But this time, after long years of negotiation, on this occasion the representatives of Austrian and Viennese politics did not need a push from outside to recognise the importance and global significance of Sigmund Freud as “one of Vienna’s most important figures”27 thus to support the renovation project. Finally, after having succeeded in securing indispensable initial funds from the City of Vienna and the Republic of Austria, with the remaining funds coming from the museum’s reserves and private sponsors, a competition for the redesign and revitalization of the Sigmund Freud Museum, and for the renovation of the building at Berggasse 19, was launched in 2017. The challenge for the invited participants was to develop a comprehensive concept that would reactivate the specific atmosphere of the late-nineteenth-century house without resorting to reconstruction or re-enactment while at the same time implementing contemporary infrastructure by means of focused building measures and designs that would meet current and future demands. The winning project was submitted by a working group formed of two Viennese and one Italian architectural studios: Czech/Angonese/ARTEC. On the one hand, their prudent and careful approach to modernising the building in order to retain the original character of Freud’s living and working space was convincing. All interventions necessary to operate a museum for so many visitors, such as the ticket counter, shop, lockers, café, etc., would occur outside of the

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authentic rooms, on the ground floor. Only the new vertical circulations—consisting of an escape stair and an elevator—would occupy floor areas that had been part of the historic uses, namely the Freuds’ former kitchen. In the words of the leading architect of the renovation project, Hermann Czech, the new conception for the Sigmund Freud Museum is not a matter of the preservation, restoration, reconstruction, or transformation of an architectural object. It does raise questions of whether and how architectural and spatial qualities should be retained, damages repaired and defects corrected (but not disavowed), and how on the basis of the existing fabric and the required new interventions a new unified whole can be created […].28

On the other hand, the project impressed with its conception of the rooms as a museum in their own right: even though the Freud family had left them empty, architectural remnants have survived, constructional “memory traces”29 that offer glimpses of insight into the everyday life of Freud the psychoanalyst, and also of Freud the tenant of an apartment building dating from the high period of Vienna’s Gründerzeit. Thus, visitors today can, for example, learn that when Freud had a built-in wall closet with an ornamental swinging door installed in the entrance hall of the apartment in 1910, a false wall was also built on both sides of the closet in order to conceal its depth. Also, the wardrobe of his practice—which with its wood panelling and hooks for the patients’ coats contains the only surviving original furnishings—offers a touching detail that may make Freud the man in his everyday life and time more tangible. In fact, the last hook by the window might have been removed during his time here; it was in the way of opening the window, as evidenced by the location where the glass pane broke. It is the small things that we are looking at here, the “subsidiary and unnoticed”,30 in which psychoanalysis is also interested. Some of the traces of former appearance and usage only became visible by uncovering them: original wallpaper, traces of fabrics that were attached to the walls, or even a telephone line in daughter Anna Freud’s bedroom. The partially exposed walls that reveal the layers underneath may leave viewers with an uncanny impression. As Freud determined with regard to other things, however, “that class of the frightening which leads back to what is known of old and long familiar” is also present in the

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uncanny, and may refer to “something which is secretly familiar [heimlichheimisch], which has undergone repression and returned from it […]”.31 However, the feeling of the uncanny can also stem from the transgression of boundaries that every visitor makes when entering the once private spaces. Or consider the intimacy that must have reigned in the former treatment room! “The visitor might be the child prying into the aftermath of some primal scene—or at least like the heroine of a gothic novel probing a cabinet or secret room”.32 The various significant changes and interventions that occurred in his apartments and the building before Freud moved in and after the caesura of 1938 were also uncovered and/or exposed to view. For instance, ceiling paintings dating from the time of the building’s construction (1889) are now visible again, and traces on the original, partially repaired star-patterned parquet tell the history of the walls that were removed in the mid 1990s to make room for special exhibitions, which can also be considered as part of (displaying) the process of de-authentification which characterises the location too. Also, vestiges of inset longitudinal rails for a repositionable exhibition wall remain discernible on the floor of Minna’s salon, the family’s living room, and the dining room. For the connoisseur of Freud’s work and the follower of analogical thinking, several metaphors of his work are offered here. First of all, the act of uncovering what is buried is the primary aim of psychoanalysis. From the outset, Freud liked to refer to archaeology when explaining the procedure of psychoanalysis. Both archaeology and psychoanalysis are concerned with uncovering what lies behind, piecing together and reconstructing, and, in the end, deciphering and translating, tapping into the events of the “remote past”.33 Furthermore, the “talking cure” is a method of remembering: what effect does the past have on the present, how can patterns and models handed down from the past be overcome so as to enable new experience? By suggesting that what has happened before in the history of a house “may be preserved and is not necessarily destroyed”,34 one may think of Freud and his assertion “that it is rather the rule than the exception for the past to be preserved in mental life”.35 As a matter of fact, Freud’s writings are replete with insights and observations about the phenomenon of remembering, based on the insight that an “objective” knowledge of everything that took place in the past is neither possible nor necessary for understanding the subject’s history. However, he did not elaborate a systematic psychoanalytic theory of memory; his allusions refer instead to different models, also to storage

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models of memory. When conceiving our new exhibition, we were certainly especially attracted to those writings that include “constructivist” approaches and emphasise the active and dynamic component of remembering as this is also how we see our task and responsibility as museum makers and curators. Also, it was our aim to reconcile the psychoanalytical insight of the crossing of time levels— the past is formed out of the attempt to first understand the present—with the expectation of a museum as an instance and institution that provides authorised materialised versions of the past.36 The act of opening up walls and scraping at them not only gives shape to the confirmation that yes, it happened like that! In addition, in their quality as fragments, these findings on the walls and the ceilings––these “windows” to the past—operate as reminders and confront the audience with the ineluctable fact that there is no longer totality: absence and emptiness reign in this building. To sense the birthplace of psychoanalysis, to see it, to paint a complete picture from the layers and the void—this is left to the “imagination and interpretation”37 of the viewers, to their desires and fantasies. This is particularly the case with Freud’s analytical divan, which as the “couch” became the symbol of psychoanalysis. While today’s museum visitors are confronted with its absence, at the same time the new presentation enables them to compensate for this lack by means of their own images and imaginations: a large expanse of exposed wall in the place where the rug once hung behind the couch—a kind of screen— invites visitors to project the image of the couch (of which they become aware when they enter the room thanks to a photograph by Engelman) onto its original place. The traces of the rug that have now been made visible are the holes from the nails that once attached it to the wall. The couch is “fort” (gone), and then it is “da” (there)38 (Fig. 2). Whereas the only information now left on the walls are facts concerning the rooms themselves, their former use and furniture, and the findings, the information on Freud and his oeuvre, his life, and his family is arranged in display cases. Each of these display cases comprises numerous exhibits to which its sequence and form are adapted. Made of glass, steel, maple, and linen, these display cases are both spacious and airy. Mostly located in the centre of a room, they invite visitors to pause, lean on the wooden handrail, contemplate or immerse themselves in the objects, and start to read the open books of the lower display case level. They address the visitors both sensually and cognitively.

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Fig. 2 Treatment Room, (© Hertha Hurnaus/Sigmund Freud Privatstiftung, 2020)

Nineteen display cases house almost 200 items; another display case contains nearly forty of Freud’s “old and grubby gods”,39 as he once described his archeological figures. This high number of exhibits—in addition to the furnishings of the waiting room—may seem surprising given the scarcity of original objects from Freud’s household in the museum’s possession. In fact, the vast majority of the exhibits consist of “epistemic things”,40 of books from the holdings of our archive— though they are beautiful books in exceedingly good condition: special printings, rare first editions, offprints, as well as foreign-language (first) editions in Dutch, English, French, Hebrew, Italian, Japanese, Polish, Russian, Spanish, Swedish. For psychoanalysis, language and speech—the use of text—are the central components of the symbolic order, which at the same time constitute the complex and dynamic cultural framework of the human being. How else but with books could Freud’s work and theory be materialised? So, these books—for the knowledge they contain, but also for their quality as three-dimensional objects—have a prominent part to play in the new permanent exhibition (Fig. 3).

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Fig. 3 Gentlemen’s Salon (© Hertha Hurnaus/Sigmund Freud Privatstiftung, 2020)

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Some pieces bear the marks of use by their previous owners; many other books contain personal dedications, from Sigmund and Anna Freud, as well as from people like the Austrian writers Arthur Schnitzler and Stefan Zweig, the French poet René Char, and Ernst H. Gombrich, the Vienna-born art historian who fled to Britan already in 1936. Handwritten dedications in books not only constitute highly personal acts and messages, but are also important sources for research, as they reflect wide networks of academic and artistic friendships and collaborations. The dedications and notes of ownership in the exhibited books and reprints, these traces of appreciation between colleagues and of active academic exchange, also allow us to shed light on all those who developed the new science of the unconscious with and beside Freud—which leads us to another curatorial desideratum: to show Freud in the context of the academic and sociopolitical discourses of his time, to avoid— in spite of indisputable periods of “theoretical solitude”41 —presenting him as a lone fighter in “splendid isolation”,42 and rather to show the historical conditions and the institutional framework of his oeuvre and his (by no means conflict-free) exchange with others working in Vienna and around the globe. Each piece demonstrates the extent to which the printed work reflects its historical era and its enduring presence. Moreover, the many books in other languages in the new permanent exhibition that accompany some of the German-language first editions serve as eloquent testimony to the international dimension of the psychoanalytical movement, and in passing also allow visitors to draw some conclusions regarding cultural specificities.43 A manuscript goes through many stages before it can be presented between the covers of a book; a printed work that is to be made available in translation requires countless additional steps with regard to content, design, organisation, and funding. “Paratextual” elements, such as blurbs, additional information on the cover, forewords, and postscripts, all of which influence the book’s reception, thus provide insight into the culture of the respective countries of publication.44 Sometimes, these can be attributed to decisions made by individual stakeholders. The title of Marie Bonaparte’s French translation of Freud’s Selbstdarstellung: An Autobiographical Study, for instance, Ma vie et la psychanalyse (’My Life and Psychoanalysis’), carries a great deal more meaning than the German original (‘Self-Representation’). Many of the books we present in the exhibition are nearly or over a century old. Once everyday objects, they are now treated as museum

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pieces nearly exempt from economic activity. Still, this does not make them silent messengers from the past: because of the intense colouring and expressive modern layout of their covers, we might compare these objects to small-format posters or prints. Also, through the distinctive titles of Freud’s texts, which will be recognised by many visitors, the invisible “interchange of words” finds a visual counterpart,45 its manifestation as a book-object, and yet leaves room for the fantasies of the viewers, the readers. One need not have any previous knowledge to be inspired by blue letters on yellow linen and to begin to muse about what the Future of an Illusion, as Freud titled his 1927 text critical on religion, religion, might be. As for the author, religious ideas are nothing but an illusion and are derived from human wishes. Since the term future has been mentioned: by remembering and commemorating the biographical and historical past as present-day forces, our new museum, our new permanent exhibition—which does without the once futuristic technologies of virtual reality or immersive media— employs the concept of the future in the Nietzschean sense of “untimeliness”: “contrary to our time, and yet with an influence on it for the benefit, it may be hoped, of a future time”.46 What is more, the new exhibition enables them to experience the complex interweaving of bot reality and phantasy in the process of memory, to develop both historical awareness and to appeal to their imagination—in sum to deal with such stuff as psychoanalysis is made on.

Notes 1. Arbeiter-Zeitung , ‘Berggasse 19’, May 7, 1954. 2. This information was presumably excluded to ensure that the plaque would not face any objections. 3. First published in 1900, this groundbreaking text not only points out the function of the dream, but also the significance of its interpretation to psychoanalytical therapy and a knowledge of the unconscious. 4. Sigmund Freud, ‘The Interpretation of Dreams (1900)’, James Strachey (ed.), Standard Edition, vols. 4–5, (London: The Hogarth Press, 1953), 238. 5. Wolfgang Huber also mentions the role of the Jewish World Congress and its demand for the construction of a representative Freud memorial, see Wolfgang Huber, Psychoanalyse in Österreich seit 1933 (Salzburg: Geyer, 1977), 145.

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6. See the minutes of the meeting of the Sigmund Freud Gesellschaft, November 28, 1968, in the archive of the Sigmund Freud Museum. 7. Uhl, Heidemarie, “Austria’s Perception of the Second World War and the National Socialist Period,” Günter Bischof and Anton Pelinka (eds.), Contemporary Austrian Studies (London: Routledge: 1997), 64–94. 8. There are of course other house muesums dealing with absence, like the Anne Frank Museum in Amsterdam or the Benjamin Franklin House in Philadelphia. 9. Lydia Marinelli, and Georg Traska, “Besuch einer Wohnung. Zur Architektur des Sigmund Freud-Museums”, Sigmund Freud-Museum (ed.), Architektur des Sigmund Freud-Museums (Vienna: Sigmund FreudMuseum, 2002), 2–8. 10. Prof. Dr. Sigmund Freud (ed.), Gedenkausstellung anläßlich der Eröffnung der Räume in der ehemaligen Ordination Sigmund Freuds in Wien 9, Berggasse 19 (Vienna: Sigmund Freud Gesellschaft, 1971). 11. See the letter from Anna Freud to Friedrich Hacker dated August 23, 1969, written in German. Anna Freud Papers, box 40, folder 1, Library of Congress, Washington D.C. 12. Cf. Hans Lobner, 20th report on his “Dienstreise des Kustos und Bibliothekars nach London” (“The Curator and Librarian’s Trip to London,” May 8–24, 1974), 1, archive of the Sigmund Freud Museum. 13. Ibid., 4. 14. Cf. Krzysztof Pomian, Collectors and Curiosities: Origins of the Museum (London: Polity Press, 1990). 15. Bal, Mieke, “Lexicon for Cultural Analysis”, Anna Babka, Daniela Finzi and Clemens Grubner (eds.) Die Lust an der Kultur/Theorie. Transdisziplinäre Interventionen (Vienna: Turia + Kant, 2013), 49–81, 53. 16. Cf. the “open letter” to the members of the International Psychoanalytical Association (IPA) that Anna Freud drafted in October 1972 and published in German and English in 1974. Therein, she addressed the necessity of providing a library for Berggasse 19 and asked every member to donate a signed copy of their publications. Anna Freud Papers, box 40, folder 1, Library of Congress, Washington, D.C. 17. Peter Geimer, Derrida ist nicht zu Hause. Begegnung mit Abwesendem (Hamburg: Philo Fine Arts, 2015). 18. Diana Fuss (with Joel Sanders), “Freud’s Ear. Berggasse 19. Vienna Austria”, Idem, The Sense of an Interieur. Four Writers and the Rooms that Shaped Them (New York, NY: Routledge), 70–103, 73. 19. Edmund Engelman, “A Memoir”, Peter Gay (ed.), Berggasse 19: Sigmund Freud’s Home and Offices, Vienna 1938. The Photographs of Edmund Engelman (New York: Basic Books, 1976), 131–143, 137.

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20. Sigmund Freud, “Findings, Ideas, Problems (1938)”, James Strachey (ed.), Standard Edition, vol. 23 (London: The Howarth Press, 1964), 151. 21. Cf. the exhibitions “My Old and Dirty Gods”: From Sigmund Freud’s Collection (November 19, 1998–February 2, 1999); Freud’s Lost Neighbours (March 26–September 28, 2003); The Couch: Thinking in Repose (May 5–November 5, 2006). 22. Kosuth’s installation stayed longer than originally planned: for seven years until 1996. 23. In 1997, donations from Clegg & Guttmann, Jessica Diamond, Marc Goethals, Sherrie Levine, Haim Steinbach, and Heimo Zobernig were added to the collection. And in, works by Susan Hiller and Wolfgang Berkowski. 24. Joanne Morra, “Seemingly Empty: Freud at Berggasse 19, A Conceptual Museum in Vienna”, Journal of Visual Culture, 12(1), April 2013, 89– 127, 107. 25. Even in museums a clear distinction between “original” and “nonoriginal”, “real” and “fake” is often not possible. ‘In this sense, museums are not only “places of authenticity” but also instances of authentification that are perceived as “authorities”.’ Dominic Kimmel, “Between Real Things and Experience. Authenticity as a Value for the Museum of the Present Day: An Introduction (nur online)”, in Museen—Orte des Authentischen? Museums—Places of Authenticity? (Heidelberg: Propylaeum, 2020), https://books.ub.uni-heidelberg.de/propylaeum/catalog/ book/745 (RGZM—Tagungen, vol. 42). 26. Freud in a letter to his son Ernst from May 12, 1938. The letter was written in German, but these four words were in English. 27. This is a quote by the mayor of Vienna, Michael Ludwig, at the museum’s official opening on September 23, 2020: The German version of this speech is available here: file:///C:/Users/fid/AppData/Local/Temp/2_beteiligte_sponsoren_zitate.pdf. 28. Hermann Czech, “Architectural Concept and Exhibition Design”, Monika Pessler and Daniela Finzi (eds.), Freud, Berggasse 19: The Origin of Psychoanalysis (Hatje Cantz: 2020), 17–23, 17. 29. In German, Freud uses the term “Erinnerungsspur”. “Memory trace” and “mnemic trace” are both used in the Standard Edition. 30. Sigmund Freud, The Interpretation of Dreams (1900), James Strachey (ed.), Standard Edition, vols. 4–5 (London: The Hogarth Press, 1953), 163. 31. Sigmund Freud, “The ‘Uncanny’” (1919), James Strachey (ed.), Standard Edition, vol. 17 (London: The Hogarth Press, 1955), 219–256, 220.

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32. Alison Booth, “Houses and Things: Literary House Museums as Collective Biography”, Kate Hill (ed.), Museums and Biographies. Stories, Objects, Identities (Woodbridge: The Boydell Press), 231—246, 234f. 33. However, Freud overcame this archaeological model in his late work, now seeing the interaction between the analyst and the analysand as a process of reciprocal transformation in which construction—and no longer reconstruction—plays a key role. 34. Sigmund Freud, “Civilization and Its Discontents” (1930), James Strachey (ed.), Standard Edition, vol. 21 (London: The Hogarth Press, 1961), 64–145, 71. 35. Ibid., 72. 36. Cf. Patricia Davison, “Museums and the Reshaping of Memory”, Sarah Nuttall and Carli Coetzee (eds.), Negotiating the Past: The Making of Memory in South Africa (Cape Town: Oxford University Press, 1998), 143–160, 145. 37. Ibid., 160. 38. Sigmund Freud, “Beyond the Pleasure Principle” (1930), James Strachey (ed.), Standard Edition, vol. 18 (London: The Hogarth Press, 1955), 3–64. 39. Sigmund Freud in a letter to Wilhelm Fliess on August 1, 1899, Jeffrey M. Masson (ed.), The Complete Letters of Sigmund Freud to Wilhelm Fliess 1887–1904 (Cambridge, MA: The Belknap Press of Harvard University Press, 1985), 363. 40. On this term, see Hans-Jörg Rheinberger, Toward a History of Epistemic Things (Redwood City: Stanford University Press, 1997). 41. Cf. Louis Althusser, “Freud and Lacan,” Writings on Psychoanalysis (New York: Columbia University Press, 1999), 52. 42. On this term, cf. Tilman Elliger, “Sigmund Freuds ‘splendid isolation.’ Materialien zur Kritik der psychoanalytischen Geschichtsschreibung,” Psyche 44(7), July 1990, 612–627. 43. With regard to the delayed British English translation of Freud’s seminal work of 1905, for instance, Arkadi Blatow has observed that, “the fact that the Three Essays on the Theory of Sexuality were only translated with a delay of forty-four years in Britain speaks volumes on the attitude toward sexuality prevailing there.” In Moscow, on the other hand, the work was published in its second edition as early as 1912. Cf. Arkadi Blatow, “Vorläufiger Bericht zur Sichtung des Buchbestands des Archivs des Sigmund Freud Museums, Wien, Berggasse 19,” unpublished. 44. Cf. Gérard Genette, Palimpsests: Literature in the Second Degree, trans. Channa Newmann and Claude Doubinsky (Lincoln/London: University of Nebraska Press, 1997).

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45. Sigmund Freud, Introductory Lectures on Psycho-Analysis, (1916–1917), James Strachey (ed.), Standard Edition, vols. 15–16 (London: The Hogarth Press, 1963), 17. 46. On this quote from Nietzsche’s Untimely Meditations, and for a discussion on psychoanalysis as a timely science, cf. Joachim Küchenhoff, Die Achtung vor dem Anderen. Psychoanalyse und Kulturwissenschaften im Dialog (Weilerswist: Velbrück, 2005), 9.

Casebooks

Madness, Memory and Delusion in Late Nineteenth-Century Colonial Barbados Leonard Smith

Introduction This chapter utilises the contents of rare lunatic asylum case records to illustrate how memory acted as a key influence upon manifestations of insanity in post-emancipation colonial Barbados. Before elaborating on this, some basic context is essential in relation to the island’s history and also its facilities for incarcerating mentally disordered people. By the mid-nineteenth century, Barbados had been one of Britain’s key overseas colonies for more than two centuries. For most of that time it was the archetypal slave society, its wealth accumulated from the enforced labour of enslaved people of African descent. In 1838, chattel slavery was formally ended in the British West Indies. However, the adjustments that followed abolition proved slow and painful, nowhere more so than in Barbados. In many ways little had really altered for its majority black

L. Smith (B) Institute of Applied Health Research, University of Birmingham, Birmingham, UK e-mail: [email protected]

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 R. Wynter et al. (eds.), Memory, Anniversaries and Mental Health in International Historical Perspective, Mental Health in Historical Perspective, https://doi.org/10.1007/978-3-031-22978-7_6

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and ‘coloured’ population by the 1870s, particularly in relation to their dependent, vulnerable economic status and dire living conditions. The machinery of government and law enforcement was still in the hands of a controlling white elite, and the whole social structure remained intricately bound up with distinctions and gradations of skin colour.1 For most Barbadians, a powerful collective memory and distressing individual recollections combined to elide with current realities. The total area of Barbados was only 167 square miles, but it had the highest population density in the British Caribbean. In August 1838, the island contained about 110,000 persons, of whom approximately 75% were designated as black, 11% as ‘coloured’ and 14% white.2 By 1900, over 180,000 people lived in a perennially overcrowded island.3 After emancipation, most had been left landless and those in rural areas had few alternatives to remaining on the plantations. A large, immobile labour supply meant low wages and unstable employment, exacerbated by repeated fluctuations in the sugar trade. The planter-dominated colonial government imposed punitive labour laws and actively restricted emigration.4 Poverty, destitution and malnutrition were widely prevalent. Housing provision was seriously inadequate, with whole families often crammed into crude, insanitary wooden huts.5 Simmering discontents among the rural black poor provided the background to a serious uprising in 1876. A new reformist Governor, John Pope-Hennessy, had sought to effect a British government policy to place Barbados within a Windward Islands confederation, with shared administration of justice and public services.6 The white ruling elite denounced this as an attack on their inalienable rights of self-determination. PopeHennessy further incensed them by condemning the dreadful state of the gaols and implementing prisoner releases, and then by publicly contrasting their prosperity with the deplorable condition of the nonwhite masses. His stance cast him as a popular hero. The white politicians’ ensuing campaign of vilification against Pope-Hennessy provoked violent, destructive disturbances throughout the island in April 1876. The ‘Confederation Riots’ continued for ten days before order was restored by the British military. In the aftermath, confederation was abandoned and PopeHennessy was transferred out to Hong Kong.7 The rebellion of 1876 proved to be a defining episode in the history of Barbados, its legacy and associated memories persisting long afterwards.

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The Unreformed Asylum The Barbados Lunatic Asylum of the 1870s was a highly defective institution, with none of the attributes of a post-reform British institution. Indeed, transmission from Britain to its colonies of modern principles and practices had been an uneven process at best. In England the legislation of 1845, comprising requirements for public asylum construction and arrangements for administration, medical oversight, staffing and inspection, served to consolidate approaches that had previously been implemented in some asylums. Conceptions of ‘moral management’ were becoming increasingly influential, with its central tenets of nonrestraint, classification, organised religious observance and, in particular, the employment of patients.8 Adoption of these approaches only occurred gradually in the colonies. The recruitment from Britain of some experienced asylum superintendents, from the 1860s onwards, proved crucial in establishing moral management-related systems in several colonial asylums.9 These developments tended to occur later, if at all, in most of those territories with largely non-white populations.10 A racially stereotyped belief clearly prevailed in certain quarters that people of colour, because of their supposed intellectual inferiority and lack of sophistication, were less likely to benefit from a progressive regime.11 Such conceptions were widespread in the West Indies, and there were additional practical considerations. The small size and populations of several island colonies meant that it was hardly possible to justify the development of a lunatic asylum substantial enough to implement key elements of a moral management system. However, in the larger or more populous places, some relevant reforms did take place gradually, commencing with Jamaica in the mid 1860s and followed by British Guiana in the late 1870s and Trinidad in the 1880s, though effectively not before 1900 in Barbados.12 In most instances, cash-strapped colonial governments were very reluctant or unable to expend the necessary resources. The additional delays in Barbados reflected the lack of priority given by its white ruling elite to the health and welfare needs of its impoverished black and coloured majority.13 The Barbados Lunatic Asylum opened in 1846, on the outskirts of Bridgetown adjoining District ‘A’ police station. It provided initially for twenty patients, on a four-acre site. The facilities were basic, comprising separate buildings for males and females, a small block for refractory

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patients and a superintendent’s house, laid out in quadrangle form.14 The asylum filled quickly and its inadequacy was soon apparent. Overcrowding became a perennial problem, despite periodic makeshift additions and adaptations. Sanitary facilities were primitive. In 1864, its many deficiencies were exposed by a British government survey of colonial hospitals and lunatic asylums, initiated in response to earlier revelations of scandalous conditions and flagrant abuses in the old public lunatic asylum at Kingston, Jamaica.15 Among the British government’s measures to promote improvements in colonial asylums was an attempt to replicate the inspectoral role of the Commissioners in Lunacy. In 1874, the appointment of an inspector of lunatic asylums in the West Indies was proposed, with the role to be undertaken by Dr Thomas Allen who had implemented far-reaching reforms in Jamaica. Although several colonies rejected the proposal, the Barbados government agreed to invite Allen, but primarily to make recommendations for the construction of a new asylum.16 However, Allen exceeded his brief and conducted a forensic examination of the existing asylum in January 1875, when it contained 130 patients. In his published report, Allen graphically described its overcrowded, highly defective state. He detailed instances of two or more patients crammed into single rooms, with several sleeping on the floors, broken bedsteads and inadequate, dirty bedding. Their physical health was further compromised by crowded, unventilated dormitories, crude and offensive-smelling privies, bath tubs containing dirty water, open cess-pits and animals running around in the yards. There were no dining or day rooms. Allen characterised the attendants as incompetent, ill-disciplined and recruited from the lower rungs of society.17 The dreadful conditions differed little from those to which most inmates had long been accustomed outside the asylum. Thomas Allen’s detailed proposals for a new asylum, based upon modern reformist principles, were largely rejected as impractical and too expensive. Despite a few minor reforms, including the keeping of case records, and some piecemeal additions of wooden huts to relieve congestion, conditions in the Barbados asylum changed little over the following years. In some ways they deteriorated as patient numbers rose inexorably, exceeding 250 in 1892. The unsustainable overcrowding was accompanied by deterioration in the buildings’ fabric and in sanitary facilities. Patient management was increasingly ineffective, as levels of violence escalated, illustrated graphically in the daily journals compiled by successive medical superintendents. At times virtual anarchy prevailed, despite the

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frequent use of mechanical restraint and locked seclusion. Any practical application of moral management principles was virtually impossible.18 Some relief finally came in 1893, with the long-delayed opening of a new lunatic asylum on the site of Jenkinsville plantation, east of Bridgetown.19 This at least offered basic standards of accommodation and space for outdoor activities. However, some of the difficulties associated with the old asylum, and memories of them, transferred along with the patients and staff. Despite improved facilities, the implementation of reforms was dilatory. Mechanical restraint and locked seclusion continued in frequent usage, classification of patients was inadequate, and schemes for occupational and other activities were very limited in scope. The Barbados authorities’ steadfast refusal to consider the recruitment of an experienced medical superintendent from Britain, despite the demonstrable benefits in Jamaica, British Guiana and Trinidad, brought further delay in the process of reform.20

Marginalised People Most of what follows is derived largely from lunatic asylum casebooks, held in the Barbados National Archives.21 The asylum’s medical superintendent, Dr Charles Hutson, began keeping the casebooks following advice from Thomas Allen during his 1875 inspection. The practice was continued by Dr Albert Field, who replaced Hutson in 1879, but it stopped in 1880. It was reinstated briefly at the new asylum after 1893. Despite variations in the amount and quality of their content, the case records provide valuable detail on the circumstances that preceded or precipitated people’s admissions, their presentations within the asylum, and on their progress or otherwise. Some supplementary information comes from the medical superintendent’s journals kept from 1875 onwards, which recorded admissions, noteworthy incidents, concerns about particular patients, and so on.22 It is worthy of note that, with all their obvious limitations, these sources offer almost unique first-hand accounts of the circumstances and experiences of black people or persons of colour, who were deemed to be suffering from mental disorders, in the nineteenth-century British Caribbean.23 Historians of mental health have long recognised that, whilst patient case records are an extremely valuable source, they have a number of serious interpretational limitations.24 The dilemmas are further compounded in the case of a former British colony like Barbados,

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where the experiences and behaviours of traumatised black patients are described, explained and diagnosed by members of the white governing class. Recent critical scholarship has focussed attention on the major limitations of the archive, related to the absence of primary sources which reveal the true nature of black people’s experiences, individually and collectively, in the Atlantic world during the era of enslavement and its prolonged aftermath. The term ‘archival silences’ aptly describes what has confronted dedicated investigators and, where limited records do exist, their very nature has committed significant ‘archival harm’ to their black subjects.25 These yawning gaps in the archive have led scholars such as Marisa Fuentes and Saidiya Hartman to develop methods of analysis and reinterpretation of extant documentary or other materials which can accurately convey more profound understandings of the deeply memorised experiences of black individuals and communities.26 Both Charles Hutson and Albert Field were white Barbadians, and they frequently betrayed their own memorised or ingrained class prejudices and racial stereotypes in their representations of patients. Nevertheless, their reporting could at times be reasonably sympathetic towards the inmates and the circumstances that underlay their exhibitions of apparent mental disturbance. Notwithstanding refraction through a white medical lens, many of the narratives resonated clearly with aspects of Barbadian society, reflecting the realities of deprivation, poverty, unemployment, poor housing and tenancy disputes, whilst also illustrating wider questions of race, class and culture. Some of the issues were thrown into sharper relief by the traumatic events surrounding the Confederation Riots, which occurred a year after the casebooks were initiated. Overall, the records do demonstrate how people’s memories and perceptions, whether accurate or impaired, played a key part in both the genesis and expression of their mental aberrations. The destitution that characterised post-emancipation Barbados directly impacted upon many of those who came to the asylum. Phyllis L. (aged 27), a black labourer, was admitted in December 1879, after presenting as ‘noisy & incoherent’, stripping herself, talking incessantly and using ‘indecent expressions’. On admission she appeared ‘rather diminutive in size, perhaps from want of food’. During her eight months in the asylum, Phyllis’s weight almost doubled, from sixty to 110 pounds, her appetite being ‘enormous’.27 Daniel C. (41), a ‘coloured’ shoemaker, had returned to Barbados after a period on the island of St Thomas. He was preoccupied with religious ideas, ‘talks incessantly on different subjects going from one

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to another—says he is inspired by God to do his work as Peter’. When admitted in January 1878, Dr Hutson described ‘a thin almost emaciated man of the shabby-genteel class’. His anaemia and dry skin were ‘the results no doubt of starvation & neglect’. Observing that Daniel was ‘depressed from his destitute state &c’, Hutson found few overt signs of mental disorder. He gained eleven pounds in weight within a fortnight, and was subsequently transferred to the parish almshouse.28 One particularly stark case was that of Joshua C. (20), a black labourer suffering from ‘dementia following epilepsy’, admitted in December 1877 after being found kneeling in the island’s Council Chamber. Hutson described him as ‘thin & apparently extremely feeble’. His mental and physical health improved rapidly and he gained nineteen pounds in fourteen days. Joshua was ‘permitted to go home as parents are old & very poor & require much his aid’. However, he was readmitted six weeks later, ‘feeble, demented & emaciated doubtless after a day or two of fits, wandering & starvation’.29 It was relatively common for impoverished people of low social status to present with perceptions or memories quite at variance with reality. Samuel A. (25), a black mason, experienced an episode of acute mania in October 1877. His violent behaviour and incoherent speech were accompanied by claims ‘at times that he is Christ & at others that he is Pope Hennessy’. He arrived at the asylum ‘handcuffed between 2 policemen shouting wildly that he was P Hennessy, that he was not mad &c’. His violent, disruptive behaviour continued for several days before he settled and recovered. He was discharged after six weeks, having gained nearly two stones.30 Venus C. (47), a black washerwoman, was admitted in February 1878 after being discovered in the bedroom of Mrs Strahan, the Governor’s wife. Venus told an examining doctor that ‘God has given her Govt House & that she went yesterday to take possession’. Dr Hutson described a rather imposing figure, ‘a tall well made & respectable looking woman—very black. Presence commanding rather than otherwise.’ She insisted that the district where she lived, Congo Town, ‘is to be called Paradise & that God has given it to her along with Govt House’.31 Venus remained a ‘very mysterious’ figure, regarding Hutson as ‘a prophet who sees visions’. She was still in the asylum in 1882.32 Arguably, such flights into apparent delusion represented the construction of an alternative, more palatable set of memories. Disputes around perceived property ownership arose often in a society where enslavement formed a powerful memory, as reflected in several cases. Distorted recollections influenced a black domestic servant, Jane

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J. (42), who twice deposited herself at Brandon’s, the home of a wealthy white family, claiming it as hers and becoming violent when challenged. She was taken to the asylum in March 1876, in a donkey cart ‘in the hot broiling sun’, bearing marks of physical restraint and beatings. Hutson observed a ‘small woman, rather emaciated, silent & reserved’. Jane’s mental and physical state steadily improved as she ‘gained flesh’ and engaged in sewing and laundry work. After eight weeks she went home ‘convalescent’, having put on twenty-two pounds.33 In other instances, matters took a more serious turn. Moses P., (57), a black labourer with a long history of mental disorder, was convinced that he owned cane fields, breadfruit trees and other property. He was arrested after thefts of produce, in March 1878. A certifying doctor noted that Moses had ‘always been working but not sufficiently to support himself’. He was discharged after two months in the asylum. When returned by a magistrate in October following further thefts, Hutson observed that he was ‘much thinner than he was when he went out & looks altogether a great deal older & feebler’. Moses remained adamant that he had been picking crops ‘in his own land’.34 Joshua C. (36), a black labourer admitted in June 1879, insisted that he owned a share in Bentley Estate, where he lived in a tree after eviction from his allotment. For two years he had been ‘troublesome & violent, menacing the managers with weapons and threatening to burn’.35 In such cases, where memory itself was contested, the line between insanity and resistance could be difficult to determine. Post-slavery Barbadian society was infused with deep-rooted prejudices relating to skin colour, which were embedded into the psyche of the dominant white population. Perceptions of white superiority and black subjection continued to permeate collective and individual memories. Within that schema, variations in lightness or darkness of shade were closely linked to social status, with attitudes and interactions determined accordingly. Some people, particularly among those regarded as ‘coloured’, would take active steps towards gaining greater ‘respectability’ or moving into a higher social sphere, which brought its own tensions and conflicts. For most elements of the black population, however, continuing economic, social and political exclusion meant that there were few such options.36 Some accepted their situation as pre-determined and beyond their control, whilst for others resentments persisted as aspirations remained unfulfilled and largely unattainable. Examples representative of these varying responses were to be found among the lunatic asylum’s patients.

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The complex nature of attitudes and relationships between the classes was frequently manifested. Elizabeth K. (32), a black huckster admitted after a disturbance in November 1877, had been talking rapidly, with visual hallucinations and beliefs that people were trying to kill her. Dr Hutson described ‘a thin delicate looking woman respectful in manner but depressed & reserved in appearance’. She was particularly distressed by the conduct of the ‘White people in the Great House’, who had allegedly ‘turned against her & mocked her’ despite her having been ‘brought up on the most intimate terms’ with them.37 Elizabeth W. (63), a ‘mulatto’ domestic servant was transferred to the asylum in June 1875 after violent behaviour in the St Joseph parish almshouse. She told Dr Hutson that ‘she was not accustomed to associate with the kind of people they have there’, boasting of her remembered associations with ‘white folk’ and with a ‘young master’ in her earlier days.38 Charles Hutson was certainly not immune to the racist preconceptions and stereotypes associated with his own white background. Mary G. (23), a labourer who had hitherto been ‘a quiet sort of girl’ was admitted in July 1875 after noisily making accusations against ‘all the people on the Estate’ and assaulting several of them. Hutson portrayed ‘a stalwart black woman with enormous mammary development & decidedly vulgar look & manner’, but whose demeanour was ‘respectful’. She had arrived at the asylum ‘dressed in the finery of wh. the negroes are so fond’, clearly regarding herself as ‘above the ordinary run of her class’.39 In the case of Mary E. (26), a labourer admitted in November 1877, he observed that boasting about a supposedly respectable upbringing was ‘by no means an uncommon trait in the character of the negro races’.40 Hutson depicted Elizabeth R. (45), a labourer admitted in January 1877, as ‘a well nourished black woman, quiet & respectful in manner & rational enough as women of her class go’.41 He described Henry O. (28), a labourer admitted in March 1876, as ‘a tall thin black man with idiotic & notoriously unintellectual face’, going on to suggest that a retreating forehead and projecting chin made Henry’s face ‘very ape-like’.42 Although Hutson recognised the plight of many of his black and ‘coloured’ patients, he clearly identified more closely with the white inmates, generally recording greater detail about their background and progress in the asylum. Elizabeth A. (48), a single woman without occupation, was admitted in December 1877 after violent, excited behaviour at the house she shared with her sister. Hutson described her on admission as ‘a white woman with fair skin and delicate features’, who was

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sitting quietly on the ward ‘under trying circumstances for one like her’. Her physical health was ‘fair though she looks a delicate woman’. He wanted to allow her a single room, but as none was available she was placed together with Keturah B., another ‘quiet, respectable looking white woman’.43 Hutson went to considerable lengths to engage with certain more prominent, articulate middle-class white patients, such as the deranged Church of England clergyman Reverend N.H.G., admitted in March 1877, and the dangerously suicidal Doctor Alex G. in December 1877.44 As a consequence of its particular history, nineteenth-century Barbados was home to a substantial, long-established ‘poor white’ population, who were well represented in the asylum. Charles A. (58), a shoemaker, was admitted in July 1875, followed by his ‘schoolboy’ son Henry (19) in April 1877, both after violent and threatening behaviour at home. According to Mrs A., Henry ‘seemed to get depressed over the poverty of his family & his inability to do anything for the relief of it’. He was discharged ‘cured’ after four months, but his father died after three years in the asylum.45 Arabella D. (30), a seamstress, was admitted in May 1875 after several suicide attempts, violence towards her sister, ‘tearing off her clothes and exposing her person to the inmates of the house’, and using ‘obscene & profane language’. It was noted that she had ‘no means of support’ other than the sister ‘who is very poor’ and unable to care for her. Diagnosed as suffering from ‘paralytic insanity’, Arabella arrived at the asylum in bad physical condition and died seven weeks later.46 In some instances, poor white patients had distinct memories of more prosperous times. Mary P. (60) was detained in a Bridgetown street, ‘naked having stripped herself to bathe at a hydrant’. She had been ‘fairly well off’ in her younger days, moving to Barbados from Antigua. Always regarded as ‘flighty’, she latterly led ‘a precarious kind of existence’ as a fortune teller. On admission in April 1876, Dr Hutson saw a ‘thin, delicate looking white woman’, who ‘looks as if she has seen better days’. Mary died after four months in the asylum.47 Several others had experienced downward social drift consequent upon their mental disorders. Abraham E. (64), a planter, was admitted for the fourth time in June 1875, having presented as restless, talking incessantly, and ‘extremely filthy and abusive & most indecent’. Dr Hutson described ‘a small & very thin white man’, who ‘looks utterly broken’. Abraham was dead within two months of admission.48 Elizabeth T. (35), a former governess, had been wandering at night, talking to herself, destroying furniture and

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threatening to kill her sister-in-law. Her insanity was attributed to a ‘fall in circumstances’. On admission in January 1878, Hutson thought her ‘ladylike’ and ‘very precise, prudish in her manner & conversation’, as well as ‘haughty’ and boastful regarding her ‘respectable connections’. She conversed with the other patients ‘in a patronizing way and thanks God that she is able to do them any good’.49 Within a few months Elizabeth was creating considerable problems. She was ‘very troublesome’, breaking crockery, cursing, quarrelling, getting into ‘frightful rages’, fighting with other patients, and she even threw a tin bowl at Hutson’s head. She was still in the asylum in 1882.50 The case records contain many allusions to different aspects of AfroBarbadian culture and heritage. In a few instances there were clear linkages back to the era before emancipation. The vivid early recollections of Charles Y. (60), a soldier admitted in March 1875, contrasted with his failing short-term memory. He was a ‘tall, stalwart old black man’, who possessed a ‘marshal bearing’ and looked younger than his years. Hutson was struck by his ‘extraordinarily clear account of his early life in Africa’. He could ‘remember clearly even the names of the different places with which he was connected in early life’. He described having been ‘lost away’ from his wife and two children when taken as a slave from ‘Congo Angoola’ by a Portuguese ship, which was then captured by an English man o’ war and taken to Sierra Leone. Charles retained a deferential attitude, referring to Dr Hutson as ‘Massa’. He remained in the asylum for at least two years.51 Such direct connections with Africa were, however, relatively unusual. From the mid-eighteenth century onwards, the great majority of black and ‘coloured’ people in Barbados were native-born ‘Creoles’.52 Nevertheless, consciousness of an African heritage persisted into the postemancipation era. A small number of Barbadians even went to settle in Africa, some as missionaries.53 The black schoolmaster Isaac R. was seemingly one of these. He went to Africa in 1869, when aged about 23, but ‘came back worse & was put at once into the Lun. Asylum’, where he remained for several years before being discharged. Following a relapse, he was readmitted in May 1877 in a confused and depressed state. His uncommunicative presentation altered little and he was still in the asylum at the end of 1878.54 West African spiritual and cosmological belief systems remained deeply ingrained within the collective memory. As Diana Paton has shown, adherence to the tenets and practices associated with ‘Obeah’ was

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widespread throughout the British Caribbean, despite colonial governments’ attempts to suppress it.55 Unusually, the Barbados authorities had been relatively tolerant and ameliorated the more drastic laws in the 1840s.56 The anthropologist Lawrence Fisher observed the continuing prevalence of beliefs related to Obeah into the second half of the twentieth century, illustrating how they still featured in Barbadian understandings of mental disorder.57 Reflecting this, several of the asylum case histories contained direct reference to Obeah, spirit possession and similar phenomena. Dorothy K. (44), a black labourer, was admitted in February 1878 after behaving strangely for some time. According to the admission certificate, she pelted her children with stones and ‘walks about with brushes & rags thinking by this means to accomplish certain wishes of hers’. Hutson described her as ‘diminutive’ and very thin, with an ‘old withered look’. Her son reported that she had been going to a ‘fortune teller’ named Mr Roach who had ‘bewitched her’, obtaining large sums of money which she could not afford. Dorothy herself admitted to Hutson that she had given Roach money for him to ‘superintend’ the shop she had started on his advice, even though he lived ‘miles away’.58 Sarah Jane P., (43), a black laundress admitted in April 1877, had various persecutory and grandiose delusions. According to her husband, she believed that neighbours would ‘fumigate her by burning something in the adjoining yard’. In the asylum, she complained to Hutson that one neighbour was constantly ‘spelling her name & burning her with a blue sperm candle’. He regarded most of her delusions as ‘apparently connected with the superstitions of obeah’.59 William C. (47), an epileptic ‘mulatto’ labourer, was readmitted to the asylum in November 1878 with various delusions of a quasi-religious nature. He told Dr Field that ‘the people mistake him for an “obeah man” but that really he is a messenger from Heaven’.60 Beliefs and preoccupations associated with Obeah influenced a continuing tendency to consult with one of the irregular practitioners who retained considerable influence among the poorer classes, despite the hostility of the medical establishment. In the case of Hester L. (34), a black labourer, this preceded recourse to more conventional modes of treatment. In early March 1878, she became deeply depressed after the death of her favourite child. After two weeks, according to her husband, ‘she fell into a kind of trance’ and could not be roused. She was taken to a police station, where she ‘screamed & sang loudly’ and refused to eat. She was seen by ‘Dr Harewood’, denounced by Dr Hutson as ‘a black

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man who goes about with nostrums &c’, who cupped her head in four places, for which he was paid four shillings. His ministrations failed and, due to overcrowding in the asylum, Hester was kept in a cell at District ‘C’ police station for seven weeks before being admitted.61 Burnette B. (16), a black girl who assisted her mother making ginger beer, was admitted in September 1880 a few days after an episode of ‘raving’ mania that started when she experienced severe abdominal pains on the way to market. A doctor had been summoned who prescribed an opiate, with little effect, and two days later she was examined by a ‘lunacy board’. In the intervening two days before her actual admission, her desperate relatives sought other help. On arrival at the asylum, according to Dr Field, Burnette’s temples were scarred, ‘the result of cupping by an obeah or quack woman’.62 Conventional Christian-based observance occupied a prominent place at all levels of Barbadian society. Religious preoccupations frequently infused patients’ presentations, both prior to and during their stays in the asylum. Norman E. (19), a ‘mulatto’ student, was admitted in October 1878, after jumping from windows and preaching to people in the streets about their sins. On arrival at the asylum he talked ‘almost entirely’ about Jesus Christ and ‘of his soul’s prospects’. He was ‘evidently anxious to lead everyone in the right way, reproving the numerous blasphemers by whom he is surrounded’. Hutson found it necessary to restrict his access to a Bible. Norman’s condition gradually improved and he was discharged after four months.63 Anne W. (32), a black huckster and Sunday School teacher who had ‘always been given to much praying & hymn singing’, was admitted in December 1875 after several weeks ‘repeating scriptural expressions & praying incoherently’. At one point she ‘gathered her children round her bed & began praying & singing very loudly’. She continued in this manner for three days, not eating or sleeping, anticipating that ‘God wd feed them all’. After an attempt to kill the children she was ‘tied hand & feet’. Another fortnight elapsed before she was taken to the asylum, where she stayed for a number of years.64 The tumultuous events surrounding ‘Confederation’ in April 1876 impacted considerably upon the asylum and its patients. The immediate area was engulfed by the disturbances. On 21 April, an agitated Dr Hutson recorded that the ‘Negroes’ outside were engaged in ‘open rebellion’. They were ‘rushing about in gangs plundering right & left’. The female patients could see the ‘performance’ and were consequently in a ‘great state of excitement’.65 Traumatic experiences and memories

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associated with the rioting were evident in the cases of several patients admitted in the aftermath. Elijah C. (30), a black tailor described by his step-father as ‘a delicate, nervous & easily excited man’, was terrified by the events. On 21 April, he was ‘greatly alarmed’ by a ‘large mob’ of ‘Confederation rioters’ gathered near his house. Two days later, he was seen peering out and repeating constantly ‘the soldiers are coming for me’. He remained ‘in a frightened state’ for several days. He then became violent and destructive, and ‘tried to kill himself with razor & scissors’, before being finally admitted to the asylum on 9 May.66 The rioting had a similar effect upon Joseph Y., a former patient who became ‘dreadfully frightened’ and went off ‘roaming and sleeping outside’ for several days. He was admitted on 3rd May, without certificates, after being taken to Dr Hutson’s house in a ‘dreadfully feeble and emaciated’ state.67 Mary T. (52), a ‘coloured’ shopkeeper admitted on 27 April, was ‘a victim of Confederation’ according to Hutson. As soon as the ‘excitement’ began, she ‘passed into a state of melancholy from which nothing will rouse her’, dreading what might befall her policeman son. She went on to become a troublesome patient and died in the asylum in 1880, from chronic diarrhoea.68

Conclusions Even though the narratives of asylum patients and their relatives were filtered through the ‘medical gaze’ of doctors emanating from within the white establishment, and accompanied by reports with a similar orientation, they nevertheless illuminated key aspects of Barbadian society during a critical transitional epoch. The case records and journal entries illustrate how symptomatology and behavioural presentations reflected people’s daily experiences, as well as their perceptions of the wider social structure which encompassed them. Individual and collective memory clearly influenced their understandings and their responses to the circumstances with which they were confronted. Those facets of memory were mediated by ingrained conceptions of racial distinction and profound experiences of its consequences. The records also tell us something about the medical officers who compiled the information, and how they tried to make sense of people who often appeared bewildering and alarming, sometimes by reversion to familiar, memorised, racially-based stereotypes. Although generally seeking to do their best for the patients, before 1893 they were

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subject to some major constraints, not least a totally inadequate institution in which it was difficult to uphold even basic standards of health and hygiene. It was hardly feasible to provide active therapeutic treatment for so many diverse people exhibiting a whole range of serious mental disorders. Although there was little detailed recording in the patient casebooks after 1880, Dr Albert Field evidently expended time and effort on compiling entries in the medical superintendent’s journals. These included short summaries regarding many of the patients admitted, and brief reports regarding discharges and deaths in the asylum. There is sufficient evidence in the journals to confirm that the circumstances which precipitated or surrounded admissions continued much as before, with poverty and its ramifications a central feature.69 For many people, their already reduced physical condition was exacerbated by the asylum’s appalling sanitary conditions, contributing to a persistently high incidence of deaths associated with diarrhoea, typhoid and tuberculosis.70 Others retained sufficient strength of mind and body to demonstrate various forms of resistance to the asylum regime, in the same way that many people in Barbados continued to show dissent after the 1876 uprising. The frequently reported outbreaks of fighting between patients, attacks on staff, and sustained efforts to damage or destroy parts of the buildings’ fabric seemed to signify something much more fundamental than a mere reaction to the institution’s poor conditions.71 An attribution of mental disturbance to altered memory, madness and delusion was only ever part of the story.

Notes 1. Hilary McD. Beckles, A History of Barbados: From Amerindian Settlement to Nation-State (Cambridge: Cambridge University Press, 1990); Idem, Great House Rules: Landless Emancipation and Workers’ Protest in Barbados 1838–1938 (Oxford: James Currey, 2004); Idem, The First Black Slave Society: Britain’s ‘Barbarity Time’ in Barbados, 1636–1876 (Mona, Jamaica: University of the West Indies Press, 2016). The term ‘coloured’ was widely used at the time to describe people who were either of mixed race or otherwise between black and white in colour. The more stigmatic word ‘mulatto’ was also often used to describe people of mixed race. 2. Beckles, A History of Barbados, 104. 3. Henderson Carter, Labour Pains: Resistance and Protest in Barbados 1838– 1904 (Kingston, Jamaica: Ian Randle, 2012), 22.

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4. Beckles, Great House Rules, 40–82, 95–113, 158–161; Bruce Hamilton, Barbados and the Confederation Question, 1871–1885 (London: Crown Agents, Eyre and Spottiswood, 1956), 3–5, 8, 12. 5. Rev. Edward Pinder, Letters on the Labouring Population of Barbados (original 1858—Barbados: Barbados Heritage Reprint Series, National Cultural Foundation, 1990), 4–6, 10–16, 28; John Gilmore (ed.), Chester’s Barbados: The Barbados Chapters From Transatlantic Sketches (1869) by the Rev. Greville John Chester (Barbados: National Cultural Foundation, 1990), 2, 21–4. 6. These would include police, prisons and a projected new lunatic asylum. 7. Beckles, Great House Rules, 135–177; Carter, Labour Pains, 132–163; George Belle, ‘The Abortive Revolution of 1876 in Barbados’, The Journal of Caribbean History, 18, 1984, 1–32; James Pope-Hennessy, Verandah: Some Episodes in the Crown Colonies 1867–1889 (London: George Allen and Unwin, 1964), 157–182; Philip Howell, and David Lambert, ‘Sir John Pope Hennessy and Imperial Government: Humanitarianism and the Translation of Slavery in the Imperial Network’, David Lambert and Alan Lester (eds.), Colonial Lives Across the British Empire: Imperial Careering in the Nineteenth Century (Cambridge: Cambridge University Press, 2006), 228–256. 8. Andrew Scull, The Most Solitary of Afflictions: Madness and Society and Britain, 1700–1900 (New Haven and London: Yale University Press, 1993), 146–174; Joseph Melling, The Politics of Madness: The State, Insanity and Society in England (London and New York: Routledge, 2006), 20–21, 46–56, 190–193; David J. Mellett, The Prerogative of Asylumdom: Social, Cultural and Administrative Aspects of the Institutional Treatment of the Insane in Nineteenth-Century Britain (New York: Garland, 1982), 23–41; Leonard Smith, Cure, Comfort and Safe Custody: Public Lunatic Asylums in Early Nineteenth-Century England (London: Leicester University Press, 1999), 207–213, 228–239, 268–277, 286– 287. 9. Catherine Coleborne, Madness in the Family: Insanity and Institutions in the Australasian Colonial World, 1860–1914 (Basingstoke: Palgrave Macmillan, 2010), 32–36, 95; Lee-Ann Monk, Attending Madness: At Work in the Australian Colonial Lunatic Asylum (Amsterdam: Rodopi, 2008), 7–13, 85–90, 155–156; Julie Parle, States of Mind: Searching for Mental Health in Natal and Zululand, 1868–1918 (Scottsville, South Africa: University of KwaZulu Natal Press, 2007), 43–45, 85–86, 105– 108; James Moran, Committed to the State Asylum: Insanity and Society in Nineteenth Century Quebec and Ontario (McGill: Queen’s University Press, 2000), 92–96. 10. James H. Mills, Madness, Cannabis and Colonialism; The ‘Native-Only’ Lunatic Asylums of British India, 1857–1900 (Basingstoke: Palgrave

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12.

13. 14. 15.

16.

17. 18. 19. 20. 21.

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Macmillan, 2000), 107–125; Margaret Jones, The Hospital System and Health Care; Sri Lanka, 1815–1960 (New Delhi: Orient Blackswan, 2009), 183–194; Ng Beng Yeong, Till the Break of Day: A History of Mental Health Services in Singapore, 1841–1993 (Singapore University Press, 2001), 16–27, 103–113. Jock McCulloch, Colonial Psychiatry and the ‘African Mind’ (Cambridge: Cambridge University Press, 1995), 1–8, 46–63, 107–119; Megan Vaughan, Curing Their Ills: Colonial Power and African Illness (Cambridge: Polity Press, 1991), 10, 101–20; Harriet Deacon, ‘Madness, Race and Moral Treatment: Robben Island Lunatic Asylum, Cape Colony, 1846–1890’, History of Psychiatry, 7, 1996, 287–297; Shula Marks, ‘“Every Facility that Modern Science and Enlightened Humanity Have Devised”: Race and Progress in a Colonial Hospital, Valkenberg Mental Asylum, Cape Colony, 1894–1910’, Joseph Melling and Bill Forsythe (eds.), Insanity, Institutions and Society (London: Routledge, 1999), 268– 291; Waltraud Ernst, ‘Out of Sight and Out of Mind: Insanity in Early Nineteenth-Century British India’, Melling and Forsythe (ed.), Insanity, Institutions and Society, 245–267. Leonard Smith, Insanity, Race and Colonialism: Managing Mental Disorder in the Post-Emancipation British Caribbean, 1838–1914 (Basingstoke: Palgrave Macmillan, 2014), 81–88, 97–116. Beckles, History of Barbados, 106–107, 140, 156; Beckles, Great House Rules, 58–62. Robert Schomburgk, The History of Barbados (London: Longman, Brown, Green and Longmans, 1847), 129–130. British National Archives (henceforth TNA), CO 885/3/4, ‘Colonial Hospitals and Lunatic Asylums’, 1–5, 15–26. The report confirmed that several West Indian lunatic asylums were in a seriously defective state. Barbados National Archives (henceforth BA), PAM C 72, Report of the Commission on Poor Relief, 1875–1877, Appendix, ‘Report of Thomas Allen, M.D., Medical Superintendent and Director of the Jamaica Lunatic Asylum, to His Excellency the Governor of Barbados’, 67–68, Appendix, I-III. Several of the other West Indian colonial governments objected to any proposal to appoint an Inspector. BA, PAM C 72. Copy also in TNA, CO 31/67, Minutes of Proceedings of the Barbados House of Assembly 1875–1876, Appendix D, 1–68. Smith, Insanity, Race and Colonialism, 111–113; Barbados Archives (henceforth BA), Medical Superintendent’s Journals, 1876–1900. The asylum still functions as the Barbados Psychiatric Hospital. Its 125th anniversary occurred in 2018. Smith, Insanity, Race and Colonialism, 113–116. BA. Barbados Lunatic Asylum, Male Case Book (henceforth CBM); Female Case Book (henceforth CBF). The casebooks are not catalogued

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23. 24.

25.

26.

27. 28. 29. 30. 31. 32. 33. 34. 35. 36.

37. 38. 39.

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and were accessed by permission of the Director of the Barbados Psychiatric Hospital and the Ministry of Health. Extracts have previously been included in Smith, Insanity, Race and Colonialism and Leonard Smith, ‘Insanity and Society in 1870s Barbados’, The Journal of Caribbean History, 52(2), 2018, 175–197. BA, Medical Superintendent’s Journals (henceforth MSJ), 1876–1900. The journals are not generally available for public viewing and those for some years are too fragile to be accessed. Unsuccessful efforts were made by the author to locate case records for other former British West Indian colonies. Jonathan Andrews, ‘Case Notes, Case Histories, and the Patient’s Experience of Insanity at Gartnavel Royal Asylum, Glasgow, in the Nineteenth Century’, Social History of Medicine 11(2), 1998, 255–281. Tonia Sutherland and Zakiya Collier, ‘Introduction: The Promise and Possibility of Black Archival Practice’, The Black Scholar; Journal of Black Studies and Research, 52(2), 2022, Special Issue, ‘Black Archival Practice 1’, 1–5; Marisa J. Fuentes, Dispossessed Lives: Enslaved Women, Violence and the Archive (Philadelphia: University of Philadelphia Press, 2016), 1– 5. Fuentes’s study focussed upon Barbados in the eighteenth and early nineteenth centuries. Fuentes, Dispossessed Lives; Saidiya Hartman, Wayward Lives, Beautiful Experiments: Intimate Histories of Riotous Girls, Troublesome Women and Queer Radicals (London: Serpent’s Tail, 2021). BA, CBF, p. 103, no. 931. BA, CBM, p. 66. no. 808. The parish ‘almshouse’ was the poor-house. BA, CBM, p. 64, no. 802. BA, CBM, p. 61, no. 793. BA, CBF, p. 57, no. 813. Ibid, 20 February, 8 May 1878, 24 April 1882. BA, CBF, p. 60, no. 818. BA, CBM, p. 71, no. 820; MSJ, 4 October 1878. BA, CBM, p. 103, no. 870. Beckles, Great House Rules, 63–69; Melanie Newton, The Children of Africa in the Colonies; Free People of Color in Barbados in the Age of Emancipation (Baton Rouge: Louisiana State University Press, 2008), 120–124, 216–221, 256–273; Cecily Jones, Engendering Whiteness: White Women and Colonialism in Barbados in Barbados and North Carolina, 1627– 1863 (Manchester: Manchester University Press, 2007), 16–20, 24–30, 175–181. BA, CBF, p. 46, no. 794. The ‘Great House’ was a generic term referring to the home of a plantation owner. BA, CBF, p. 4, no. 680. BA, CBF, p. 5, no. 682.

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40. 41. 42. 43. 44.

45. 46. 47. 48. 49.

50.

51. 52. 53. 54. 55.

56. 57. 58. 59. 60. 61. 62. 63. 64. 65. 66. 67. 68. 69.

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BA, CBF, p. 48, no. 797. BA, CBF, p. 36, no. 753. BA, CBM, p. 25, no. 716. BA, CBF, p. 51, no. 803; p. 49, no. 799. BA, CBM, p. 47, no. 765; p. 65, no. 804. Despite Hutson’s best endeavours, Dr Gordon died from previously self-inflicted wounds which he had exacerbated during his eight days in the asylum. BA, CBM, p. 11, no. 683; p. 52, no. 776. BA, CBF, p. 3, no. 677. BA, CBF, p. 20, no. 719. BA, CBM, p. 10, no. 681. BA, CBF, p. 53, no. 806; MSJ, 11 January 1878—Hutson described her here as ‘a respectable looking White (or nearly so) woman with very precise manners & good address’. BA, CBF, p. 53, no. 806, 31 May, 30 September, 31 December 1878, 5 June, 6 October 1879, 23 May 1881; MSJ, 18 February, 11 April, 15 May, 31 July, 27 August, 5 September, 30 November, 24 December 1878. BA, CBM, p. 2, no. 671. Beckles, Great House Rules. Newton, The Children of Africa in the Colonies, 12–13, 273–80. BA, CBM, p. 54, no. 777. Diana Paton, The Cultural Politics of Obeah: Religion, Colonialism and Modernity in the Caribbean World (Cambridge: Cambridge University Press, 2015). Obeah comprised a complex set of beliefs, memories, rituals, predictions and remedies. Paton, Cultural Politics of Obeah, 125, 142–143. Lawrence E. Fisher, Colonial Madness: Mental Health in the Barbadian Social Order (New Jersey: Rutgers University Press, 1985), 105–134. BA, CBF, p. 55, no. 809. BA, CBF, p. 41, no. 773. BA, CBM, p. 74, no. 823; MSJ, 20 November 1878. BA, CBF, p. 61, no. 827. BA, CBF, p. 106, no. 956. BA, CBM, p. 83, no. 843; MSJ, 8, 14 October, 5, 9, 11, 18 November 1878. BA, CBF, p. 10, no. 697. BA, MSJ, 21 April 1876. BA, CBM, p. 29, no. 723. BA, MSJ, 3 May 1876. BA, CBF, p. 52, no. 721; MSJ, 28 April, 8, 14 August 1876, 22 January, 6 February 1878. BA, MSJ, 26 July 1883–19 December 1891.

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70. BA, MSJ, 10 July 1882–31 December 1891. 71. BA, MSJ, 4 February 1881–31 August 1891.

Gone but not Forgotten: Acts of Remembrance in the Late-Nineteenth and Early-Twentieth-Century Asylum Katherine Rawling

Introduction: Forgetting and Losing in the Total Institution The long-stay institution still casts its shadow over the history of asylums and psychiatry. The prominent historian of psychiatry, Andrew Scull, characterised asylums as ‘mansions of misery’,1 ‘cemeteries for the still breathing’2 and, most famously, ‘museums of madness’.3 In the popular imagination, too, the asylum is often portrayed as a sinister Gothic house of horrors—designed to hide (and therefore help the public forget) that the mad existed, literally hiding them from view in the ‘massive mausoleums of madness whose relics still litter the countryside’.4 In one popular book on the archetypal institution, Bethlem Hospital, the author states ‘asylums were instruments of social control, prisons disguised as hospitals, where the poor and incurable could be swept out of sight’.5

K. Rawling (B) University of Leeds, Leeds, UK e-mail: [email protected]

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 R. Wynter et al. (eds.), Memory, Anniversaries and Mental Health in International Historical Perspective, Mental Health in Historical Perspective, https://doi.org/10.1007/978-3-031-22978-7_7

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Asylum casebooks have proved fruitful ground for scholars wishing to gain insight into institutional life and patient experiences. Open up any casebook ledger from an asylum and one is confronted with masses of detail about people’s lives: name, age, sex, religion, occupation, living arrangements, physical appearance, eye and hair colour, and sometimes, and importantly for this chapter, patient photographs. Historians have mined these records to write a revised history of asylums and the people who occupied them, preferring instead to emphasise the permeability of asylum walls, the enduring relationships between patients, families and friends, and the continuing attempts at care and therapy.6 And yet the notion that asylums were places for forgetting persists and, therefore, deserves continuing scholarly attention. This chapter actively engages with the notion of forgotten people and questions the assumption that on entering or, indeed, leaving the asylum people were forgotten. I add complexity to this discussion by exploring two case studies from the private Holloway Sanatorium, Surrey, in the south-east of England, to consider memory, remembrance, and forgetting between staff and patients in the institution. In two specific examples, one in which staff remembered patients, the other highlighting remembrance between patients, photography and photographs play a crucial role. Furthermore, the two examples show the ways in which broader photographic and remembrance practices flowed through the asylum walls. In both cases, the photograph was a vehicle through which patients and staff were connected and thereby remembered. The twin concepts of forgetting and losing are recurring themes in writing and thinking about the asylum, both in terms of emotional and practical issues. When writing about the effects of committal on the families of patients, Jade Shepherd frames this in terms of the ‘loss’ of a relative ‘to’ the institution, explaining that families experienced this absence or ‘loss’ of a spouse, parent, child, sibling, or other family members as a form of ‘bereavement’.7 Loss could have a literal dimension too; Rob Ellis notes several cases in which patients were ‘lost’ due to administrative error when families were told either that their relatives had died when they had not, or that their relatives were still living when they had, in fact, already died. Ellis notes one case in which relatives were called to a seriously ill patient’s bedside only to discover it was a case of mistaken identity and they were, in fact, not related.8 The fear of patients being

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‘lost in the system’ then was a real one, especially as the number of institutions and patients they contained grew in Britain during the second half of the nineteenth century.9 In photography, too, memory and loss are well-established, central issues and theorised in seminal work by scholars like Roland Barthes, Annette Kuhn and Marianne Hirsch.10 As a means of recording, of fixing in time and recalling past events or people, photography is intimately connected to memory and remembrance. The historian Jennifer Green-Lewis states that ‘the perceived threat that this state [the state of the subject being photographed] will be lost is inherent in the act of photographing’.11 In many ways, photography is, in Susan Sontag’s view, an ‘inventory of mortality’ and a ‘documentary of how we age’.12 From this perspective, photographs give the viewer access to subjects who are no longer there and exist only in memory, as well as to our own younger selves. Building on Barthes’ Camera Lucida (1980) Hirsch argues that love and loss, presence and absence, life and death are the ‘constitutive core of photography’.13 These themes have usually been discussed in reference to family photography, and in particular to those family photographic practices or photography ‘work’ that is done by women; the cultural geographer Gillian Rose shows that the ‘storing, displaying and circulating of family photographs is a strongly gendered activity’.14 (Moreover, in a broader sense, women have played a significant role in the history of various aspects of photography; as ‘high art’ and commercial photographers, as subjects, and on the technical production and processing side as colourists, developers, and re-touchers working in studios and backrooms.15 ) In another sense, many of our typical encounters with photographs are a form of photography ‘work’ when, even on the most superficial level, we employ photographs to help us in the job of remembering. Rose describes the explicit use of photographs in mothers’ memory and photographic work when, for example, they look at old baby pictures to remember how small their children once were.16 Rose argues that as a result of this photographic work, family photographs produce a domestic spatiality and temporality that stretches far beyond the walls of the home which is revealed only by examining what is ‘done with’ the photographs rather than concentrating solely on what they show.17 Here I want to apply these arguments to another type of photography and another type of photograph, that taking place in the asylum, which,

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much like the family home, was a site of human interaction and relationships. In the two examples discussed below it is again women who are involved in the photography ‘work’, as the photographic subjects in both cases, and in the second example, as givers and receivers of photographs. In contrast with other studies of asylum casebook photography, including my own work, which gives equal weight to both the content and context of patient photographs, it is what is done with the photographs in these two examples that is significant and my primary concern here.18 In addition, and again in contrast to many patient photographs produced in asylums in onsite photographic rooms and pasted into the medical casebooks, the two images discussed below are professional studio portraits, which links them further to women’s photographic work in the commercial photography industry of the period. By viewing the asylum as a site of human relationships I do not assume or imply any view on what these relationships might have been like or deny the sometimes, and perhaps especially in our view, harmful nature of those relationships, especially from a patient’s point of view. This is not an exercise in condemnation or rehabilitation, but an exploration of the ways in which photographs and photographic practices played a complex part in remembrance practices in the asylum of the late-nineteenth and early-twentieth century. These two sites of forgetting, remembrance, and loss, the asylum and the photograph, coalesce in the asylum casebook that contains patient photographs. The asylum superintendent and photographer Dr Hugh Welch Diamond who produced some of the earliest asylum patient photographs in the 1850s, spoke of the practical usefulness of photographing patients in his famous paper to the Royal Society given in 1856. Explaining their practical value as an aide memoire he claimed: ‘I have found the previous portrait of more value in calling to my mind the case and treatment, than any verbal description I may have placed on record’.19 Furthermore, the idea that the casebook itself was a repository for important but easily forgotten information was also invoked by Dr James Crichton-Browne, superintendent of the West Riding Lunatic Asylum. In his 1871 preface to the first volume of the asylum’s Medical Reports, in which he explained his publishing rationale, Crichton-Browne referred to the potential problems that could be caused if large quantities of patient, clinical, and investigative information became lost forever inside dusty casebooks. He urged the ‘utilisation of much valuable information’, information that had ‘hitherto [been] buried in case-books and diaries’ adding ‘how far it [the published version of the reports] has

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fulfilled its purpose, in rescuing from forgetfulness anything worthy of remembrance, its readers must decide’.20 From the 1880s, photographing patients for the casebook became an increasingly common practice in English asylums.21 A patient photograph’s function in this context was varied and experimental, and extended beyond the simple desire to use the photograph as a visual identity record.22 It is true that in many cases taking photographs of patients enabled doctors to put a face to a name, but as historians are becoming increasingly aware of their potential, as well as their complexity, as historical sources, the fluid and ambiguous nature of patient photography is coming to light.23 In addition, patient photos are implicated in present-day discourses on remembering the past. For Barbara Brookes, looking at patient photographs is a necessary step in ensuring ‘we’ do not forget the people in the photos; they ‘stand as a reminder of the individuality of the people who entered the asylum walls’ and ‘assist in remembering the suffering of individuals’.24 Arguably it is this intention that motivates much of the use of historical patient photographs in other public contexts like heritage and social media, the patient image standing alone as a memorial to past lives and experiences. Therefore, these patient photos, indeed like any photo, function in the present, in every subsequent viewing of the image, and can act as a tool or prompt that may help the viewer ‘remember’ historical actors. Photographs of patients operate on several levels and can carry multiple meanings. As a category or genre of medical image, asylum casebook photographs are ambiguous and complex, produced in various styles and formats through experimental and fluid practices without standard procedures or regulations, and often without any direct discussion by doctor-photographers that reveals their aims and motivations behind photographing their patients.25 However, unlike most surviving patient images, the images I discuss below are not photographs taken specifically for inclusion in the casebook, rather they are images produced elsewhere, in a professional studio, that were then added to the medical notes. Therefore, the medical officers’ motivation for including these images in the casebooks is even harder to determine than usual. Nevertheless, the inclusion of this type of photograph in the medical casebook further complicates overly simple assessments of asylum photography in particular, and medical photography more generally, that assume photographs were used in this context for straightforward or obvious reasons; again, it is what is or has been done with the photographs that

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inform their significance and meaning. Here I make the case for using, not simply photographs, but casebook photographs in particular, to consider remembrance in the asylum. By examining two examples taken from the surviving casebooks from Holloway Sanatorium, this chapter draws parallel strands together; the asylum as a place for forgotten people, the photograph as a memory aid and an object and symbol of remembrance, and the casebook itself as a container of large amounts of information that could easily be forgotten. In so doing, I consider some of the ways in which staff remembered their patients and patients remembered each other in an attempt to problematise questions around both remembrance and photography in the institution.

Remembering Photographs in the Institution Holloway Sanatorium was a private ‘hospital for the insane’ at St Ann’s Heath, Virginia Water, Surrey in the south-east of England. It was opened in June 1885 and was founded and financed by the patent medicine manufacturer Thomas Holloway (1800–1883) with the aim of filling a perceived gap in provision for patients of the middle classes who would neither enter a public asylum nor could be cared for privately at home.26 The Sanatorium’s charitable status from 1889 meant that it was required to form at least a third of its patient body from third-class patients who paid lower weekly rates. Patients from the ‘impoverished’ middle classes were then subsidised by the higher fees paid by the second and first-class patients.27 It was, therefore, an institution on a different scale and with a different remit compared to the large county and borough asylums that opened across England from the 1840s. According to figures compiled by Anne Shepherd, from 1885–1905 there were 4,073 certified and voluntary patients admitted to the Sanatorium, whereas at Brookwood Asylum, a large public institution 10 miles away in Woking, 8,891 patients were admitted in the first 30 years of operation alone (1867–1897).28 Enid C. was admitted to the Sanatorium in April 1906, aged 26. She was single and of no occupation.29 Her case notes state she was suffering her first attack of one month’s duration, the supposed cause of which was a love affair. She was in an excited state and experiencing hallucinations and delusions of hearing, smell, taste, and perception and was placed on a suicide caution. However, Enid was not a long-stay patient; five months later, in September 1906, she was discharged ‘recovered’. A further entry in November 1907 noted she ‘continued well’.30

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Asylum patients had been photographed since Diamond experimented with his patients at Surrey County Asylum in the 1850s but, by the late-nineteenth century, as photography became more familiar and accessible, many asylums adopted photographic practices in one form or another, from the regular and uniform to the intermittent and erratic. Crucially, the increased accessibility of photographic technologies in the late-nineteenth century applied to patients as well as practitioners, and it is likely that the patients at the Sanatorium were more familiar with photography, either as subjects or, indeed, photographers, than their poorer counterparts. Unlike some contemporary institutions like Newcastleupon-Tyne City Lunatic Asylum, in which patients were photographed only once, usually very soon after admission, the photographing of patients was practised on a frequent, yet unpredictable, basis at the Sanatorium.31 As a result, the surviving Sanatorium casebook archive is particularly rich and extensive in photographic material. Some patient casebooks contain hundreds of photographs of patients while others, like Casebook 17 for certified female patients admitted from August 1905 to March 1907, containing Enid’s records, does not include any patient photographs at all. However, inserted between the casebook pages is a large cut-out excerpt from an illustrated magazine advertising ‘MISS CORISANDE: The classical dancer, who recently appeared at the Æolian Hall’ (Fig. 1).32 The clipping was taken from the Illustrated Sporting and Dramatic News, from Saturday 29 May 1909, two years after the final note in her case. In its original form, the photograph of a reclining Enid takes up the foot of the printed page which shows a photo-montage of other actors and stage performers including ‘Mr Lewis Waller as Hotspur in Shakespeare’s Henry IV at the Lyric Theatre’ and ‘Mrs Gladys Desmond who was recently in Our Miss Gibbs at the Gaiety Theatre’ (Fig. 2).33 Enid is picturing reclining on her left side, leaning on her elbow which rests on a plush cushion. Her hand supports her head as she casts her eyes downwards towards her feet. She is dressed in a dark, fulllength dress decorated with beads and metallic embellishments around the neckline, under the bust and around the waist. She wears a beaded headdress covering the crown of her head while her shoulders, décolleté and arms are bare, making a striking contrast with the dark material of her gown. The character she presents in this image speaks to contemporary popular fascination with the exotic; her reclining pose is reminiscent of an odalisque and her costume carries Eastern or Grecian influences.

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Fig. 1 Case notes for Enid C., Holloway Sanatorium Case Book Females no. 17: Certified female patients admitted August 1905-March 1907, MS 5157/5160, Wellcome Collection, London

By any standards, and even in light of the variable practices at the Sanatorium, this is an unusual object to find in the medical casebooks making it a very different order of image compared to other casebook photographs for several reasons. While casebook patient photographs are by no means standardised in content, style, or material form, they are nonetheless, usually smaller and often less noticeable on the casebook page.34 In contrast to other patient images taken for the Sanatorium casebooks, probably by a member of staff and produced onsite in the dedicated photographic room, this patient image was taken by a professional photographer at Urbanora Studios, 89-91 Wardour Street, London, either specially for the magazine or commissioned by Enid or her representatives as publicity material.35 Stage performers had embraced burgeoning photographic culture since the mid-century and most photography studios catered for theatrical clientele.36 Performers like actors, singers, and dancers would send photographic portraits of

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Fig. 2 Illustrated Sporting and Dramatic News, Saturday May 29 1909, p.13 © Illustrated London News Ltd/Mary Evans

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themselves to theatre managers, booking agents, and advertisers, while negatives were distributed via image wholesalers who then supplied bookshops, newsagents, and sheet music vendors with the latest celebrity portraits.37 It should be noted that a central aim of this shrewd and profitable commercial marketing strategy was to ensure that the performer in question would not be forgotten, neither by potential employers nor the public. A further key difference with Enid’s photograph is that, unlike most casebook photographs, this image was always destined for publication or a public audience of some kind.38 Finally, the fact that no other images appear in this particular casebook makes the picture all the more striking; the other Sanatorium casebooks are full of patient photographs, therefore in the context of the surviving archive, this image, and the casebook that contains it, are very unusual examples. What has happened to the image provides insight into how casebooks were produced and photographic elements woven into them. An unknown person, possibly one of the medical officers has annotated the image by double-underlining in red pencil the caption where it reads ‘MISS CORISANDE’, the angle and direction of the pencil strokes suggesting speed and firm, deliberate intention. The magazine clipping is the only image the medical officers collected of this particular patient, an image that was produced and published almost three years after she left the Sanatorium. What are we to make of this image? Asylum casebooks contain photographs of patients for many reasons and the patient photograph as a type or category of image is an ambiguous, complex, and multi-functional object.39 However, this patient image and its temporal and material difference compared to other casebook photos makes it even more ambiguous and intriguing. We might wonder what its purpose is, especially as it can bear no influence on an active case, Enid having left the Sanatorium before the image was even taken and published, let alone collected and added to the casebook. If photographs are used as visual evidence in this context as patient photos are often presumed to be, what might this image be evidence of? Several possibilities present themselves. The clipping provides biographical evidence of the fate of the patient as she went back into the world outside the institution. Alternatively, it may function as evidence of the Sanatorium’s success in treating a young woman, who claimed during her time as a patient that she could dance and sing, enabling her to make something of her talents. It is also possible that the clipping was used as evidence of her continuing good health. It also serves

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to demonstrate the determination of the medical officers to secure an image of their patient and so complete their records. If the reader of the casebooks, who in the first instance is assumed to be the medical officer, encountered this image, either in passing as they looked for another case or because there was some reason to refer to Enid’s case in particular, were they supposed to make some connection with or inference from the image of her and her case history? What this case study does show is that staff remembered their patients. We might imagine how this came about. Did a medical officer or some other staff member read the Illustrating Sporting and Dramatic News ? Did they come across the photograph when they were browsing the pages and recognise their former patient? Was it common for staff to keep abreast of the comings and goings of former patients’ lives? This is not unprecedented as there are other instances in which newspaper clippings are added to patient case notes adding biographical detail to the fate of patients after they left the asylum.40 The final note in her case from November 1907 remarking that she ‘continues well’ certainly suggests that staff were somehow aware of the fate of some patients after they had been discharged. Furthermore, some patients continued their association with the Sanatorium after their official discharge by remaining as voluntary boarders; Shepherd calculated that from 1885–1905 a total of 1,258 male and female voluntary boarders were treated at the hospital.41 While Enid did not remain as a voluntary boarder, the fact that many patients did suggests that it was not unprecedented for some form of relationship to continue after certification ended. Therefore, although the inclusion of this type of image is highly unusual, what is less remarkable is that Enid’s case raises several questions that are left unanswered by the case notes themselves. If the magazine clipping of Enid suggests that the Sanatorium staff remembered her, my second case study considers photographic acts of remembrance between patients. Slipped between the pages of Casebook 11, for certified female patients admitted May 1898-May 1899, is a large formal portrait of a very fine-looking lady (Fig. 3).42 Hilda S., a patient at the Sanatorium from December 1904 to March 1906, stands in a professional studio setting against a painted decorative backdrop showing an imagined romantic landscape. She angles her body in three-quarter pose and looks directly into the camera’s lens. Wearing an elegant pale dress with frills, lace and flounces, a fur is draped loosely around her upper arms, a probable sign of her privileged social status and entirely in keeping

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with the social status of the typical patient at Holloway Sanatorium. Like the studio portrait of Enid, Hilda’s portrait too will have cost money to produce, and certainly more than the casebook patient photographs produced in onsite asylum photographic rooms. It is reasonable to assume that Hilda was familiar with having her portrait taken considering her social class and status. Thus, several features including the print quality, content, and staging of these two images imply they are of a different social order to the majority of casebook examples. As was often the custom when giving formal photographic portraits, across the bottom right corner of the print is written ‘Yrs Affectionately, Hilda S. Easter 1905’. On the verso is a further dedication which reads: ‘To my friend Miss L.–– in memory of some half hours of real enjoyment at St Ann’s—passed together at the piano in the Recreation Hall’ (Fig. 4).43 If the date of the inscription is correct, Hilda wrote the dedication while still a patient at the Sanatorium. Hilda was 30 years old

Fig. 3 Notes and mounted photograph of Hilda S. (c.1905), Holloway Sanatorium Case Book no. 11, certified female patients admitted May 1898-May, MS 5157/5159, Wellcome Collection, London

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when she was admitted in early December 1904 suffering from her first attack which had begun seven months previously. She was described as excitable and emotional in her conversation and ideas. Interestingly, like Enid C., Hilda also had theatrical ambitions; the supposed cause of her condition was listed as ‘insanity from theatrical failure’ and a note from May 1905 states: ‘Her belief in the career awaiting her induces her to spend her hours in practice of singing with the result that her voice is overstrained’.44 (We might wonder if, for Hilda, the portrait may also have functioned on some level as a promotional image as she imagined her prospective career as a performer.) By the time Hilda was admitted in 1904, Miss L. had already been a patient at the Sanatorium for 12 years. The timing of the inscription and the medical officer’s note implies that the older Miss L. had accompanied Hilda during these prolonged periods of singing practice. Read together, these events and the photographic object that encapsulates them, have competing meanings; Hilda experienced her relentless singing practices as ‘happy times’ around the piano with her friend, as time well spent in perfecting her talents. The reporting medical officer interpreted this activity as clinical evidence of her irrational mental state. The portrait bears no relation to the patient notes it sits between. The photograph is slipped between the pages of notes for Emma S. most probably after falling out of its original place amongst the notes of either Hilda, which appear in Casebook 16 or of Miss L., a voluntary boarder at the Sanatorium from 1892–1913.45 As a loose object, its original place in the casebook and the way in which it was collected and then used in relation to the medical notes is hard to determine. Asylum medical officers often collected patient letters and other writings as clinical evidence of a patient’s distress levels or coherence, as well as samples of patient handwriting; Hilda’s case notes also mention her 125-page ‘resumé of her life’ (from 1904 onwards) which was kept by medical officers.46 Therefore, it is possible that this photograph functioned, for the medical staff at least, in a similar way as an object of clinical interest. However, despite the uncertainty caused by the photograph becoming materially unmoored, when it comes to its meaning as a photograph, here we have a portrait being used in a very familiar and conventional way. The phrase ‘in memory of’ clearly identifies it as a memento of times past, as an object of exchange between two people who cared for each other, and shared experiences while they were being treated at the Sanatorium at the same time. In many ways, this photograph epitomises Elspeth Brown

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Fig. 4 Notes and verso of mounted photograph of Hilda S. (c.1905), Holloway Sanatorium Case Book no. 11, certified female patients admitted May 1898-May, MS 5157/5159, Wellcome Collection, London

and Thy Phus’ double meaning of ‘feeling photography’.47 As an object, the photograph is held and felt when it is received and must be turned over in the hands to read the dedication. The photograph and its inscription, and the intention behind its giving, then function as a prompt to or sign of feeling, of affection between two friends. In this way, the haptic, emotional, material, and visual qualities of this photographic exchange combine to produce its original meaning. Therefore, while the medical officers’ reasons for keeping the photograph are uncertain, it is clear that the original intention behind its gifting was one of remembrance and commemoration. In considering this photograph, the example of family photography is instructive. In her discussion of family photography, Hirsch pays particular attention to the mother-daughter relationship expressed in and through photographs, as a set of photographic moments between two women.48 For Rose, women are also at the heart of family or domestic

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photos; Rose found that women are the ones who ‘do things’ with photographs, they carry out the ‘photo work’ of arranging, sorting, dating, framing, and giving.49 In this example from the Sanatorium too, we have women doing ‘photo work’ in the form of photographic gifting, but in, on the surface at least, a very different space or environment. Yet it is well known that asylums were constructed as domestic or familial spaces and, like the family, the institution was a place of human relationships and interactions.50 The Sanatorium was particularly invested in efforts to foster a domestic and familial atmosphere; ‘companions’ were employed to live amongst the patients51 and Shepherd notes that the luxurious surroundings of the Sanatorium ‘were designed to make [the patients’] transition from home to institution easier. The preservation of normality by the creation of a homely but luxurious environment was believed to aid patient recovery’.52 Moreover, the earlier Holloway Sanatorium casebooks contain several group shots of patients, arranged in a conventional style typical of amateur family photography.53 Therefore, in giving a portrait of herself to Miss L., Hilda S. was engaging in an entirely conventional and familiar (familial even) photographic practice built around the central place of photography in remembrance and network-building. However, this practice was ultimately subverted; the photograph never fulfilled its intended purpose but was instead inserted into the medical casebook. We may well wonder if Miss L. ever saw the photograph of her friend.

Temporal and Spatial Disruption Much like Rose’s family photographs that connect relatives across time and space, the photographs of both Enid and Hilda stretch spatially and temporally beyond the asylum walls. The expected temporality of the patient photo is disrupted by Enid’s image. In contrast to practices at some other contemporary asylums, there were no set times when patients would be photographed at the Sanatorium; some patients were photographed quite soon after admission while others were photographed only after they had been there for many years, and some not at all. The image of Enid then, placed into the casebook nearly three years after her discharge, when she was no longer a patient and, according to the notes, ‘recovered’, subverts the standard temporal narrative of a case history. There is no photograph of Enid taken while she was a patient to compare with her image as Miss Corisande. Therefore, there is no sense of a before

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and after, a pre- and post-recovery visual record, or the magazine image as acting as a visual counterpart to an image showing a disordered patient placed earlier in the case notes. What this image does create is a temporal and spatial link between a person’s life outside the asylum to their records inside. It is a reminder that many patients were somewhere else after (and before) the asylum, and that their lives should be defined beyond their experiences inside the institution.54 This temporal disruption extends to the viewer’s perspective too; it is highly unusual and, therefore, disorientating to see an image of ‘a patient’ taken after they have left the asylum, an encounter that historians of psychiatric institutions rarely experience. As a prompt to memory, in remembrance of ‘happy times’, Hilda’s portrait is intended to transcend these boundaries as a token or marker of past times. In contrast, when Enid is photographed as Miss Corisande, the photograph shows the patient in the future, creating, at least in relation to the case notes, a disorientating effect. Presence and absence then, components of Hirsch’s ‘constitutive core’ of photography are clearly at work here. While Rose suggests that ‘family photos articulate absence, emptiness, and loss as well as togetherness’,55 I argue that these two examples show that this can be applied effectively in different material and discursive contexts and to different types of photographs.

Networks, Relationships, and ‘Circuits’ of Feeling It is becoming increasingly evident that asylums should be considered in terms of networks and relationships. Psychiatric institutions operated within networks of other institutions like workhouses, prisons, and hospitals and also had a place in wider communities and in networks of care involving families and friends.56 Inside the institution, too, networks were created as patients and staff formed relationships of various sorts with each other. While the concept of a network has been used to reconsider everyday experiences of patients, families and staff, and the practical workings of life inside the asylum, this has not been applied so readily to the idea of forgetting and remembrance. The photographs of both Enid and Hilda make this possible and show that just as approaches within the history of the family can be used to shed light on the history of mental ill-health, so too can histories of family photography.57 Clearly, a person or persons at the Sanatorium remembered Enid, extracted the magazine image, located her case notes and inserted the clipping amongst them. This act stretched and disrupted temporal and spatial boundaries certainly,

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but in addition it formed a link, a relationship between Enid the patient and Miss Corisande the classical dancer. The photograph of Hilda, dedicated to Miss L. is more direct evidence of another version of a network, a friendship in this case. Rose describes the ‘memberships’ that family photographs create; it is these feelings of membership that are activated when things are done with photos—sending to distant relatives, arranging in family groups on the sideboard, up a staircase, or in an album, and while carrying out the photo-work of looking and viewing.58 In giving a photograph of herself to her friend, and regardless of whether her friend received it or not, Hilda sought to create a bond between herself and Miss L. Moreover, her dedication and the scene it describes of two women around a piano in the recreation hall creates the ties of membership experienced by two patients who experienced the Sanatorium at the same time. However, this particular network extended beyond Hilda and Miss L. Miss L.’s (Cornelia’s) case notes reveal that she was a voluntary patient at the Sanatorium for 21 years from 1892–1913. She was very fond of music and a talented pianist; her enjoyment of music is mentioned in the first few lines of her case notes on admission, and the medical officers noted that how to play the piano seemed to be the only thing she could remember how to do. Cornelia’s story told in her case notes is one of a long-stay patient, with slowly failing health.59 However, as well as being friends with Hilda she was also known to Enid. She had accompanied Enid on the piano, who wrote in a letter affixed to her notes: ‘I knew Miss L. was a genius the moment I heard her play and I had complete proof of it this morning, the way she accompanied me when I sang – because I did not follow the song as it is written’.60 Thus Hilda’s photograph ‘rescues from forgetfulness’61 a web of individual connections between patients and staff which would have been lost if her portrait had not been kept inside the casebook. As Hirsch argues, the viewer, too, is fully implicated in these networks. However, while for Hirsch it is the ‘looks’ of familial recognition between viewed and viewer in a photograph that consolidate family relationships and ties, for example, when we see our own facial traits in the photograph of a relative,62 in the two cases discussed here it is what is done with and to the photograph that reinforced ties between the historical actors then and subsequent viewers since. By giving her friend a dedicated and signed photograph of herself, Hilda tapped into what Brown and Phu describe as the ‘active emotional circuit between the viewer and the photograph’.63 ‘Circuit’ is a fitting term here because it brings us

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back full circle to remembering and remembrance in several ways. Firstly, the portrait embodies shared memories between two women. Secondly, whoever placed the magazine clipping into the casebook had to have remembered Enid as a patient, bearing in mind that it is possible that remembering was easier for staff in a smaller, more exclusive institution like Holloway Sanatorium. Finally, it was through researching these two highly unusual casebook photographs that the interconnections between the three women, their case notes, and their photographs were revealed.

Conclusion Using theoretical and analytical frameworks that have been applied to other types of photograph can help us consider more deeply patient images and the role photography played, not only in casebooks, but also in asylum life. By applying analytical principles from family photography to photographs of patients, we are able to show that in the case of Enid C, Hilda S. and Cornelia L., at least, patients were not forgotten; they were remembered both by staff and by each other. In both cases it is not necessarily the content of the patient images that is relevant here, after all, the casebooks from Holloway Sanatorium and countless other asylums contain many formal or ‘unusual’ portraits of patients. Rather it is the use that the photographs are put to in this explicitly medical and institutional context that is important. Just as Rose focuses in on what is done to and with family photos to uncover their meaning and significance, it is by considering what was done to and with the photographs of Enid and Hilda that we can begin to provide insight into the way remembrance operated in the Sanatorium. If we had limited ourselves to the confines of the immediate records, what is said about photography in the case notes and in other administrative documents, we would not find many answers. Only by thinking beyond the asylum to consider patient photographs in the wider context of photographic practices more generally can we gain a deeper understanding of not only of how patients were remembered and how they remembered each other, but the role photographs played in that process. Cornelia played the piano for Enid and also for Hilda. Hilda wished to be remembered by Cornelia, she wanted her friend to remember the ‘happy times’ they had spent together so she gave her a portrait. Enid remembered Cornelia, she wrote about her in her letter, and the medical staff remembered Enid so they kept a magazine feature about her, which also happened to be a photograph.

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In this way, a web or network of photographic exchanges and remembrances developed, between the women in the photographs and between the photographic objects themselves. Just as in the family space women’s relationships with their family photos ‘articulate absence, emptiness and loss as well as togetherness’,64 so too in the institution.

Notes 1. Andrew Scull, ‘The Insanity of Place’, History of Psychiatry, 15 (2004), 417–436, 422. 2. Ibid., 428. 3. Andrew Scull, Museums of Madness: The Social Organisation of Insanity in England (London: Allen Lane, 1979). 4. Scull, ‘Insanity of Place’, 425. 5. Catharine Arnold, Bedlam! London and Its Mad (London: Pocket Books, 2009), 5. 6. Peter Bartlett and David Wright (eds.), Outside the Walls of the Asylum: The History of Care in the Community 1700–2000 (London: Athlone Press, 1999); Graham Mooney and Jonathan Reinarz (eds.), Permeable Walls: Historical Perspectives on Hospital and Asylum Visiting (New York: Rodopi, 2009). 7. Jade Shepherd, ‘Life for the Families of the Victorian Criminally Insane’, The Historical Journal, 63 (2020), 603–632. 8. Robert Ellis, London and its Asylums, 1888–1914: Politics and Madness (London: Palgrave Macmillan, 2020), 64, n.177. 9. The phrase ‘lost in the system’ is from ibid., index. 10. Roland Barthes, Camera Lucida: Reflections on Photography (trans. Richard Howard) (London Vintage books, 2000, 1st pub. in trans 1981, orig. in French 1980); Annette Kuhn, ‘Photography and Cultural Memory: A Methodological Exploration’, Visual Studies, 23 (2007), 283–292; Marianne Hirsch, Family Frames: Photography, Narrative and Post-memory (Cambridge MA: Harvard University Press, 1997). 11. Jennifer Green-Lewis, Framing the Victorians: Photography and the Culture of Realism (Ithaca and London: Cornell University Press, 1996). 12. Susan Sontag, ‘Melancholy Objects’, On Photography (London: Penguin, 1977), 51–82, 70. 13. Hirsch, Family Frames, 4. 14. Gillian Rose, ‘Family Photographs and Domestic Spacings: A Case Study’, Transactions - Institute of British Geographers, 28 (2003), 5–18: 8. 15. There is a large literature addressing the different roles women had and have in photography such as Val Williams, The Other Observers: Women Photographers in Britain 1900 to the Present (London: Virago, 1991). For

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16. 17. 18.

19.

20. 21. 22.

23.

24.

25. 26. 27.

28. 29.

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a brief introductory overview see Liz Wells, ‘Women and Photography’ Robin Lenman and Angela Nicholson (eds.), The Oxford Companion to the Photograph (Oxford: Oxford University Press, 2005). Rose, ‘Family Photographs’, 12. Ibid., 7. See for example Katherine D. B. Rawling, ‘“The Annexed Photos were Taken Today”: Photographing Patients in the Late-Nineteenth-century Asylum’, Social History of Medicine 34 (2021), 256–284. Hugh W. Diamond, ‘On the Application of Photography to the Physiognomic and Mental Phenomena of Insanity’ (1856) reprinted in Sander L. Gilman, The Face of Madness: Hugh W. Diamond and the Origins of Psychiatric Photography (New York: Brunner/Mazel, 1976), 19–24: 24. James Crichton-Browne (ed.), The West Riding Lunatic Asylum Medical Reports (London: J&A Churchill, 1871), iv. Emphasis added. Rawling, ‘“The Annexed Photos”’. Ibid.; Katherine D. B. Rawling, ‘“She Sits All Day in the Attitude Depicted in the Photo”: Photography and the Psychiatric Patient in the Late Nineteenth Century’, Medical Humanities, 43 (2017), 99–110. See ibid. and also Rory du Plessis, ‘Beyond a Clinical Narrative: Casebook Photographs from the Grahamstown Lunatic Asylum, c. 1890s’, Critical Arts, 29 (2015), 88–103; Susan Sidlauskas, ‘Inventing the Medical Portrait: Photography at the ‘Benevolent Asylum’ of Holloway, c.1885– 1889,’ Medical Humanities, 39 (2013), 29–37. https://doi.org/10. 1136/medhum-2012-010280; Caroline Bressey, ‘The City of Others: Photographs from the City of London Asylum Archive,’ 19: Interdisciplinary Studies in the Long Nineteenth Century, 13 (2011). http://doi. org/10.16995/ntn.625. Barbara Brookes, ‘Pictures of People, Pictures of Places: Photography and the Asylum’, Catherine Coleborne and Dolly Mackinnon (eds.), Exhibiting Madness in Museums: Remembering Psychiatry (London: Routledge 2011), 30–47, 31. Emphasis added. Rawling, ‘“The Annexed Photos”’. No author, ‘The Holloway Sanatorium: Opening by the Prince of Wales’, The Standard, 16 June 1885, issue 19008, 3. Anne Shepherd, ‘The Female Patient Experience in Two Late-NineteenthCentury Surrey Asylums’, Anne Digby and Johnathan Andrews (eds.), Sex and Seclusion, Class and Custody: Perspectives on Gender and Class in the History of British and Irish Psychiatry (Amsterdam and New York: Rodopi, 2004), 223–248: 227. Ibid., 228, 231. Female patients might also be listed as ‘gentlewoman’ in the casebooks. Shepherd notes that in 1893, 85% of female admissions had no occupation and were ‘of good social standing’. Ibid., 232.

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30. Case notes for Enid C., Holloway Sanatorium Case Book Females no. 17: Certified female patients admitted August 1905–March 1907, Wellcome MS. (hereafter WMS.) 5160, 166. 31. There were no standard rules governing the use of photography in asylums in the period and institutions developed their own practices according to the particular priorities and inclinations of the staff and governing authorities. As such it is impossible to make general claims about patient photography at the time. For detailed discussions of patient photography and of Holloway Sanatorium in particular see Rawling, ‘“The Annexed Photos”’ and Rawling, ‘“She sits all day”’. 32. This is the Enid’s stage name and not the name she is listed under in the Sanatorium records. 33. Illustrated Sporting and Dramatic News, May 29, 1909, 13. 34. See my comparison of different asylum photographs in Rawling, ‘“The Annexed Photos”’. 35. The Sanatorium was equipped with its own photographic room in 1889. The Medical Superintendent’s Report for the year 1889, recorded in Fourth Annual Report of Holloway Sanatorium, Registered Hospital for the Insane for the year 1889 (London: John Barker and Co., 1890), 17. 36. David Mayer, ‘“Quote the Words to Prompt the Attitudes”: The Victorian Performer, the Photographer, and the Photograph’, Theatre Survey, 43 (2002), 223–251, 227–228. 37. Ibid., 229. 38. This is not to say that no other casebook patient photographs were ever either published or viewed by a more ‘public’ audience; there are examples in which casebook images were published in doctors’ medical writing. See Rawling, ‘“She Sits All Day”’, 104. 39. See ibid. and Rawling, ‘“The Annexed Photos”’. 40. For a discussion of newspaper clippings in casebooks see Katherine D. B. Rawling, Photography in English Asylums, c.1880–1914: The Institutional Eye (London: Palgrave Macmillan, 2020). 41. Shepherd, ‘The Female Patient Experience’, 231. 42. Notes and mounted photograph of Hilda S. (c.1905), Holloway Sanatorium Case Book no. 11 (Certified female patients admitted May 1898–May), WMS.5159, inserted between pp. 95–96. 43. Mounted photograph of Hilda S. (c.1905), Holloway Sanatorium Case Book no. 11, certified female patients admitted May 1898-May, WMS 5157/5159, inserted between pp. 95–96, verso. 44. Case notes for Hilda S., Holloway Sanatorium Case Book Females (Certified female patients admitted February 1904–August 1905), Surrey History Centre (hereafter SHC.) 3473/3/8, 257–62, 257, 262. 45. Ibid., 257–262; case notes for Cornelia L., Holloway Sanatorium Case Book Females (Voluntary Boarders admitted March 1890–March 1897), SHC. 3473/3/28, 3–6, 10, 16, 18, 26, 29–30.

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46. Case notes for Hilda S., SHC. 3473/3/8, 257–62. Doctors transcribed extracts of Hilda’s ‘resumé’ as evidence of her delusions and religious excitement on pp. 260–261. For insight into the use of patient letters by medical staff see Allan Beveridge, ‘Life in the Asylum: Patients’ Letters from Morningside, 1873–1908’, History of Psychiatry, 9 (1998), 431–469, in particular 434–435; Rebecca Wynter, ‘“Horrible Dens of Deception”: Thomas Bakewell, Thomas Mulock and Anti-Asylum Sentiments, c. 1815– 1860’, Thomas Knowles and Serena Trowbridge (eds.), Insanity and the Lunatic Asylum in the Nineteenth Century (London and New York: Routledge, 2016), 11–28, 20. For contemporary doctors’ views on the handwriting of the insane see G. Mackenzie Bacon, On the Writing of the Insane (London: John Churchill and Sons, 1870) and L. Forbes Winslow, Mad Humanity: Its Forms Apparent and Obscure (London: C&A Pearson, 1898). 47. Elspeth H. Brown and Thy Phu (eds.), Feeling Photography (Durham and London: Duke University Press, 2014), 14. 48. Hirsch, Family Frames. 49. Rose, ‘Family Photographs’. 50. The role of domesticity and homeliness is discussed widely in the literature on nineteenth-century asylums. A recent study is Jane Hamlett, At Home in the Institution: Material Life in Asylums, Lodging Houses and Schools in Victorian and Edwardian England (Houndmills: Palgrave Macmillan, 2015). 51. Superintendent’s First Annual Report for 1886 in First Annual Report of Holloway Sanatorium: Registered Hospital for the Insane for the Year 1886 (London: John Barker, 1887) as cited by Shepherd, ‘The Female Patient Experience’, 226. 52. Shepherd, ‘The Female Patient Experience’, 226. For a discussion of the homeliness of private asylums, including Holloway Sanatorium, see Hamlett, At Home in the Institution, 38–61. 53. See for example the first casebook, Holloway Sanatorium Casebook June 1885–January 1889, SHC.3473/3/1. 54. Bressey, ‘The City of Others’. 55. Rose, ‘Family Photographs’, 7. 56. The connections between different types of Victorian institution were a key finding of revisionist historiography of the nineteenth-century asylum; see for example the collection of essays in Joseph Melling and Bill Forsythe (eds), Insanity, Institutions, and Society, 1880–1914: A Social History of Madness in Comparative Perspective (London: Routledge, 1999). For a more recent study of the circulation of people around and between different local institutions see Cara Dobbing, ‘An Undiscovered Victorian Institution of Care: A Short Introduction to the Cumberland and

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58. 59. 60. 61. 62. 63. 64.

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Westmorland Joint Lunatic Asylum’, Family and Community History, 19 (2016), 3–16, https://doi.org/10.1080/14631180.2016.1144957. David Wright, ‘Getting Out of the Asylum: Understanding the Confinement of the Insane in the Nineteenth Century’, Social History of Medicine, 10 (1997), 137–155, applies approaches to the history of the family to the question of why the insane were confined. Rose, ‘Family Photographs’. Case notes for Cornelia L., SHC.3473/3/28, 3–6, 10, 16, 18, 26, 29–30. Enid C., letter inserted in case notes, WMS.5160, inserted between 165– 166. Crichton-Browne (ed.), West Riding Medical Reports (London: J&A Churchill, 1871), iv. Hirsch, Family Frames, 2. Brown and Phu, Feeling Photography, 13. Rose, ‘Family Photographs’, 7.

The Institute for Imbecile Children: Remembering the Lives and Experiences of the Patients Rory du Plessis

The Alexandra Hospital in Cape Town celebrated its centenary in 2021, thus making it the oldest operational facility in South Africa for the care of adults, adolescents and children with intellectual or learning disabilities. The centenary offers an opportune moment to address Don Foster’s lament, levelled in 1990, that ‘[a]lmost nothing has been written about the history’ of intellectual or learning disability in South Africa.1 Regrettably, over two decades later, Foster’s declaration still stands true. Works devoted to the history of intellectual or learning disability in South Africa are covered only by Foster and M. Minde, whose primary focus is on the history of the legal provisions and institutions for the care of people with intellectual or learning disabilities.2 Although their work is groundbreaking, by concentrating solely on the history of institutions and the law, one can argue that they inadvertently relegated people with intellectual or learning disabilities to ‘non-speaking, supporting roles … that

R. du Plessis (B) University of Pretoria, Pretoria, South Africa e-mail: [email protected]

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 R. Wynter et al. (eds.), Memory, Anniversaries and Mental Health in International Historical Perspective, Mental Health in Historical Perspective, https://doi.org/10.1007/978-3-031-22978-7_8

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tell us little about their lives’.3 In this chapter, although I also focus on a specific institution, I use the casebook of the Institute for Imbecile Children, from 1895 to 1913, with the aim of exploring the lives and experiences of the children.4 While Alexandra is the oldest facility that is still in use, the first facility for people with intellectual or learning disabilities in South Africa—and more broadly, the first on the African continent5 —was the Institute for Imbecile Children. The Institute opened in 1895 on the grounds of the Grahamstown Lunatic Asylum (hereafter ‘the Asylum’) in Makhanda (formerly known as Grahamstown).6 In the late nineteenth century, the town was a commercial settlement with close proximity to the eastern border of the Cape Colony.7 Dr Thomas Duncan Greenlees (1858–1929) founded the Institute and was appointed as its visiting medical officer from its inception to 1907. In addition to this appointment, Greenlees held the post of medical superintendent of the Asylum, from 1890 to 1907, and was appointed as the surgeon-superintendent of the Chronic Sick Hospital from 1890 to 1903.8 The Institute was envisaged by Greenlees as a place for children who could be ‘trained and educated, so as to become useful units in the world’s hive of industry’.9 Contrary to his intention, however, the population of the Institute consisted of children in which there were very few ‘prospects of mental improvement’.10 Greenlees deplored the ‘hopeless condition’ of the Institute’s patient population and bemoaned that ‘[w]hile we are filling our beds with such hopeless cases any attempt at education would seem to be an utter farce’.11 Owing to the ‘hopeless cases’ admitted to the Institute, Greenlees remarked that the Institute had failed to fulfil ‘the functions for which it was originally designed’.12 Greenlees’s loss of faith in the Institute set in motion its slow demise: in 1905, the ‘systematic education’13 of the children was abandoned, and the last admission to the Institute took place in September 1913. While the Institute was unsuccessful in educating and training the children, it was remarkably successful in creating a ‘home for the care and nursing’ of the children where the staff aimed to make their ‘little patients as comfortable and happy as possible’.14 The Institute’s annual reports seek to demonstrate that the staff were committed to the care and wellbeing of the children by maintaining their bodily health, and offering them a diverse array of amusements and recreations. The consideration of the Institute as a ‘place of sanctuary, a place of care’15 for the children, and how it provided them with positive experiences, is the focus

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of this chapter.16 In pursuing this area, I do not claim that institutionalisation was free from instances of neglect, abuse and harm.17 Rather, in accordance with Stef Eastoe, it is an acknowledgement that a focus on only the negative aspects of institutionalisation runs the risk of further stigmatising the ‘asylum and the idiot in history’.18 The exploration of the life stories and experiences of the children relies chiefly on the accounts recorded in the casebooks. While casebooks are regarded to be the ‘principal primary source’19 in historical studies of the lives of people with intellectual or learning disabilities,20 they are also riddled with limitations and problems. For example, the casebook medium is often predominated by a pathologising and dehumanised construction of the children. Nevertheless, in between the scornful portrayals of the children are ‘snapshot[s] of past lives lived, traces of voice and echoes of experience’.21 In the exploration offered in this chapter, I have sought to highlight evidence of such snapshots. Nevertheless, I do not claim that such evidence presents an unmediated account of a patient’s voice, or an inclusive biography of a patient.22 Rather, I claim that the evidence provides a valuable resource for painting a humane portrait of the Institute’s children. The result thereof is the development of a ‘useable past’23 for people with intellectual or learning disabilities. Thus, rather than rehearsing the ‘“low” value which has historically been attributed to people with learning disabilities’,24 I seek to show how the memory of their lives ought to include facets of them having experienced or encountered ‘a good life’,25 and how they ought to be remembered as ‘a presence in this world that should be expressed in positive terms’.26 The Institute’s casebook contains the cases of 101 children, of which 51 were female and 50 were male. The institute was reserved for white children—this feature is indicative of the racist and segregationist ideologies of the Cape Colony,27 as well as broader colonial histories,28 whereby the coloniser and colonised were housed in separate wards or sites.29 On opening, the Institute housed 15 children, and by 1904, it had accommodation for 28 children (14 in the male ward, 14 in the female ward). For the period 1895 to 1904, the average number of children residing in the Institute was 19. The Institute’s casebook identifies that there were 43 cases of epilepsy, 30 cases of paralysis and 43 cases of mutism. Ten of the children were recorded as being multiply disabled, as they were diagnosed with epilepsy, paralysis and mutism. This study is delimited to the cases for the children who, owing to multiple factors, required lifelong institutional care.30 Significantly, for the children who were later admitted to

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the Asylum, a glimpse is provided of their late adolescent and adult lives through the entries recorded in the Asylum’s casebooks. The chapter is divided into four main parts. First, I investigate the various routes to the Institute. The discussion identifies the diverse healthcare and welfare sites that the children encountered before being admitted to the Institute. The discussion also seeks to identify several themes in the casebook that may point to some of the factors and reasons for the families of the children seeking their commitment to the Institute. Second, in developing a ‘useable past’ for the children, I focus my attention on the casebook entries that details how the children lived meaningful lives at the Institute and benefitted from its therapeutic regimen. Third, I identify the healthcare facilities that provided for the children’s care once they were transferred from the Institute. Of significance, I explore the casebooks of the children who were transferred to the Asylum to discuss the continuation of their life story. Fourth, I offer a reading of three patient photographs to include the casebook content that pertains to the children’s life history. This interpretative strategy offers the viewer an invaluable testimony of the individuality and humanity of the patients. In the Institute’s annual reports and casebook, the children were diagnosed as suffering from either idiocy or imbecility. In the ensuing discussion, I have opted to use these terms instead of the current terminology of intellectual or learning disability. The basis thereof stems from a recognition that the terminology of imbecility and idiocy during the period under study ‘are products of and contingent upon specific social and intellectual environments, and perform specific functions within those environments’.31 Nevertheless, I have endeavoured to minimise the use of the said terminology, and by identifying the children by their first names, I have sought to foreground an emphasis on their individuality.

Routes to the Institute Some children were admitted to the Institute as transfers from various healthcare and welfare sites. Edith was admitted to the Institute in November 1895 from the Old Somerset Hospital in Cape Town where she was a patient for two years.32 For Isabella, the route to the Institute included numerous transfers between multiple sites. Isabella’s journey started at a hospital in Kimberley before she came under the care of St Peters Home, a welfare home and orphanage in Grahamstown. Thereafter, in 1891, she was admitted to the Chronic Sick Hospital (CSH).33

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The sites encountered by Edith and Isabella were overwhelmingly illsuited for their care. The Old Somerset Hospital was an institution of ill repute reserved for ‘lunatics, lepers, paupers, and the chronic sick’34 that has been described as the ‘bedlam’ of the Cape.35 The CSH, situated three miles from the Institute, admitted patients who were ‘infirm from old age or physical disease’.36 Both of these hospitals were neither earmarked nor resourced to care for imbeciles and idiots, and therefore it is likely that the care they offered to Edith and Isabella was minimal. Moreover, the adult patient body of the hospitals would surely have increased the children’s vulnerability and risk of being exposed to violence, abuse and harm.37 The Institute’s casebook does not provide comprehensive insight into the array of reasons that informed a family’s decision to commit their child; nevertheless, there are several themes in the casebook that may point to some of the factors that informed their decision. A domestic context marked by tragedy and poverty figures prominently in numerous pages of the casebook. Christian was found by the authorities to be unattended and locked up in his home. On interrogating the father, the authorities ascertained he was a drunkard, and Christian’s mother was dead. The father confessed that he resorted to locking Christian in the house when he left for work, as he had no one to watch over him.38 More broadly, the death of a parent features prominently in the cases admitted to the Institute. For instance, Gideon’s admittance to the Institute was preceded by the death of both of his parents.39 A family’s loss of a breadwinner or a primary caregiver, as well as families besieged by poverty and financial woes, were significant issues that contributed to their incapacity to provide continued care for their children.40 For these families, it is possible to suggest that the admittance of their child to the Institute was ‘an act of care, not of exclusion’41 as it offered a guarantee to the families that their children would have access to food and healthcare. While this is a hallmark of the cases investigated in this chapter, it is important to underscore that the low number of admissions to the Institute is indicative of families who shunned institutional care for their children. Greenlees remarked that one factor to account for the low admittance to the Institute was a mother’s ‘maternal instinct [being] so keen that she cannot part with her hopeless progeny’.42 Another pertinent factor for the low admittance of patients was the Institute’s connection with the Asylum that resulted in prejudice ‘in the eyes of parents’.43

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For the children with epilepsy, the severity and frequency of seizures was an important feature in the medical certificates contained in the casebook. Gertrude’s epilepsy commenced when she was nine months old, after which her family embarked upon various medical treatments that over several years ‘gave no good results’. She was admitted to the Institute at the age of 12 with the frequency of her seizures being a defining feature of her medical certificates.44 Arthur suffered his first epileptic seizure when he was nine years old. By the time of his admittance to the Institute, his epileptic seizures were characterised by their severity and the high rate of recurrence.45 It is reasonable to suggest that for the families of children who also suffered from epilepsy, the medical care needs of the children could be better met by the Institute than by home-based care.46 A large proportion of children were admitted to the Institute as low-grade idiots and imbeciles with multiple disabilities. It is imperative to recognise the significant challenges that the multiple disabilities of these children posed to their continued wellbeing, physical health and to their lived realities. Johanna was suffering from epilepsy, partial paralysis and mutism; she had ‘little control of herself’ and required constant supervision.47 The trio of brothers, Bartholomew,48 Diederick49 and Johannes,50 were all suffering from varying degrees of paralysis and were classified as low-grade idiots and imbeciles. In particular, Bartholomew was ‘bedridden’ and required assistance in every way possible. Matthys entered the Institute suffering from hydrocephaly, deafness, muteness and severe visual impairment.51 A trope that is shared in the majority of these cases is the Institute’s staff noting that, on admission, the children were in a ‘dirty and neglected condition’.52 It is possible to infer that the condition of the children points more to the limitations of home-based care, and less to uncaring on the part of family members. Many of the children required assistance with feeding, eating, washing, dressing and various physiological functions. The optimal form of this assistance necessitated caregivers to monitor and support the children throughout the course of the day and night. For most families, it is likely that they did not have the resources to provide optimal home-based care. Nevertheless, the age of the children on admission provides evidence that their families offered a form of care that preserved and sustained their lives. By way of example, Matthys was admitted to the Institute when he was 12 years old, which means that despite his multiple disabilities and being ‘utterly helpless so far as self help is concerned’,53 his family provided a degree of nurturing

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that maintained his health and supported his continued existence for several years. The discussion has drawn attention to the role of the Institute in providing shelter and care for children whose families had unfavourable domestic circumstances, or a space that offered constant medical supervision, care and treatment for children who were either suffering from epilepsy or were multiply disabled. Nevertheless, we cannot discount the fact that children most certainly experienced stress and anxiety from being separated from their homes and families.54 One example of this is William who was most heartbroken by his admission to the Institute; he expressed his feelings to Greenlees, saying that ‘his mother threw him away’.55

Daily Life and Experiences at the Institute In the annual reports of the Institute, Greenlees propagated a discourse of the children as ‘deficient’. He bemoaned that a large proportion of the Institute’s admissions were ‘not only defective mentally but likewise physically’ and were regarded as ‘sadly deficient in the barest capabilities of taking care of themselves’.56 In this discourse, the focus was on the children’s impairments as well as the dissemination of a stigmatised conception of the children as a homogenous grouping of ‘the most hopeless and helpless of stray waifs of humanity’.57 In propagating this discourse, Greenlees excluded evidence from the Institute’s casebook of the children who improved in physical mobility, and who completed commendable ward duties. Accordingly, in the discussion that follows, although the casebook documents that the children made poor progress in their lessons on the alphabet and counting, some were nevertheless able to walk better, while others were valued for their abilities to undertake skilled work, do ward duties and assist with the caregiving of other children. For the children who were suffering from paralysis, muscle atrophy and infantile paralysis (polio), the Institute’s incorporation of gymnastic exercise into its therapeutic regimen aided the development of the children’s muscles and mobility.58 Sam was described to be ‘[m]aking wonderful progress in his walking’, having been unable to walk prior to entering the Institute. Although Sam walked unsteadily, it did not hamper his moseying movements at the Institute and engaging in spirited exploits, to such an extent that later casebook entries described him as a ‘restless

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mischievous little chap’.59 Sophia was described in the admission documents as semi-paralysed and ‘[b]asically helpless’. In contrast to this feeble figuration of Sophia, at the Institute her physical improvement was manifest in her ability to wash herself with the help of the nurses, and to go out for walks.60 The documents that supported the application for Maria’s admittance to the Institute outlined that she was in a poor physical condition, was unable to walk, and with regard to her mental ability was deemed to be ‘incapable of improvement’. Nevertheless, after two years at the Institute, Maria gained strength in her legs and would hold onto railings to move about. Her physical strength and mobility continued to progress and eventually she would wander about the Institute by holding onto the furniture.61 By propagating a discourse of deficiency, the doctors omitted or silenced casebook narratives where the children were lauded for their ability to perform ward duties and to execute skilled tasks. On the one hand, we need to be cognisant that such expressions of praise are indicative of the Institute’s need for industrious patients who offered economic benefits to the establishment, by reducing its day-to-day running costs.62 On the other hand, the work duties assigned to the children can be regarded as their being included in the ‘rituals and routines’63 of the Institute. In this way, in contrast to a dehumanised construction of the children as deficient and hopeless, they are ‘defined as an integral part’64 of the Institute, as they performed valuable roles, and even made unique contributions. The casebook indicates that the girls assisted with housework, the boys at gardening, and the more able and older children would assist in the care, feeding and dressing of those who were younger and feebler. In Danielina’s case notes, for example, we are confronted by entries that describe her as suffering from microcephaly and her ‘mental reaction’ as ‘practically nil’, yet she was also lauded for being able to do housework and to help with the other children.65 For several of the children their work duties were an important source of self-worth.66 Arthur took much interest in gardening. Not only was Arthur ‘happy at gardening’, he was also so conscientious and zealous in his work that he became solely responsible for managing one of the Institute’s gardens. This responsibility entitled Arthur to a form of parole, in which he could work in his garden unaided and without staff supervision. Thus, Arthur’s work ethic and enthusiasm was rewarded by the Institute granting him the privilege and independence to work outside the wards, and to have a measure of self-direction in tending the garden, to realise his

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personal vision for the space.67 In broad outline, it is worth noting that while some patients received praise from the staff for executing the tasks assigned to them, and while others gained self-worth from accomplishing duties, neither of these aspects provided the children with efficacious pathways or discharge routes from the Institute. In the case notes for those children with multiple disabilities and who were classified as low-grade idiots and imbeciles, while there is an inordinate focus on the children’s disabilities, this does not mean that the children lived a life defined by experiential poverty. Rather, the case notes contain evidence of the children experiencing pleasure and expressing happiness. Christian delighted in singing and was described to be ‘happy enough in his own way’.68 Catherine brimmed with a pleased expression at the sight of bright objects,69 and Diederick was happy to sit on the veranda of the Institute.70 Eva Feder Kittay suggests that it is only when we consider a person in terms of the ‘fullness of [their] joys and capacities that we can view [their] impairments in light of [their] life’.71 In following this line of reasoning, once we recognise the children’s expressions of happiness and pleasure, we can comprehend their lives to be rich in experiences rather than lives solely defined by the dominant clinical narrative of the casebook, and by incapacity. Thus, Diederick’s inability to walk or speak, and Catherine’s supposed lack of educational abilities, are only one part of their life stories. The other part is constituted by their capacity for pleasure and happiness. In the casebook entries for Christian, while some portrayed him to be a ‘hopeless idiot, dirty, unable to do anything for himself and cannot speak a single word’, others painted him to be a ‘happy little fellow’ with an excellent ear for music.72 By recognising both parts, we are confronted by the ‘discordant set of abilities and disabilities’ that the low-grade idiots and imbeciles with multiple disabilities exhibited.73 For Kittay, it is this ‘unevenness’ that should colour our understanding of the lives lived by children with intellectual or learning disabilities.74 In adopting this approach, despite the severe disabilities and incapacities faced by the children, we are able to keep in view an understanding of them as ‘sensitive human beings’75 who have ‘capacities for love and for happiness’.76

Transfer Routes The Institute was intended for the care of children who could be trained and educated to follow a trade. With this intention in mind, once the

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patients were approaching adulthood or were deemed to be ‘hopeless cases’ for ‘mental or intellectual improvement’,77 their discharge from the Institute was initiated. For the children under discussion in this chapter, owing to their families’ adverse domestic situations, as well as several other mitigating factors that impeded a family’s ability to provide care for their loved ones,78 the only route available to them was a transfer to the CSH and the Asylum. As there are no archival records for the CSH’s casebooks, it is impossible to provide a detailed and nuanced perspective of the lives and experiences of the Institute’s patients once they were transferred to the CSH. Nevertheless, by reviewing records of the Asylum that contain entries about the CSH, it is possible to provide a partial and preliminary sketch of the main features of the care offered by the CSH. For ablebodied and older patients, the CSH operated along the lines of a welfare home that provided food and accommodation. Unlike at the Institute, the movements of the patients were less restricted at the CSH.79 Although there was a greater freedom of movement at the CSH, the patients were required to ensure that their conduct and behaviour was above reproach. Patients who posed a nuisance to the townsfolk or who engaged in unscrupulous behaviour were often admitted to the asylum where their movement was restricted. In a Foucauldian reading, the patients of the CSH had to maintain self-discipline in order to preserve their freedom of movement as well as to safeguard their continued stay in the hospital. Thus, patients of the CSH who upheld self-control were rewarded with the privilege to wander into town and to partake in the town’s offerings and events, or to find employment. For patients like Arthur who, while at the Institute, was fond of gardening, had experience working with a farmer, and was frequently bestowed with parole privileges,80 it is plausible that the freedom he received at the CSH allowed him to search for work among the townsfolk, and offered him the possibility of some form of integration with the town and its communities. For the children who were young and multiply disabled, they most likely experienced at the CSH a significant decrease in quality care. The CSH was plagued by staff shortages;81 one appalling example of this is how the hospital functioned for several years without a permanent night nurse. The absence of such an appointment at the hospital meant that the ‘many feeble and bedridden cases’ where ‘attended to by fellow-sufferers, perhaps nearly as ill as themselves’.82 For the Institute’s children who were transferred to the CSH with multiple disabilities, like Johanna who

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suffered from partial paralysis, mutism and would have epileptic seizures on most nights,83 the lack of round-the-clock nursing would surely have impacted on their quality of life, health and wellbeing. After Greenlees’s tenure as the surgeon-superintendent of the CSH ended in 1903, the new incumbent sought to prioritise the care of the aged and infirm, and thus the transfers of imbecile and idiot patients to the CSH were met by a growing aversion and reluctance. Furthermore, there was a marked unwillingness at the CSH to continue to care for some of the imbeciles and idiots who made up the patient body of the hospital. This is explicitly evidenced in the case of Ellen.84 Ellen was originally sent to the CSH in July 1896 from the Institute.85 In January 1905, Ellen was retransferred to the Institute on the grounds that she and a few other imbeciles and idiots were ‘noisy and therefore a source of annoyance’ to the adult patients of the CSH.86 Ellen’s retransfer was the result of several years of bitter complaints where the imbeciles and idiots were blamed for producing a soundscape at the CSH characterised by a cacophony of constant crying and howling.87 Greenlees rejected apportioning blame solely to the imbeciles and idiots for the disgraceful soundscape of the CSH, as he remarked that when the adult patients were under the influence of alcohol, they were extremely raucous. Nevertheless, Greenlees’s counterargument did not persuade the staff of the CSH. As the CSH was primarily intended to care for paupers, the aged and the infirm, the removal of imbeciles and idiots was encouraged on the grounds that ‘those who are sick in body can obtain but little rest owing to the noises made by those who are sick in mind’.88 Furthermore, the CSH underscored that it was impossible to manage the children’s behaviour and care for their needs owing to the unsuitability of the hospital’s facilities and their staff shortages.89 From 1903 and onwards, in general the CSH opposed transfers from the Institute, and if they did accept the transfer of a child, it was under the proviso that ‘in the event of their becoming troublesome or noisy, they will be readmitted’90 to the Institute. For the Institute’s patients who were transferred to the Asylum, it is possible to investigate the continuation of their life story by locating their records in the Asylum’s casebooks. Unlike at the Institute where the staff provided undivided attention to the children, at the Asylum, the interests of the staff were divided across the heterogeneous patient body, and the bulk of the attention was directed to the care of patients in recent and acute stages of mental illness that had a higher chance of recovery and discharge. Despite the limited attention of the staff towards imbecile and

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idiot patients, the casebooks contain an indication that the patients’ lives at the Asylum were punctuated by work experiences, and nurturing relationships with the staff and patients of the Asylum. Such an indication offers us ‘humanizing sentiments’91 by which to consider and conceive of their lives and experiences at the Asylum. For the able-bodied patients, a fascinating feature is the continuity of performing ward duties and labour at both the Institute and the Asylum. It is also evident that these patients cannot be understood to be docile, unassuming and a biddable body of asylum drones. Rather, they can be defined as ‘distinct, unique individuals with particular and specific characteristics that set them apart from others’.92 At the Institute, Myrtle was liable to occasional fits of uncontrollable temper, but was also praised for her ward work and in assisting with the ‘care of the more helpless of the children’.93 At the Asylum, Myrtle continued in ward work where she was considered very ‘useful’. Alongside such praise from the staff, Myrtle was also regarded to be a ‘mischief maker’ who was very often in trouble for instigating and provoking unrest on the ward. Nevertheless, this did not preclude the staff from concluding that Myrtle ‘enjoys life on the whole’.94 William assisted with caring for the feeble children at the Institute,95 and at the Asylum, he helped ‘as much as possible’ with the other patients. After several years at the Asylum, William’s work repertoire came to include tasks at the infirmary ward, the dining hall and tending to the gardens. He was regarded to be ‘anxious to help’ the staff of the Asylum but would also threaten violence and curse loudly if he was not pleased with the staff listening to or fulfilling his requests and needs.96 By scrutinising the casebooks, it becomes apparent that the former patients of the Institute were able to establish bonds with the patients of the Asylum. On her transfer to the Asylum from the Institute, Elizabeth was described to be bewildered and ‘rather lost’.97 Soon thereafter, she had settled down, which was in part attributed to her doing ‘well enough with the other patients’.98 For the Institute’s patients who were multiply disabled, their transfer to the Asylum exposed them to the risk of being ‘maltreated’99 by Asylum patients who were violent. In particular, Greenlees considered the Asylum ‘unfitted for treatment’ of adults who were multiply disabled as they were ‘helpless’ to defend themselves against the stronger patients.100 One means for the imbecile and idiot patients with multiple disabilities to be kept safe at the Asylum was if they were taken under the wing of another patient. For instance, Jason, who was suffering from epilepsy and significant hearing loss, was concluded by the doctors

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to be ‘helpless’ and requiring ‘constant attention’.101 An Asylum patient, Edkins, took ‘an interest in him’ and thus safeguarded Jason from injury. Apart from protection, the casebook indicates that Jason was ‘well looked after’ by Edkins.102 Thus, the nurturing bond forged by Edkins made it possible for Jason to thrive at the Asylum. Johannes,103 a low-grade idiot with multiple disabilities, was transferred to the Asylum when he turned 19. While at the Institute, he displayed a capacity for pleasure as he enjoyed sitting on the veranda in the sun. On his admission to the Asylum, while the doctors underscored that ‘he cannot be educated in any way’ and his ‘[i]ntellectual faculties [are] little better than those of an infant’, it is also clear that Johannes’s capacity for pleasure had developed and expanded. When spoke to, Johannes would smile and laugh. Thus, despite Johannes being unable to ‘understand what is said to him’, he was responsive to the staff’s contact and expressed delight in receiving attention from them.104 Of equal significance, it is possible to suggest that Johannes was not a passive recipient of care,105 but sought to reciprocate in ways that were possible to him.106 The doctors perceived that Johannes was ‘anxious to give as little trouble as possible’, for instance. Johannes’s disabilities hindered his capacity to be a ‘fully competent participant in a relationship’ but it is also evident that he made an effort to contribute ‘something to the partnership’.107 What begins to emerge from this discussion is a portrait of Johannes as responsive to the contact of staff by greeting them with smiles and laughter, and a person who endeavoured to reciprocate or contribute in his relationship with the staff.108 In sum, despite the patients having entered the Asylum as supposedly uneducable cases, the above discussion has highlighted how a ‘useable past’ for their lives and experiences at the Asylum can be composed of ‘positive terms’.109 The discussion underscores the individuality of the patients, offers an appreciation of their capacities for pleasure and happiness, their acts of reciprocation in their relationships, as well as the bonds of care and affection established between staff and patients.

Casebook Photographs In a path-breaking study, Mark Jackson examined a ‘previously neglected set of sources’,110 photographs and demonstrated how they can ‘increase our understanding of the histories of people’ with intellectual or learning disabilities.111 Recent scholarship has continued to address and articulate

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how photographs offer a resource to humanise people with intellectual disability,112 and to bring into view their lives and identity as individuals rather than patients.113 Building upon this scholarship, I offer a reading of the Institute’s photographs to include the casebook content that pertains to the children’s life history. Significantly, this interpretative strategy provides the viewer with a testimony of the individuality and humanity of the children. The Asylum and the Institute adopted a heterogeneous photographic practice through which a succession of photographic styles and techniques were explored in the casebook photographs.114 To this end, while some casebook photographs adopt the styles and conventions of portraiture, other photographs are akin to the genre of clinical photography, and a significant portion of photographs resemble gaol mugshots. In a photograph of siblings Andrea and Gysbert (Fig. 1), they are pictured outdoors and neatly attired. Of interest, although both siblings had a marked impairment in their ability to stand and walk, this was not emphasised in the photograph. Instead, it can be argued that their impairment was downplayed by the way that they were posed for the photograph: Andrea was seated and Gysbert was certainly able to prop himself up by holding onto the chair. This form of posing follows the conventions of ‘citizen portraits’115 where the focus is on the dignity of the subjects rather than on signposting their disability. In her reading of the casebook portraits of the Caterham Asylum in Surrey, Eastoe proposes that the photographs provide a glimpse of the ‘care practices and intimacy’ offered by the Institute to its patient body.116 Following this line of argument, the healthy-looking and well-nourished siblings, as well as their neat and clean dress and grooming, might be seen as a product of the Institute’s efforts and interests in the ‘care, attention and management of patients’.117 Moreover, while it is unclear if the children may have posed for the photograph in such a way as to express and assert their individual identity, or if they were posed by the staff to stage-manage and curate how the Institute was portrayed to inspectors and government authorities, the result is conspicuously clear: the portrait of the siblings offers a sensitive, dignified and humane representation of the subjects.118 For Ariella Azoulay, ‘it is our historic responsibility, not only to produce photos, but to make them speak’.119 One means to do so is to open up a reading of the photos to include ‘dimensions of time and movement’.120 By adopting Azoulay’s interpretative strategy—through the inclusion of the casebook entries for the moments that preceded and

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Fig. 1 Andrea and Gysbert (Western Cape Archives and Records Service, HGM 24, 46)

followed the photograph of the siblings—we humanise the photographed subjects by bringing into view their range of experiences and the unique details of their life stories.121 Andrea and Gysbert, aged 13 and 11 respectively, were admitted to the Institute from the CSH, where they were patients for several years.122 It is evident that during their time at the CSH there was little attention paid to their education and intellectual development: Andrea was hesitant in speech and did not know her age, and Gysbert could not state his age or name. Soon after admission,

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Andrea took an interest in her lessons and progressed very well. She assisted the nurses with the housework and helped with attending to the other children. Gysbert progressed slower with his education but reached numerous milestones. After the Institute abandoned systematic education for the children, the teaching duties of Andrea and Gysbert were taken up by Eva,123 a patient from the Asylum. Both of the siblings improved in their learning under her tutelage. In this regard, their life stories highlight the kindness of outside parties, who were willing to contribute to the wellbeing of the children. When the siblings were not helping the nurses by looking after other children, they attended and greatly enjoyed the weekly dances hosted by the Asylum. In 1910, the Institute’s doctor wrote several letters to their relatives to enquire about finding a home for them. In the replies to the letters it soon became evident that their extended family was in dire circumstances, with the replies relating that in their immediate family they ‘only have a sister who is dependent on others and is not in a position to make a home for them’.124 Owing to the severe financial struggles that informed their family’s decision not to take the siblings to stay with them, they were transferred to the CSH. Before they were transferred, the doctors reviewed their cases and concluded that Andrea was ‘[a]ppreciative of everything done for her’,125 and that Gysbert was ‘quite capable of enjoying life’.126 To further illustrate Azoulay’s interpretive strategy, and to underscore how the act of beholding the casebook photographs is an opportunity to witness the ‘individuality and the humanness’ of the children,127 I turn to the photographs of George (Figs. 2 and 3). At seven years old, George was admitted to the Institute in a state of reduced physical health and with poor communication skills.128 After only two months at the Institute, he had improved physically, was able to answer questions, and was playing with the other children. A year into his institutionalisation, he was said to be in the ‘best of health and fairly bright intellectually’. Once George turned 10, he would sometimes get into ‘ungovernable fits of temper’, and although the staff complained that he was ‘full of mischief’, they found him to be a ‘happy laughing little fellow’. As George approached adolescence, he became bad tempered, and on account of him striking and biting the other children, he was often placed in seclusion. At this point, the staff presented a denigrated portrayal of him, stating that his ‘mischievousness is his only sign of intelligence’. The case entries do not offer an explanation for George’s outbursts of temper. Yet, it can be

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suggested that a possible factor for George’s outbursts was his displeasure of coming into contact with the younger children. To substantiate, a common trope for the patients who approached adolescence was that they would often become annoyed and bothered by the younger children. For example, Dorothy at times would become ‘irritated by the other children’ and desired to ‘live with grown-up people’.129 From the age of 15, George showed a marked improvement in his behaviour and conduct with the other children, and was ‘quite helpful in the ward, tidy, can say a few words and appreciates kindness’. Significantly, George was regarded to be so ‘very useful’ in the care of the younger children, that he was ‘too productive to discharge’130 and thus was kept at the Institute despite being in early adulthood. George remained at the Institute until he turned 21 after which he was transferred to the Valkenberg Asylum in Cape Town. By looking at the two photographs of George, we witness how he matured into an adult, and by including the casebook entries, we become witness to how his ‘powers of speech’ advanced over the years and how he developed nurturing bonds of care and support for the younger children.

Conclusion This chapter has sought to add a further facet to our memory of the Institute to include a richer appreciation of the lives and experiences of the admitted children. Although the patients were deemed ‘hopeless cases’ for training and education in the Institute’s annual reports, the casebooks of the Institute and the Asylum present a portrait of the patients’ lives and experiences as meaningful, as well as cataloguing their capacity to relish pleasure, express happiness and engage in reciprocal relationships. These findings aid in developing an enriched ‘useable past’ for the children; the emphasis is on enshrining the memories of their lives as ‘full of joy, of love, of laughter: a life that includes the appreciation of some of the best of human culture … and the delights of nature’.131 While the patient’s capacity for a ‘good life’132 was made possible by the care and therapeutic regimen of the Institute and the Asylum, it is certain that for some of the patients who were transferred to the CSH, their capacity was constrained by the lower quality of care and the limited therapeutic regimen of this site. The Institute may have failed to fulfil its function to train and educate the children, but in comparison to the CSH, it succeeded in fulfilling a care role.

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Fig. 2 The young George (Western Cape Archives and Records Service, HGM 24, 48)

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Fig. 3 The mature George (Western Cape Archives and Records Service, HGM 24, 117)

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Notes 1. Don Foster, ‘Historical and Legal Traces 1800–1990’, Susan Lea and Don Foster (eds.), Perspectives on Mental Handicap in South Africa (Durban: Butterworths, 1990), 21–70, 23. 2. Foster, ‘Historical and Legal Traces’; M. Minde, History of Mental Health Services in South Africa. Part IX. The Protection and Care of the Feebleminded’, South African Medical Journal, 49, 1975, 1716–1720; M. Minde, History of Mental Health Services in South Africa. Part X. Institutions for Defectives’, South African Medical Journal, 49, 1975, 1890–1894. 3. Nic Clarke, ‘Opening Closed Doors and Breaching High Walls: Some Approaches for Studying Intellectual Disability in Canadian History’, Histoire sociale/Social History, 39, 2006, 467–485, 485. 4. For further discussion of the Institute for Imbecile Children, see Rory Du Plessis, ‘The Life Stories and Experiences of the Children Admitted to the Institute for Imbecile Children from 1895 to 1913’, African Journal of Disability, 9, 2020, https://doi.org/10.4102/ajod.v9i0.669; Rory Du Plessis, ‘The Janus-Faced Public Intellectual: Dr Thomas Duncan Greenlees at the Institute for Imbecile Children, 1895–1907’, Chris Broodryk (ed.), Public Intellectuals in South Africa: Critical Voices from the Past (Johannesburg: Wits University Press, 2021), 200–221. 5. Reports on the Government and Public Hospitals and Asylums, and Report on the Inspector of Asylums. Cape of Good Hope Official Publications. G60–1903, 121. 6. Section 77 of the Lunacy Act of 1897 legalised the Institute as a separate establishment from the Asylum. See G28–1898, 22. 7. In 1806, the British established the Cape Colony. In 1910, the Cape Colony was united with three other colonies to form the Union of South Africa. 8. Rory Du Plessis, Pathways of Patients at the Grahamstown Lunatic Asylum, 1890 to 1907 (Pretoria: Pretoria University Law Press, 2020). 9. G20–1897, 26. 10. G21–1899, 24. 11. Ibid. 12. G60–1903, 122. 13. G32–1906, 89. 14. G57–1905, 87. 15. Stef Eastoe, Idiocy, Imbecility and Insanity in Victorian Society: Caterham Asylum, 1867–1911 (London: Palgrave Macmillan, 2020). 16. See also Dorothy Atkinson and Jan Walmsley, ‘History from the Inside: Towards an Inclusive History of Intellectual Disability’, Scandinavian Journal of Disability Research, 12(4), 2010, 273–286.

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17. For an overview of the institutional responses to intellectual or learning disability, see Pamela Dale and Joseph Melling (eds.), Mental Illness and Learning Disability Since 1850: Finding a Place for Mental Disorder in the United Kingdom (London: Routledge, 2006); James W. Trent, Inventing the Feeble Mind: A History of Mental Retardation in the United States (Berkley and Los Angeles: University of California Press, 1994); David Wright, Mental Disability in Victorian England: The Earlswood Asylum, 1847–1901 (Oxford: Clarendon Press, 2001) and Rebecca Wynter, ‘Pictures of Peter Pan: Institutions, Local Definitions of ‘Mental Deficiency’, and the Filtering of Children in Early Twentieth-Century England’, Family & Community History, 18(2), 2015, 122–138. 18. Eastoe, Idiocy, Imbecility and Insanity. 19. Jean Denise Hoole, ‘Idiots, Imbeciles, and the Asylum in the Early Twentieth Century: Bevan Lewis and the Boys of Stanley Hall’ (University of Aberdeen: Unpublished PhD thesis, 2012), 179. 20. Clarke, ‘Opening Closed Doors’, 470; Eastoe, Idiocy, Imbecility and Insanity. 21. Eastoe, Idiocy, Imbecility and Insanity. 22. Du Plessis, Pathways of Patients, 26. 23. Holly Allen and Erin Fuller, ‘Beyond the Feeble Mind: Foregrounding the Personhood of Inmates with Significant Intellectual Disabilities in the Era of Institutionalization’, Disability Studies Quarterly, 36, https://doi. org/10.18061/dsq.v36i2.5227. 24. Jan Walmsley, ‘Healthy Minds and Intellectual Disability’, Steven J. Taylor and Alice Brumby (eds.), Healthy Minds in the Twentieth Century: In and Beyond the Asylum (London: Palgrave MacMillan, 2020), 95– 111, 103. 25. Ibid., 105. 26. Eva Feder Kittay, Learning from My Daughter: The Value and Care of Disabled Minds (Oxford: Oxford University Press, 2019), 6. 27. Harriet Deacon, ‘Racial Categories and Psychiatry in Africa: The Asylum on Robben Island in the Nineteenth Century’, Waltraud Ernst and Bernard Harris (eds.), Race, Science and Medicine, 1700–1960 (London: Routledge, 1999), 101–122 and Sally Swartz, Homeless Wanderers: Movement and Mental Illness in the Cape Colony in the Nineteenth Century (Cape Town: UCT Press, 2015). 28. Waltraud Ernst, ‘Colonial Policies, Racial Politics and the Development of Psychiatric Institutions in Early Nineteenth-Century British India’, Waltraud Ernst and Bernard Harris (eds.), Race, Science and Medicine, 1700–1960 (London: Routledge, 1999), 80–100. 29. For the children of colour who were admitted to the Asylum, they were generally transferred to poorly resourced institutions that were earmarked for patients suffering from chronic forms of mental illness.

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30. For a discussion of the discharges from the Institute, see Du Plessis, ‘The Life Stories’. 31. Patrick McDonagh, C. F. Goodey and Tim Stainton, ‘Introduction: The Emergent Critical History of Intellectual Disability’, Patrick McDonagh, C. F. Goodey and Tim Stainton (eds.), Intellectual Disability: A Conceptual History, 1200–1900 (Manchester: Manchester University Press, 2018), 1–25, 1. Greenlees’s views on imbecility and idiocy were shaped by eugenic discourses. For further discussion, see Du Plessis, ‘The Life Stories’. 32. Grahamstown Lunatic Asylum Casebooks. Western Cape Archives and Records Service. HGM 24, 8. 33. Ibid., 29. 34. Sally Swartz, ‘The Great Asylum Laundry: Space, Classification, and Imperialism in Cape Town’, L. Topp, J. E. Moran and J. Andrews (eds.), Madness, Architecture and the Built Environment: Psychiatric Spaces in Historical Context (London: Routledge, 2007), 193–213, 196. 35. Ibid., 194. 36. G37–1891, 44. 37. Du Plessis, Pathways of Patients. 38. HGM 24, 7. 39. Ibid., 60. 40. Sarah F. Rose, No Right to Be Idle: The Invention of Disability, 1840s– 1930s (Chapel Hill, NC: University of North Carolina Press, 2017), 57. 41. Eastoe, Idiocy, Imbecility and Insanity. 42. Thomas Duncan Greenlees, ‘The Etiology, Symptoms and Treatment of Idiocy and Imbecility’, South African Medical Record, 5(2), 1907, 17–21, 20. 43. See G55–109, 128. 44. HGM 24, 49. 45. Ibid., 52. 46. Hoole, ‘Idiots, Imbeciles’, 212. 47. HGM 24, 3. 48. Ibid., 31. 49. Ibid., 32. 50. Ibid., 33. 51. Ibid., 57. 52. Ibid., 31. 53. Ibid., 57. 54. Eastoe, Idiocy, Imbecility and Insanity; Hoole, ‘Idiots, Imbeciles’, 52. 55. HGM 24, 41. 56. G25–1900, 20–21. 57. Ibid. 58. G20–1897.

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59. 60. 61. 62.

63.

64. 65. 66. 67. 68. 69. 70. 71. 72. 73.

74. 75. 76. 77. 78. 79. 80. 81. 82. 83. 84. 85. 86. 87. 88. 89. 90. 91. 92.

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HGM 24, 61. Ibid., 78. Ibid., 96. Lee-Ann Monk, ‘Exploiting Patient Labour at Kew Cottages, Australia, 1887–1950’, British Journal of Learning Disabilities, 38(2), 2010, 86– 94, 86. Robert Bogdan and Steven J. Taylor, ‘Relationships with Severely Disabled People: The Social Construction of Humanness’, Social Problems, 36(2), 1989, 135–148, 145. Ibid. HGM 24, 44. Monk, ‘Exploiting Patient Labour’, 91. HGM 24, 52. Ibid., 7. Ibid., 14. Ibid., 32. Kittay, Learning from My Daughter, 6. HGM 24, 7. Eva Feder Kittay, ‘The Personal Is Philosophical Is Political: A Philosopher and Mother of a Cognitively Disabled Person Sends Notes from the Battlefield’, Metaphilosophy, 40, 2009, 606–627. Eva Feder Kittay, ‘At the Margins of Moral Personhood’, Ethics, 116(1), 2005, 100–131, 128. Allen and Fuller, ‘Beyond the Feeble Mind’. Eva Feder Kittay, Love’s Labor: Essays on Women, Equality, and Dependency (London: Routledge, 1999), 152. G27–1896, 39. For example, see Rose, No right, 57. Du Plessis, Pathways of Patients. HGM 24, 52. G21–1899, 28. G24–1894, 68. HGM 24, 3. Ibid., 66. Ibid., 2. Ibid., 66. Colonial Office correspondence. Western Cape Archives and Records Service, 14 March 1904, CO 7576. Ibid. 13 January 1904, CO 7576. 8 August 1910, CO 7800. Bogdan and Taylor, ‘Relationships’, 145. Ibid., 141.

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93. 94. 95. 96. 97. 98. 99. 100. 101. 102. 103. 104. 105. 106. 107. 108. 109. 110.

111. 112. 113. 114.

115. 116. 117. 118.

119. 120. 121. 122. 123.

HGM 24, 17. HGM 22, 92. HGM 24, 41. HGM 8, 205. HGM 24, 39; HGM 22, 137. HGM 22, 137. 30 March 1904, CO 7576. 28 August 1903, CO 7570. See also Hoole, ‘Idiots, Imbeciles’, 237. HGM 24, 62; HGM 11, 35. HGM 11, 35. HGM 24, 33; HGM 9, 137. HGM 9, 137. Allen and Fuller, ‘Beyond’. Bogdan and Taylor, ‘Relationships’, 144. Bogdan and Taylor, ‘Relationships’, 143. Kittay, ‘At the Margins’, 126. Kittay, Learning from, 6. Mark Jackson, ‘Images from the Past: Using Photographs’, D. Atkinson, M. Jackson and J. Walmsley (eds.), Forgotten Lives: Exploring the History of Learning Disability (Kidderminster: BILD Publications, 1997), 65– 74, 65. Ibid., 66. Hoole, ‘Idiots, Imbeciles’. Eastoe, Idiocy, Imbecility and Insanity. For further discussion, see Rory Du Plessis, ‘Beyond a Clinical Narrative: Casebook Photographs from the Grahamstown Lunatic Asylum, c. 1890s’, Critical Arts, 29, 2015, 88–103. Robert Bogdan, Picturing Disability: Beggar, Freak, Citizen, and Other Photographic Rhetoric (Syracuse: Syracuse University Press, 2012), 144. Eastoe, Idiocy, Imbecility and Insanity. Ibid. See Katherine D. B. Rawling, ‘“She Sits All Day in the Attitude Depicted in the Photo”: Photography and the Psychiatric Patient in the Late Nineteenth Century’, Medical Humanities, 43, 2017, 99–110; Susan Sidlauskas, ‘Inventing the Medical Portrait: Photography at the “Benevolent Asylum” of Holloway, c 1885–1889’, Medical Humanities, 39, 2013, http://dx.doi.org/10.1136/medhum-2012-010280. Ariella Azoulay, The Civil Contract of Photography (trans. R. Mazali and R. Danieli). (New York: Zone Books, 2008), 122. Ibid., 14. Bogdan and Taylor, ‘Relationships’, 142. HGM 24, 45; HGM 24, 46. HGM 22, 28.

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124. 125. 126. 127. 128. 129. 130. 131.

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14 June 1910, CO 7800. HGM 24, 45. Ibid., 46. Ibid., 142–143. Ibid., 24, 48. Ibid., 24, 99. Rose, No Right, 74. Eva Feder Kittay, ‘Equality, Dignity and Disability’, M. A. Lyons and F. Waldron (eds.), Perspectives on Equality: The Second Seamus Heaney Lectures (Dublin: Liffey Press, 2005), 93–119, 110. 132. Ibid.

Oral Histories

Surprise and Nostalgia: Staff Narrate the Closure of an American Psychiatric Hospital Elizabeth Nelson, Emily Beckman, and Modupe Labode

After 150 years of treating psychiatric patients, Indiana’s Central State Hospital, located in the midwestern United States, closed in 1994 after a string of preventable patient deaths. In 1991, Lydia Shelby died of overmedication, and later that year another patient, June Highsaw, froze to death in her room, again with over-medication as a contributing factor.1 In the spring of 1992, a patient named Linda Heine drowned in a bathtub while attending staff were playing cards. The attendants dried and dressed Heine’s body, and placed it in bed, to make it appear that she died in her sleep.2 Over the decades of Central State Hospital’s existence, patients’

E. Nelson (B) · E. Beckman Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA E. Beckman e-mail: [email protected] M. Labode National Museum of American History, Washington, DC, USA

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 R. Wynter et al. (eds.), Memory, Anniversaries and Mental Health in International Historical Perspective, Mental Health in Historical Perspective, https://doi.org/10.1007/978-3-031-22978-7_9

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deaths in suspicious circumstances—and subsequent media interest— were not unusual.3 However, in this case, the response was markedly different. Days after Heine’s death, the state agency that oversaw the hospital suspended new admissions, and shortly thereafter, a governorappointed task force investigated conditions within the hospital.4 Within four months of Heine’s death, Evan Bayh, the Democratic Governor of Indiana, issued an order to close Central State Hospital (CSH) by June 30, 1994.5 While we examine patients’ narratives about life in the hospital and the process of deinstitutionalisation elsewhere,6 this chapter presents a targeted analysis of former staff perspectives as revealed through oral history interviews conducted between 2017 and 2019. Our aim is not to construct a definitive account of ‘what really happened’ during the final years of CSH. Indeed, there are irreconcilable contradictions in our sources that make such a reconstruction impossible. Rather, we focus on expressions of surprise and nostalgia that emerge in the oral histories with former staff to shed light on the internal momentum of institutions and the lived experience of deinstitutionalisation for those entrusted with patient care. CSH opened in 1848 as the Indiana Hospital for the Insane. Originally located two miles west of Indianapolis, a city that would eventually grow to surround the hospital, CSH was the first and largest of Indiana’s system of psychiatric institutions. As historian Ellen Dwyer has demonstrated, like many state-run mental hospitals in the US, CSH experienced cycles of overcrowding, scandal, and reform throughout the nineteenth and early twentieth centuries.7 In keeping with international trends, as more faith (if not funding) was invested in community mental health services after the Second World War, the patient population at Central State declined from over 2,200 in the 1950s to fewer than 500 in the 1980s. For the patients that remained in the hospital’s final decades, the facilities and care provided often proved inadequate, despite legal action and protest. Dwyer’s research makes clear that the circumstances which triggered the hospital’s closure in the early 1990s were not exceptional.8 Staff corruption, inadequate funding, patient abuse, and accidental deaths were endemic to the institution. Dwyer’s conclusions echo contemporary media coverage about the patient deaths of the 1990s, with newspaper headlines like ‘Hospital’s Decay Rooted in Indiana’s Neglect of the Mentally Ill’, reflecting a growing public sentiment that closing CSH and shifting to community-based care was both necessary and inevitable.9

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Dwyer concludes that when the governor ‘finally announced his decision to close Central State Hospital, some were angry but few surprised’.10 However, although media reports of abuse, death, and poor conditions at CSH did appear with increasing frequency in its final decades, former staff almost uniformly recall the announcement of the hospital’s closure as unexpected. In contradiction to journalistic and historical narratives that depict CSH as a site of perpetual horror, many staff interviews reveal nostalgic attitudes towards the institution and describe the closure as an interruption, a termination of care, and the disruption of a community. For this reason, we situate our work in the context of a recent wave of scholarship on the memory of late twentieth-century psychiatric institutions. Nostalgia is a pervasive theme in oral history interviews with former hospital staff, in a variety of sites around the world. For instance, Verusca Calabria’s chapter in this volume, ‘An Exploration of the Function of Nostalgia in Oral Histories of Asylum Life’, examines nostalgia among former hospital workers in Nottingham as important counternarratives to the dominant story of psychiatric institutions as sites of abuse and neglect.11 In the 2018 monograph Broken: Institutions, Families, and the Construction of Intellectual Disability, Madeleine C. Burghardt found similarly nostalgic themes in the narratives of former staff from an institution in Ontario, Canada.12 Burghardt describes being struck by the stark differences between the narratives of former staff of the Ontario Hospital School in Orillia, who described their work as the ‘best job they’ve ever had’,13 and former residents’ harrowing accounts of dehumanisation and abuse. Burghardt regards these discrepancies as ‘prompts to investigate the unequal conditions that would have given rise to such differences in the first place’.14 Given the structural violence that characterised CSH, we share Burghardt’s critical perspective on staff narratives and consider the uncomfortable truths that are missing in them. At the same time, we seek to understand the narrative work of ‘surprise’ and ‘nostalgia’ in these recollections. In our study, many remembered feeling surprised at the announcement that the hospital was closing. They asserted that the decision to close was the result of ‘politics’, an explanation that was not unfounded; as in Great Britain, political expediencies and budgetary concerns were major drivers of deinstitutionalisation.15 However, narratives of surprise also served to deflect attention from the realities of patient abuse and staff culpability, demonstrating the extent to which patient mistreatment and death had been largely normalised at CSH. Therefore, narratives of former CSH staff are significant not

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only because they are reminiscences of a time of significant reform in psychiatric hospitals, but also because they suggest the persistence and adaptability of paternalistic ideas of care, even in the most abusive of contexts. Retrospective idealisation of the hospital, moreover, may also represent narrators’ attempts to account for the limited success of community-based care.16 According to many staff, homelessness, chronic mental instability, or premature death among former CSH patients were the result of the hospital’s closure, retrospectively validating (in their view) the hospital’s important work as a place of protection for people with mental illness.

Oral History and Narrative The oral histories analysed in this essay were conducted as part of a larger research initiative on the final years and closure of CSH that centres the experiences of patients with intellectual disabilities and their caregivers. To date, we have collected nearly thirty oral histories from people who either worked at CSH or had direct knowledge of the institution during its final years, including psychologists, occupational and rehabilitation therapists, social workers, dieticians, and nurses.17 We recruited several narrators after we were invited to an annual reunion of the former CSH staff in 2018. We reached out to as many former staff as we could find and relied, in part, on word-of-mouth communication to recruit narrators to our study. Those interviewed are not a representative sample of all staff who worked at CSH in its final years; they merely represent those who were willing to speak to us. We found that many participants were eager to be interviewed, as they saw our oral history project as an opportunity to ‘set the record straight’ and counter the predominant narratives about the hospital,18 which are resoundingly negative. The passage of time since the hospital’s 1994 closure may have contributed to the willingness of some to share their stories. As one nurse stated, ‘for years, I wouldn’t even tell you I ever worked at Central State Hospital, to be honest with you. I just didn’t. And those reunions, I didn’t go to any of them … I was embarrassed. I was embarrassed. I was ashamed that any of that happened’.19 Our position as professors and researchers at a local university and the use of an oral history framework, which assumes that the

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narrator’s perspective has value, may have encouraged some narrators to talk to us, in part, because they assumed that our research would take their viewpoint seriously. Oral history, which values both explanation and silences, is about meaning-making and narrative. In his important paper ‘In Defence of Narrative’, philosopher Anthony Rudd claims that ‘[w]e can only make sense of an action as an action if we place it in a context, describing the agent’s intentions, the social and cultural settings which made those intentions intelligible, and the past situation to which the intended action was a response … So a narrative is teleological; it provides reasons, not just (efficient) causes’.20 As researchers, we chose to analyse the oral histories as narratives produced through the interview process, attending to narrators’ active process of making sense of a tumultuous series of events. Rudd states that our sense of self depends largely on our ‘capacity to tell a coherent story about ourselves’. 21 This insight helps explain why staff might have been reluctant to accept the impending closure despite the revelations of the hospital’s structural violence and the public outcry that followed. We know that people often cope with potential disruptions by working strenuously to maintain the continuity of their own personal narratives. Rudd reminds us that we ‘cannot understand personal identity or ethics without thinking in narrative terms, but narrative itself presupposes protagonists who are persons, and also the making of evaluative judgments’.22 We interpret recurring themes of surprise and nostalgia as attempts to explain the discontinuities brought about by the hospital’s closure, and in doing so reveal how deinstitutionalisation disrupted personal and professional identities. The CSH staff, many of whom had been working at the hospital for years, likely expected their story to continue much as it always had. Much of how they defined themselves relied on this kind of continuity, predictability, and routine, and many had invested in rehabilitative programmes they believed improved patients’ health, self-sufficiency, and quality of life. ‘Narrative is crucial for the understanding of the identity of persons because narrative (as distinct from chronicle or mere causal sequence) is simply the form in which self-conscious agents make themselves intelligible to themselves as agents persisting through time, and therefore through change’.23 The surprise and shock that many staff experienced at the hospital closing not only resulted in severe disruptions of personal narratives, but also of personal identity. Thus, the stories they

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shared through the oral histories can be read as retrospective attempts to construct individual, and institutional, narrative coherence.

Surprise In many interviews, the concept of surprise emerged as narrators responded to a question about how they learned that the hospital was closing. Some narrators volunteered that they were surprised or ‘shocked’ by the news, but in many cases, the interviewer introduced the idea, by asking, for example, ‘Were you surprised when you heard the governor’s announcement that the hospital would close?’24 Surprise is an explanatory phenomenon, arising in the difference between what was expected and what occurs. The less expected an event is, the more surprised a person is by the event.25 Surprise at the announcement of the hospital’s closure was shared both by narrators who were working at the hospital and those who had departed before the announcement.26 As one former staff member said, ‘[I]t came as a shock to everybody. In fact, we weren’t expecting it to be closed although, like I said, it [the patient deaths and cover up] was a dark blot on the administration at the time’.27 A nurse described her sense of ‘disbelief’ because ‘we were doing good in my building’.28 This narrator’s insistence that she was part of the good work in Central State co-exists with an implicit acknowledgement that the hospital was not a monolith, and very different conditions could, and did, exist in different areas. Because the supervisors, staff, patient ‘populations’, and physical infrastructure varied so widely, this narrator was surprised that the entire hospital would be held responsible for the inexcusable actions that occurred in one unit. In fact, a few narrators remembered speculating that if state officials could just see the exemplary work in their area of the hospital, Central State could remain open. A psychologist who developed an art therapy programme explained that: ‘… I thought if I made the art program good enough, you know, then people from the community or people with influence would say, “We can’t close the hospital because Dr. [JM] is doing this good thing”’.29 One nurse wished that she could have shown the governor her patients, who were receiving thoughtful and attentive care, with schedules filled with activities. She explained that she thought highly of the governor and believed that he had been misinformed. Yet in the same sentence, she acknowledged that the closure was part of a

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nationwide process of deinstitutionalisation: ‘I liked [the governor] and I respected him but I think he had poor counselling about all of that and also that was the mental health tendency at that point, to get people out of [hospitals]’.30 Surprise and speculation about ways to save CSH may reveal the narrators’ simultaneous belief in the efficacy of the hospital’s rehabilitative model and their inability to imagine that the people who lived in Central State could live in any other circumstance. As one recreation therapist said, ‘I just could not imagine all of those folks out in the community. It’s kind of like, how can you all of a sudden just, you know, do this and where are these people going to go…’.31 Many of the narrators explained the unexpected course of events as due to ‘politics’, a term that implied state officials’ disreputable jockeying for power and influence. The staff we spoke with were unconvinced that the policy decision was driven by a concern for patients’ wellbeing. They frequently mentioned Indiana Governor Evan Bayh, a Democrat who had a reputation as an ambitious politician, speculating that Bayh closed the hospital so that he could win reelection by portraying himself as an economically prudent manager.32 One narrator asserted: ‘Evan Bayh used it [the closure] as a political thing. I’m going to save you a lot of money. We’re going to close this place’.33 His visit to Central State Hospital in June 1992, just before he announced the hospital would close, figured in several oral histories.34 Another narrator, CB, was a Democratic Party stalwart and had started working at CSH in the 1960s. She said, ‘I was the last going down to keep that hospital open. Everybody that knows me knows I’m a staunch Democrat and worked very hard to get Evan Bayh elected but I fought him tooth and nail to keep him from closing that hospital … All of my friends and my patients were there’. CB implied that the Governor was not being true to his party’s policies when she accurately recalled that Republican Ronald Reagan had used economic efficiency as a justification for his policies of closing psychiatric hospitals when he was California’s governor in the 1960s, as well as blocking federal funding to mental health services when he was the US president in the 1980s. She described lobbying state legislators to oppose Governor Bayh’s order to close Central State.35 In this interview, the narrator melded paternalism, support of residential institutions, and opposition to the Republican Party—even though the hospital closed under a Democratic governor.36

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The idea of closing CSH, however, did not originate with Governor Bayh; since the 1970s numerous politicians had regularly raised the possibility. Significant changes in social services policy and funding at the state and federal levels finally made closing feasible by the 1990s.37 The narrators’ focus on the Governor and his ambitions may be an effort to make intelligible the myriad policy decisions that facilitated the closure. For months following the announcement, numerous stakeholders—state legislators, family members, organised labour—attempted to legally challenge or influence the Governor’s decision. These bitter arguments involved various manoeuvres which could be dismissed as ‘politics’.38 Moreover, explaining CSH’s closure as a local political strategy obscures the national trend towards closing psychiatric hospitals, which few narrators acknowledged. The causes of this trend were complex and did include neoliberal political strategies. However, it is important to recognise that deinstitutionalisation also emerged from a radical and multifacted critique of psychiatric institutions’ carceral logics and conditions of life. As Liat Ben-Moshe argues in Decarcerating Disability, the narrative that efforts to trim state budgets drove deinstitutionalisation can obscure the hard-fought battles of institutionalised people and their allies to end the practice of confinement.39 Only one person, who had occupied an administrative role, stated flatly that he was not surprised when he learned that the hospital would be closed.40 He later clarified that conversations with key decision-makers had led him to believe (‘[y]ou just kind of got a feeling’) that closing the hospital was one of the options under consideration. He referred to an investigative journalist whose nationally broadcast 1972 film about the unconscionable conditions in which patients lived at Willowbrook, a state institution in New York City, reportedly turned many viewers against large hospitals: ‘… it was also part of the national pulse, the national trend to start closing these institutions. And then everyone would bring up Geraldo Rivera’s experience at Willowbrook and all that stuff from years before’.41 Thus, the narrators’ assertion that ‘politics’ explained the closure also elides and minimises how neglect and mistreatment of patients catalysed the decision to close the hospital. Even when interviewers directly posed questions about patient deaths and subsequent investigations, several narrators claimed that they did not recall the specific incidents or even that patients had died at all. Few mentioned the investigations, indictments, and trials which occurred during the two years in which the hospital was

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closing. For example, while some former staff members expressed distress and regret when discussing Linda Heine’s death, they also emphasised that she lived in a different part of the hospital than the area that was their immediate responsibility. We interviewed several people who, we later found, had been listed as defendants in the lawsuit concerning the death of June Highsaw. None volunteered this information during the interview.

Nostalgia Nostalgia is a longing for the past, or, literally, a ‘homesickness’ in which the beneficial aspects of past experiences predominate. Oral historians have long considered narrators’ expression of nostalgia as doing important work in narrators’ recollections.42 Nostalgia may obscure uncomfortable aspects of the past or serve as commentary on an inferior present. Feelings of nostalgia are often associated with identity and narrative coherence, in that they establish a past self who is contained within the person today. Even more, as Calabria suggests in this volume, nostalgia aids in the formation of a collective identity, fostering a sense of belonging for ‘lost communities’.43 In the oral histories, nostalgia pushes against a popular narrative that the hospital was a place where patients were tortured, neglected, and killed. We do not interpret the workers’ narratives as in themselves a refutation of that narrative, as there is ample evidence that many patients were harmed at the hospital. Rather we regard the themes that emerged from our interviews—including quality of care, family relationships and teamwork, celebrations, and regrets about the decision to close—as often genuine, a form of reclaiming their experiences as former CSH staff and endowing those experiences with narrative coherence. This is particularly significant given the staff members’ general reluctance to acknowledge that the positions and work they valued and enjoyed occurred within the same system that caused great harm. As a reviewer of our manuscript suggested, the nostalgia expressed in the oral histories may be more accurately expressed with the Welsh word ‘hiraeth’, yearning, grief, and longing for something that no longer exists, and perhaps never did.44 Although many narrators expressed nostalgia, there was a significant group of narrators that had very different recollections of Central State. One nurse explained her attitude, ‘I came away not with high respect for the system ... there. It was a good fit for me to leave. I think it was

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probably a good fit for them for me to leave’. 45 Additionally, there were narrators whose nostalgic affect ceased when recounting extremely painful incidents associated with their work. In general, however, the following analysis examines where and how many narrators deployed nostalgia in their interviews. Most CSH staff asserted that their work had value and that CSH itself was a positive work environment. They claimed that they and their immediate colleagues approached their work with professionalism and regard for their patients’ best interest. In this respect, nostalgia is about identity and integrity. The narrators made it clear that they believed they provided good care for their patients, and that they knew their patients well. Some described themselves as being proud of the patients who thrived under their care. ‘It wasn’t just, “we were just nurses”; we were a group of people that cared about the patients. That’s what was important’.46 Another staff member, a dietician, explained: I was very proud of the patients, our work with the patients, and how we got to know them. We gave them all this, whenever we taught them, they learned things. It may have been baby steps, but they eventually learned and they remembered, and it made their lives better when they practiced different things. That made me proud.47

Generally, staff described their relationships with patients and coworkers in familial terms, claiming ‘… it was almost like a big, happy family, the whole hospital was. You see it at the reunions, that group, to continue to want to get together and everything’.48 When reflecting on working together, narrators emphasised how patient care was implemented by interdisciplinary teams which met regularly. Of these meetings, nurse said, ‘Oh, it was educational. You learned more about the patient than ever, at least I always did, and it was a time that you could see the patient, how much they’ve improved … I could talk with the doctors and find out if we could get different medicines that would help them get better. Anyway, I loved those meetings. Good times’.49 Another nurse, who had been at CSH for many years, recalled meaningful, collaborative efforts. ‘I worked with the same doctor and the same psychologist for years … It was a wonderful experience. We were a great team. I really valued working with them and their knowledge’.50 Many narrators referred to the parties they threw with the patients and the outings they regularly took beyond the hospital grounds.

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They described these events with enthusiasm and some even shared photographs that demonstrated that staff and patients enjoyed one another’s company. These shared celebrations included holiday parties, baby showers for staff members, going away parties for patients who left the hospital, as well as barbeques and camping trips.51 One narrator recalled her observations of the overall sense of happiness among the patients at CSH. I don’t remember them [patients] being anything but happy, but we were there, there was a lot more entertainment done at Central. When we had parties for the staff, the patients came, too… . There was a lot of pitch-ins [i.e., communal meals in which staff brought food to share], really, with staff, for whatever reason, whether it be someone retiring, or … special occasions, Easter, everything. So, [sigh] I think they were happy, I really do. There’s some I assume didn’t want to be in the hospital, but I, maybe it’s because most of them were chronically mentally ill, that they were happy.52

For some workers, regarding the patients as ‘family’ extended to blurring the separation between their home life and their work at the hospital by inviting their patients into their homes or bringing home-cooked food to the hospital: ‘[W]e had staff that took patients home with them for Christmas and Thanksgiving and holidays. The staff who had to work that day brought in food and they had their own Thanksgiving right there on the ward’.53 These positive memories were often paired with strong feelings of discontent about the closing of CSH, and protests that life in the community was not in the best interest of patients. One narrator said: my life there, I felt good. I felt comfortable walking in the place. I didn’t feel frightened of the patients. The staff that I worked with had been there for many years, they knew the patients. They were not somebody who just hollered and screamed at them. They got out and they worked with them and to me I think that closing Central State was the worst thing that could happen to a lot of our patients.54

Part of the frustration about Governor Bayh’s decision to close the hospital was that it cemented the public’s negative image of the hospital and its staff. When asked about how local journalists discussed the hospital and the closing, narrator CB told us, ‘you can understand how angry I get

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when I read garbage in the paper about Central State Hospital because they haven’t talked to [us]’.55 Thus, many of the narrators used the interview as an opportunity to assert that they cared for their patients, that they worked well as a team and generally liked and respected those they worked with. One nurse, who was particularly expressive during her interview, concluded with these remarks, ‘I just hope I’ve conveyed the … quality of care that we gave for the most part. Now there were some, I’m sure, negligence someplace along the line. Yeah, I know there was but [my unit] had a high standard and … at least I and some other staff really cared for the patients. There was some fun involved too and … yeah, I would convey that’.56 The recollection of happy memories was associated with a strong sense of camaraderie among many of the CSH staff members. It was also a form of reading backwards through painful memories of the time after CSH closed. Several staff remembered former patients who died in preventable accidents soon after the closure. As one sheltered workshop supervisor explained, ‘they [former patients] were taken out of their home and placed where they didn’t know anybody, they didn’t feel safe … it scared them to death’.57 One man attempted to leave his new group home and return to CSH. According to the supervisor’s recollections, he filled a grocery cart with his possessions and as he walked along a road a car accidentally struck and killed him. Another man drowned in a retention pond near his group home. The supervisor recalled that she attended fourteen funerals for former patients in the two years following the closure of the hospital.58 Another staff member, an attendant, attributed premature deaths and homelessness to the removal of interpersonal supports that he and other staff had been able to provide to ensure patient security and safety: ‘[T]aking care of [themselves], we found that a lot of patients, they couldn’t do it. I see them on the street to this day’.59 Some staff linked patient deaths after the closure to the interruption of rehabilitative programmes that aimed to teach patients to live independently. One recreation therapist said, Safety of our residents was the number one concern. Are they ready? Some were and some weren’t. They were going to close regardless of who was ready and I felt outraged about that. Now we have some that didn’t make it and are deceased because of that decision. We have some that I’m sure are doing fine but if you’re not ready they don’t just let you go out and be in an apartment with somebody else and you’re supervised part of the

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time and then you end up drowning in the apartment pool because you weren’t supervised.60

For some staff members, nostalgic feelings about working at CSH might be partly explained by subsequent work experiences at other state hospitals. The Department of Mental Health’s strategy for preserving some jobs for laid-off CSH staff was to reallocate positions by seniority. Because many employees were unable to move across the state to take up positions, most personnel transfers were to the other state-run psychiatric hospital in Indianapolis, the LaRue D. Carter Memorial Hospital. With these transfers, many staff at LaRue Carter Hospital were fired to accommodate CSH staff who had seniority in the state employment system: ‘A lot of people at Larue Carter were displaced with Central State people, a huge number of nurses, RNs [registered nurses]’.61 Several who transferred to Carter recalled the distrust and overt hostility they experienced in their new workplace. As one nurse explained, ‘It was just because they were hurt too. They, their hospital was disrupted. They got us over there. We took their jobs. We booted out good workers, and so I can understand how they felt’.62 To add to these tensions, former CSH employees who moved to LaRue Carter Hospital carried the stigma of the patient deaths that triggered the hospital closure. To some white employees, the experience of being stigmatised seemed comparable to racial discrimination. As a nurse remarked: [O]ne of the [other] nurses said to me, now I know what it’s like to be discriminated [against]. I was in my building. I wasn’t there [where patients had died], but because I work at Central, I was a killer of people. When we moved to Carter, and before we moved to Carter, I remember them coming over, and the nurse saying if you try to kill my people, my patients, I will fire you.63

Another nurse said, ‘I also tell people that when I went to Larue Carter Hospital, I think I truly learned the definition of what it feels like to, ah, someone to be prejudiced. I really felt it. I knew then what it truly meant … [Because we were from Central] we were treated so bad’.64 Given these difficulties, memories of CSH might seem rosy in retrospect. Nostalgia may work to shore up a more positive sense of identity as a defensive response to the stigma that followed CSH staff for many years.

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Given the traumatic events that led to CSH’s closure, moreover, nostalgia may be a mode of projecting professionalism and sense of mission, while also indirectly expressing staff members’ own grief, feelings of loss, and sense that they knew the best interests of the patients.

Conclusions Surprise and nostalgia are indicative of particular orientations in time: thwarted expectations of continuity into the future, or a longing for an idealised past. Narrators’ recollections of feeling surprised about the hospital’s closure can furnish new insights into the experience of deinstitutionalisation as it happened, and in particular the internal momentum of institutions. The surprise that former CSH staff members expressed reflect their experience prior to the 1990s, in which patient deaths or deplorable conditions caused public outrage, but no threat of closure. In the 1980s, for example, state inquiries into patient suicides and federal investigations into ‘unconstitutional conditions of confinement’ prompted limited reform, not the dissolution of the hospital, in large part because of the state of Indiana’s resistance to enacting policies which would make funding community care feasible.65 While top-down policies were important in perpetuating institutional care, so too were the investments of hospital staff, who considered their work necessary and important. While these attitudes might point towards the personal interests served by the institution, such as providing staff with employment and positions of relative power, we might also consider the reasons why staff members consistently emphasised care for patients and the existence of a real community at the hospital. To take staff narratives of care seriously is not to minimise the existence of violence and oppression at the hospital, but rather to explain how staff continued their work despite these realities. As Burghardt showed in Broken, there is a strong correlation between low expectations concerning the abilities of people with mental illness and intellectual disabilities and the defence of institutions. Some of the narratives of former CSH staff betray paternalistic attitudes towards patients, which made it impossible for many to imagine an alternative to institutionalisation. The belief that people with severe mental illness or disability really had no other option could lead staff to consider their work a noble and difficult effort. Genuine investment in such efforts over the years, including the labour behind the

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development of rehabilitative programmes like art and recreation therapies, set staff members up for a shock when the Governor announced that patients would be better served in the community. Poor outcomes for former patients after discharge could be taken as evidence that the hospital closure was unnecessary and tragic. While narratives of surprise can tell us much about the disappointed expectations of former staff in the unfolding of the deinstitutionalisation process during the 1990s, narratives of nostalgia are also indicative of constructive interventions on the part of the narrators today. In this way, our project to gather narratives from former CSH staff is not one of simple data collection about past experiences, but a dynamic interchange in which our study has provided the narrators with an opportunity to shape new understandings of the hospital and counter predominant narratives about the hospital as a site of abuse and neglect. Nostalgia also works to reconfigure the narrator’s self-conceptions as caring professionals, after having carried the shame and stigma of being a former CSH employee— comparable to how attendance at the annual reunions contributes to a positive sense of group identity. Our argument is not that nostalgic recollections were untrue—there seems to have been real elements of fun, care and community at the hospital—but that these recollections also perform important work today, as we and the former CSH staff members re-construct the history of deinstitutionalisation.

Notes 1. George Stuteville, ‘Woman Froze to Death in State Hospital’, Indianapolis Star, 6 December 1991, A-1, A-6; ‘Grand Jury Probe Urged in Icy Death’, Indianapolis News, 6 December 1991, C-1; ‘Deaths of Mental Patients Spark Drug Investigation’, The Star Press (Muncie, Indiana), 11 November 1991; Rex Redifer, ‘Family to Sue of Central State Patient’s Death’, Indianapolis Star, 20 December 1991, B-1, B-2. 2. Susan Hanafee, ‘Death Leaves Family with Memories of Woman Who Battled Mental Illness’, Indianapolis Star, 25 March 1992, A-1. 3. Ellen Dwyer, ‘The Final Years of Central State Hospital’, Journal of the History of Medicine and Allied Sciences, 74(1), 2019, 107–126. 4. Our larger research project examines the roles played by gender and race in the closure of Central State Hospital. For instance, women’s deaths at the hospital in the early 1990s seem to have garnered much more attention in both media coverage and official investigations compared to men’s. In addition, we explore why the death of Heine, a white woman,

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5.

6.

7.

8. 9. 10. 11.

12.

13. 14. 15. 16.

was quickly followed up with a decisive response to close the hospital, in contrast to the deaths of Shelby and Highsaw, who were Black. In the lawsuit they filed against the hospital, Shelby and Highsaw’s families claimed that the welfare of white patients was given greater priority at Central State. See ‘Central State Settles Suit’, The Tribune (Seymour, IN), 8 June 1994; Clark v. Donahue, ‘Third Amended Complaint for Damages’, p. 4. Box 19, vol. 1, case no. IP92-237C, United States District Court, Southern District of Indiana. Elizabeth C. McDonel, Lucinda Meyer, and Richard Deliberty, ‘Implementing State-Level Mental Health Policy Reforms in Indiana: Closing a State-Operated Psychiatric Hospital and Passing Major Mental Health Reform Legislation’, International Journal of Law and Psychiatry, 19(3– 4), Summer–Autumn 1996, 248–249. Evan Bayh (born 1955) is the son of a prominent Democratic senator and statesman, Birch Bayh (1928–2019). Evan Bayh served two terms as governor (1989–1997) and two terms as US Senator (1999–2010). Emily Beckman, Elizabeth Nelson, and Modupe Labode, ‘Voices from the Newspaper Club: Patient Life at a State Psychiatric Hospital (1988– 1992)’, Journal of Medical Humanities, 21 May 2020. https://doi.org/ 10.1007/s10912-020-09617-7. Ellen Dwyer, ‘Mental Health Care in Early Twentieth Century Indiana and the Limits of Reform’, Indiana Medical History Quarterly, 9(1), 1983, 23–27. Dwyer, ‘The Final Years of Central State Hospital’. Linda Graham Celeca, ‘Hospital’s Decay Rooted in Indiana’s Neglect of Mentally Ill’, Indianapolis Star, 17 May 1992, A-10. Dwyer, The Final Years of Central State Hospital’, 125. Verusca Calabria, ‘An Exploration of the Function of Nostalgia in Oral Histories of Asylum Life’, Rebecca Wynter, Jennifer Wallis and Rob Ellis (eds), Anniversaries, Memory and Mental Health in International Historical Perspective: Faith in Reform (London: Routledge, 2023), 231–256. Madeline C. Burghardt, Broken: Institutions, Families, and the Construction of Intellectual Disability (Montreal: McGill-Queen’s University Press, 2018). Ibid., 155. Ibid., 170. Andrew T. Scull, Decarceration: Community Treatment and the Deviant— A Radical View (Englewood Cliffs: Prentice Hall, Inc., 1977). In this sense, our findings about nostalgia echo those of oral historians who have investigated another set of institutional reforms in the late twentieth-century United States, the process of school desegregation. After interviewing students and teachers about their memories of all-Black

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18. 19.

20. 21. 22. 23. 24.

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schools in Florida, Barbara Shircliffe concludes, ‘In their nostalgia about [segregated schooling]… former students and teachers are not claiming African Americans benefited from school segregation, but rather, they are pointing to the ironic legacy of desegregation and the tension between community control and integration’ (Shircliffe, ‘“We Got the Best of That World”: A Case for the Study of Nostalgia in the Oral History’, The Oral History Review, 28(2), Summer–Autumn, 2001, 59–84, 60. Similarly, nostalgia about patient life at CSH must be read through narrators’ understandings of the failures of community-based care. We are using the term ‘narrators’ here to emphasise, in keeping with Michael Frisch, that these oral histories were jointly created by the narrators and the interviewers. In keeping with best practices recommended by the Oral History Association, the narrators signed a release statement, allowing us to quote them in our scholarship and deposit the oral histories in the IUPUI University Library. Because of the stigma associated with both mental illness and working at a psychiatric hospital, in this essay we have decided to preserve the privacy of these narrators and refer to them by their initials. Notes taken by Elizabeth Nelson during conversation with CB at annual CSH Reunion, spring 2018. Oral history interview with LS, 20 June 2018, 19. The recording and transcript of this and all subsequently cited oral history interviews are currently held by the Medical Humanities and Health Studies Program, Indiana University-Purdue University, Indianapolis (IUPUI), but will be deposited at the IUPUI Ruth Lilly Special Collections and Archives. Anthony Rudd, ‘In Defence of Narrative’, European Journal of Philosophy, 17(1), 2007, 62. Ibid., 60. Ibid., 61. Ibid., 63. Our interview questions concerning staff experiences of the closure were guided in part by a previous study conducted by the Indiana Consortium for Mental Health Services Research, which tracked attitudes and quality-of-life measures among patients, staff, families, and other stakeholders during and after the closure process. This group found that ‘CSH employees had a difficult time accepting the reality of the closure. Many never really believed that it would happen.’ See Debra J. Mesch, John H. McGrew, Bernice A. Pescosolido, and Diana F. Haugh, ‘The Effects of Hospital Closure on Mental Health Workers: An Overview of Employment, Mental and Physical Health, and Attitudinal Outcomes’, The Journal of Behavioral Health Services & Research, 26(3), 1999, 305–317, 306.

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25. Meadhbh Foster and Mark Keane, ‘The Role of Surprise in Learning: Different Surprising Outcomes Affect Memorability Differentially’, Topics in Cognitive Science, 11, 2019, 76. 26. See, for example, the oral history interviews with LS, 20 June 2018, 19; KS, 2 October 2018, 16; JM, 23 March 2018 (Part 1 of 2), 30. 27. Oral history interview (hereafter OHI) with SB, 12 October 2018, 14. 28. OHI with CW, 26 June 2018, 14. 29. OHI with JM, 23 March 2018 (Part 1 of 2), 31. 30. OHI with JD, 19 June 2018, 12. 31. OHI with JH, 21 May 2018, 22. 32. OHI with JM, 28 March 2018 (Part 2 of 2), 34. 33. OHI with VC, 3 May 2018, 25. 34. OHI with MF, 21 May 2018 (Part 2 of 2), 19. 35. OHI with CB, 18 October 2018, 14. See also, McDonel, Meyer, and Deliberty, ‘Implementing State-Level Mental Health Policy Reforms in Indiana’, 239–264. 36. OHI with CB, 18 October 2018, 11–12. 37. McDonel, Meyer, and DeLiberty, ‘Implementing State-Level Mental Health Policy Reforms in Indiana’, 245, 248–251. 38. Mark Finnane has found similar examples of resentment about deinstitutionalisation as political manoeuvring among former staff of the Wolston Park Hospital in Queensland, Australia, which closed in 2001. At a 2004 reunion, a former staff member read the following poem: Down sizing is the politically correct way to go We’ll build a brand new complex to put on show Its up-to-date features will surely make other States sigh Is it a monument to a politician’s dream or a pie in the sky? First of all we’ll form the confused into a Transitions Team With plenty of paperwork but no answers that gleam Then let’s determine which staff will be the ones to stay Offer the others a carrot and hopefully some will slink away. See Mark Finnane, ‘Opening Up and Closing Down: Notes on the End of an Asylum’, Health and History, 11(1), 2009, 9–24 (poem appears on p. 19). 39. Liat Ben-Moshe, Decarcerating Disability: Deinstitutionalization and Prison Abolition (Minneapolis: University of Minnesota Press, 2020). 40. OHI with MF, 21 May 2018 (Part 2 of 2), 18–19. 41. OHI with MF, 21 May 2018 (Part 2 of 2), 20. Geraldo Rivera, a US journalist, directed a short, influential film for broadcast television Willowbrook: The Last Great Disgrace in 1972 about the abysmal conditions

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43. 44.

45. 46. 47. 48. 49. 50. 51.

52. 53. 54. 55. 56. 57. 58. 59. 60. 61. 62. 63. 64. 65.

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in a state hospital for children with intellectual disabilities in New York City. In subsequent years, Willowbrook became a shorthand reference for wretched state facilities for people with disabilities. Benjamin Weiser, ‘Beatings, Burns, and Betrayal: The Willowbrook Scandal’s Legacy’, New York Times, 21 February 2020, https://www.nytimes.com/2020/02/ 21/nyregion/willowbrook-state-school-staten-island.html?action=click& module=RelatedLinks&pgtype=Article (accessed: 15 April 2020). For nostalgia in oral histories as a way that narrators claim authority, create identity, and reconcile disparate aspects of the past, see Jennifer Helgren, ‘A ‘Very Innocent Time’: Oral History Narratives, Nostalgia and Girls’ Safety in the 1950s and 1960s’, Oral History Review, 42(1), 2015, 50– 69; Stefan Ramsden, ‘“The Community Spirit Was a Wonderful Thing”: On Nostalgia and the Politics of Belonging’, Oral History, 44(1), 2016, 89–97; Shircliffe, ‘“We Got the Best of that World”’, 59–84. Calabria, ‘An Exploration of the Function of Nostalgia’, 234–236. We deeply appreciate the comments of Dr. Rebecca Wynter, who suggested this concept. ‘Hiraeth, n’, OED Online, March 2021. Oxford University Press. https://oed.com/view/Entry/85866024? (accessed: 4 March 2021). OHI with DM, 4 October 2018, 14. OHI with CO, 25 June 2018, 5. OHI with KS, 3 October 2018, 20. OHI with LS, 20 June 2018, 24. OHI with LS, 20 June 2018, 6. OHI with CW, 26 June 2018, 1. For an analysis of how patients wrote about these parties in the DDU Review newsletter, see Beckman, Nelson, and Labode, ‘Voices from the Newspaper Club’. OHI with LS, 20 June 2018, 24. OHI with JH, 21 May 2018, 4. OHI with CO, 25 June 2018, 5. OHI with CB, 18 October 2018, 14. OHI with JD, 19 June 2018, 16. OHI with VC, 3 May 2018, 16. OHI with VC, 3 May 2018, 29. OHI with LL, 3 December 2018, 17. OHI with LF, TD, and BO, 16 August 2017, 33. OHI with MF, 21 May 2018 (Part 2 of 2), 24. OHI with LS, 20 June 2018, 20. OHI with CW, 26 June 2018, 13. OHI with LS, 20 June 2018, 20. Dwyer, ‘The Final Years’, 110–113; 115–s118.

An Exploration of the Function of Nostalgia in Oral Histories of Institutional Care Verusca Calabria

Introduction Asylums dominated the care and treatment of people with mental ill health for well over a century. Towards the end of the twentieth century, in the UK, Europe, and America, many were replaced with the advent of care in the community. It has been over 200 years since the introduction of the 1808 County Asylum Act, which authorised county and borough authorities to use public money to build asylums in Britain. The rise and fall of the asylums have attracted a constant discourse within mental health policy based on the belief in reform in order to address shortcomings in care. This discourse coloured the moves to close the mental hospitals and introduce policies to promote community-based care as the mainstream solution. The central tenet of twentieth-century policy of community care centred on the hospital being no longer viewed as the preferred location

V. Calabria (B) Nottingham Trent University, Nottingham, UK e-mail: [email protected]

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 R. Wynter et al. (eds.), Memory, Anniversaries and Mental Health in International Historical Perspective, Mental Health in Historical Perspective, https://doi.org/10.1007/978-3-031-22978-7_10

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for receiving care; the new ideal heralded integration rather than separation from the community.1 The underlying assumption that health and social care has positively progressed, in contrast to the outmoded residential care provided in institutions, has influenced official reports and reviews of the literature.2 The dominant perception of institutional care as undesirable assumes the superiority of the community care paradigm. This became a common sense view that underpinned public policy and professional practice, and a self-evident truth for many health and social care professionals alike.3 However, what is not usually acknowledged are the positive aspects of care within mental hospitals as expressed by patients and staff and the regrets about the institution’s demise that are revealed through personal memories about the old system of care. This chapter aims to critically examine the place of nostalgia in oral histories of institutional care and the function it serves in the face of drastic changes that have occurred with the move from mental hospitals to community care practices. It draws on my doctoral study, which combined participatory action research with oral history. The empirical study explored the experiences of giving and receiving care at Mapperley and Saxondale hospitals in Nottinghamshire, between 1948 and 1994. These memories were collected thirty years after the closure of the hospitals. Mapperley hospital, originally the Borough of Nottingham Lunatic Asylum, opened in 1880 and closed in 1994. Saxondale hospital opened in 1902 as the Radcliffe County Asylum to replace the Sneinton Lunatic Asylum, which was demolished; the hospital closed in 1988. This applied oral history study made it possible to examine the relationship between personal and collective experiences of living and working in these institutions while harnessing the knowledge by experience of former patients and retired staff.4 The mixed methods approach challenged the dominant perception of these sites as outmoded and total institutions, which tends to exclude the often-contradictory meanings of the hospitals both as closed depersonalising environments and as healthcare systems that could function as sanctuaries and places of respite and of belonging.5 The chapter is structured in three parts. The first section focuses on the specificity of oral history in researching the past and the role played by nostalgia in the negotiation of individual and collective past experiences. The second part of the chapter focuses on how nostalgia is expressed in the oral histories of latter-day institutional care. The final part explores what nostalgia for the old system of care in institutions can reveal about current mental health policy and its shortcomings. The objective is to

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consider the impact of forcefully silencing positive narratives of care in the old state mental hospitals that do not easily fit within the prevailing discourse of residential care as undesirable, and the implications of this enforced amnesia for historiography and mental health policy.

Nostalgia and Oral History Oral history as a primary source of knowledge has made important contributions to the history of medicine.6 It is particularly suited to investigate both the nature and function of nostalgia in narratives about life in psychiatric institutions. Oral history as a source for the study of memory can inform our understanding of the past by revealing the hidden and collective meanings given to lived experiences and events. It has often been associated with both grassroots and progressive politics, the democratic desire to amplify the voices of marginalised and oppressed groups, and of those forgotten by traditional documentary history.7 Oral history is not just a unique source about the past, it is also a subject for historical inquiry in its own right as it seeks to investigate not only what is remembered but also how and why the past is remembered in a particular way.8 What makes oral history different is that it opens a window onto the realm of subjectivity. Oral testimonies comprise both a source of autobiographical memory and a source about the nature of memory. In this sense, oral histories must be understood as a narrative product of the interplay between the past and the present, which are necessarily filtered, constructed, and a selective product of memory.9 An analysis of oral histories must take into account how the social structure affects what is told and what is omitted, such as silences, omissions, and fabulation, and the purposes these serve. For instance, silences about particular experiences must be recognised not only as a form of control but also as an expression of agency.10 Moreover, oral history can help to unravel the implications of individual and shared misremembering about past events.11 Oral history can assist in identifying the ways in which individuals strive to create memories by linking personal experiences to public events in order to add meaning to and make sense of their lives. The unique value of oral history rests not so much in the accuracy of events but in the meanings ascribed to them and the purposes these meanings serve. Its specificity rests on inter-subjectivity, which is bound up with memory, and viewed as ‘an active process of creation of meanings.’12 The intersubjectivities at play offer rich sources of interpretation in understanding

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knowledge produced through time and place, as well as the influence of personal agency and the social structure in determining what is revealed and omitted through content and form.13 Historically, nostalgia has been conceptualised as a medical disease and a psychiatric disorder.14 Nostalgia for the past has been predominantly understood in negative terms such as ‘expressing modern malaise,’ or a kind of ‘romantic bad faith.’15 Historian Pierre Nora saw the expression of nostalgia for the past as a rebellion against the dislocation and anxiety as a result of the unprecedented change caused by modernity, and as a way to preserve as many fragments of the past as possible.16 Nostalgia plays a significant role in the construction of collective identity.17 It is commonly viewed as a form of selective memory that functions to foster a sense of collective belonging for lost communities.18 Nostalgic practices may act to obscure the legacy of unequal power relations and to serve dominant socio-political and economic agendas; nostalgic notions of the past may be appropriated and invested in by reactionary politics.19 However, nostalgia can tell us as much about the past as it does about individual and collective present concerns. Historian Raymond Williams defined nostalgia as a ‘structure of feeling’ that expresses a sense of a lack of agency as well as embodying an experience of loss in the present.20 Nostalgia in individual and collective narratives can function as retrospective as well as prospective meaning-making,21 signifying the wish to preserve the past in the hope of a better future. In the face of an unstable present, nostalgia may be an expression of the desire to return to a more stable past, but the kind of past one longs for depends on one’s present position in society.22 The residents of the ex-mining village of Wheatley Hill in County Durham, for instance, engaged in a form of selective remembering by appropriating symbols from a bygone era as part of a community heritage event, creating a sense of collective identity, belonging, and continuity. The village was once part of a significant coal-producing area in the northeast of England, but now suffers from high levels of unemployment following the closure of the pits in the late 1960s. Local residents engaged in selective remembering of a lost past in the form of nostalgic reflections as a strategy to cope with the effects of the drastic changes the town faced. Nostalgia reaffirmed individual and collective identities and enhanced community cohesion as villagers created a sense of continuity in the face of a perceived lack of it, revealing present concerns.23 Nostalgia has also been found to help reconstruct narratives of community during wartime.

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For instance, personal and shared nostalgic memories can support grand narratives such as the collective image of the stoic, hard-working Finnish women during wartime.24 Nostalgia in personal narratives may serve to re-evaluate the past, namely, to register and critically evaluate the drastic changes that have occurred in the last half-century. In the Lost Trades of Islington project, long-standing residents of Islington, London (UK), engaged with nostalgic memories of the past. The process enabled the critical evaluation on how changes to the local area affected individual narrators. This in turn revealed the complex interconnections between memory, place, and emotion, as well as the continuities and discontinuities between the past and the present.25 Anthropologist Ray Cashman observed the use of critical nostalgia in an Irish community in Northern Ireland. The town commemorated its past through everyday material culture in order to appeal to a historically informed sense of community despite the sectarianism therein. Nostalgia fostered cooperation in the Irish town through the restoration of local material culture and helped to improve community relations and local ties; in doing so, the active process of forgetting how local ties transcended sectarian divisions was resisted. The triggering of nostalgia through the display of everyday material culture from the past helped to reassert local community identity, harking back to a shared past where local ties superseded the sectarianism of the region.26 Nostalgia can be seen as a cultural practice that can serve as a response to a wide range of local personal and collective needs in the face of modernity. Nostalgic narratives about a distant past must be understood in the context of conflicting moral claims to place attachment. Sociologist Mike Savage sees nostalgia as a key tool for those whose belonging is defined by local rootedness in order to counter the moral claims to belonging made by new, middle-class, mobile incomers, for whom attachment to place is a choice rather than the product of kinship connections or long residence.27 In this sense, nostalgia for the old system of care provided in psychiatric institutions can pose a challenge to the widespread assumption of progress in mental health reform by shedding light on the contested meanings of care therein. Some patients perceived aspects of care in mental hospitals from the mid-to-late twentieth century to be preferable to the care received in the context of care in the community from the 1990s onwards.28

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Nostalgia in Oral Histories of Institutional Care The main issue with memorialising the old Victorian asylums rests on their contested histories; since the 1960s, asylums have been stigmatised as sites of incarceration, primitive treatments, and patient abuse. Most of the former psychiatric asylum facilities in the UK and elsewhere have been sold to private investors and redeveloped into luxury flats, although a few hospitals retained parts of their buildings for the re-provision of inpatient and outpatient mental health services (see Fig. 1).29 Real estate developers have been operating a form of strategic forgetting of the history associated with the old asylum buildings. Most of the redevelopment brochures and planning documents have removed these histories due to the stigma attached to the bricks and mortar, thus performing a kind of selective remembrance.30 However, former asylum sites are containers of memory for those who lived and worked in them, a common occurrence in narratives of lost communities.31 A body of research has provided evidence to show that patients retain an emotional attachment to these institutions after their closure, suggesting asylums could be remembered in ways beyond that of stigmatised sites; these institutions often served as surrogate families and refuges during mental health crises and convalescence.32 Nostalgia for the now-closed state mental hospitals has been found to be a recurring feature in social studies on the impact of deinstitutionalisation.33 Research conducted by geographers on the meanings of psychiatric asylum sites held by patients and staff in the twentieth century found these facilities to be meaningful social spaces.34 The oral histories of ex-patients who received care at Mapperley and Saxondale hospitals in Nottinghamshire (UK), between 1948 and 1994, and of retired staff who gave it, convey an overwhelming sense of nostalgia for the old system of care, reminiscent of other oral histories of life in mental hospitals in the mid-to-late twentieth century. There has been a long-established tradition of innovation in mental health services in Nottingham, such as early community care, therapeutic community principles, and open-door policy at Mapperley hospital from the 1940s onwards.35 The oral histories discussed in this section were produced as part of a study which combined participatory action research and oral history methodologies.36 Twenty people with first-hand experience were interviewed multiple times; some of their family members and carers took part in group activities as part of the iterative phases of the research. The main objective of combining the two methodologies was to reverse the

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Fig. 1 Half of Mapperley hospital wards (the male side), converted into luxury flats with commanding views over South Nottinghamshire (Image author’s own)

marginalisation of stakeholders in mental health research, namely service users and their significant others, whose voices, involvement, and coproduction have become increasingly important in the design and delivery of services.37 The study relied on a mix of one-to-one and group encounters to build a shared understanding of how the research would take place, what kind of data would be collected and how meanings would be derived from the data and used to generate findings, including a shared plan for dissemination.38 The oral histories co-produced with ex-patients and retired staff challenged the hitherto dominant narrative of psychiatric care in institutions in the latter part of the twentieth century as total institutions, predominantly perceived to be based on discipline and punishment. The oral testimonies reveal helpful social and spatial aspects of care in the old system, demonstrating the importance of the therapeutic environment of the mental hospital, as well as the relationships fostered within it, for

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patients’ recovery.39 The oral histories provide evidence of the loss of the hospital communities as places of safety and belonging.40 Recalling personal memories of care in the mental hospitals evoked nostalgic emotions in former patients, staff, and others, such as family members. Nostalgia was present both in the recollections of what life was like in the mental hospitals and when recounting experiences of neglect in the community, either from first-hand or observed experiences. Feelings of nostalgia were attached to both the built environment in terms of its internal and external spaces and the social landscape in terms of the formal and informal rehabilitation provided by the communities that existed therein. Although individual oral history interviews contained negative as well as positive elements of historical experiences of inpatient care, the positive memories were often framed in the context of current concerns for the wellbeing of former patients, who still rely on mental health services. There was a strong consensus that there is a lack of access to adequate support in the current system of community care. Anne was a patient at Saxondale hospital in 1974 when she was 17 years old. She remembered that the hospital provided a chance to meet people who were going through similar experiences and to get support from staff who had time to provide care, which she perceived to be lost in the current system: I had very low mood and self-worth. The staff were quite pleasant and would talk to you, nowadays they are too busy with the paperwork, and lots is going wrong. But back then they had time.

She recalled occupational therapy (OT) was helpful during her convalescence in hospital: I was quite happy to go there, it’s creative and a form of art therapy which can help to express how you feel, to uncover the cause of what’s caused you to be unwell rather than blotting them out with drugs, I thought about becoming an occupational therapist after that. Now you don’t get access to OT, it’s all gone.

After a six-month-period of hospitalisation, Anne went back to volunteer at the hospital as an OT assistant in the late 1970s. She was unable to train as an occupational therapist due to long-term mental health difficulties.

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Ex-patients and staff attributed symbolic meanings of home and belonging to their time in the hospital, such as a homely and family-like environment, a place of safety and sanctuary, reminiscent of commemorative histories of hospitals that report family-like and homely environments therein.41 It also reflects the experiences of some patients during the late nineteenth and the early twentieth century who considered the institution their home, which could offer respite from the outside world.42 Michael was an inpatient at Saxondale hospital in the 1970s. He held seemingly contradictory feelings about the hospital; he acknowledged being stigmatised for becoming a mental patient, an aspect of institutional life associated with the traditional critique of asylums as ‘total institutions’ that spurred deinstitutionalisation.43 However, Michael also recalled the hospital as a place of refuge and of belonging where ‘I could be myself and feel at home amongst people like myself in a way I do not feel living in [the] community.’ Rodney had repeated hospitalisations at Saxondale hospital in the 1970s and 80s. During his involvement with the study, he often expressed a longing for the old system of residential care by repeatedly stating that ‘it was a really therapeutic place.’ He recalled how the sporting facilities contributed to a sense of feeling part of a supportive, structured environment to which patients belonged: There was life there and there were facilities there that were second to none, they had a wonderful cricket pitch, I suppose they didn’t play very good cricket but that wasn’t important, the things were all there and these were made available to patients.

Rodney explained what is missing from care in the community: There’s an absence of community and an absence of care. The experience of care in the hospital is arching back to the time when people were kind and gentle as a profession. When you lose the sense of who you are, the importance of feeling safe and protected is more important than anything else.

Liz trained and became a staff nurse at Saxondale in the mid 1980s and went to work as a community mental health nurse after closure. She reflected on what changed in the provision of care: There were lots of social opportunities in the old system, such as the coffee bar, football, cricket and other social activities like occupational therapy.

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One of the things I have struggled with in the new system is the pressure I feel on the administration; before 80% of my time was spent face to face with patients, more recently it is less than 50% because of the amount of admin. This is the context of psychiatric nursing in the community, the quality of contact has declined.

Louise is from the Caribbean and came to work as a psychiatric nurse at Saxondale hospital in the 1970s and stayed until its closure in 1988. She saw herself as a mother figure to long-stay patients for whom the hospital was their home: ‘I was ward Sister for two female wards at Saxondale, it was like a family.’ She experienced grief when patients were moved out of the hospital as part of the closure: ‘I started crying, they were like my family.’ She repeatedly referred to the hospital as a family unit, seeing the female patients she cared for as part of her extended family: Saxondale was a lovely place to work, it was like a family unit, it was a really well set out place, it was a family-oriented place, so not only with the patients and staff and all grades of staff, it was home.

She felt it would have been better to improve what was available in the mental hospital than start a new system of care where the relationships that had existed in the hospital were fragmented in the community care system. This echoes what Nelson et al. in this volume found in their analysis of the oral histories of former staff of the now closed Indiana’s Central State Hospital who emphasised the importance of the relational care provided therein, no longer available in new system of care. Louise described the place as feeling like a ‘ghost hospital’ during closure: It was a sad time, the wards were closing one at a time, the hospital was dying, that’s the word I can use for that, it was the death of that community.

Others echoed Louise’s sentiments. Gill trained as a nurse at Mapperley hospital in the 1970s and worked there until it closed. She was keen to stress the importance of the social rehabilitation available therein: The rehabilitation in the old days was good, you could give a lot of time to people and got to know the patients very well, now there is no time to talk to the patients.

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Linda worked as a hairdresser at Mapperley hairdressing salon from 1973 to 1995; she explained that the reason she stayed working at the hospital until its closure was because she loved her job. She referred to the familiar atmosphere of the hospital as a key factor in forming good relationships with patients and helping them get better: Everybody had a good relationship with the patients, it was such a relaxed, easy place to work in, that’s how I remember it, it was amazing, proper family.

Feelings of nostalgia were also expressed through the sense of loss of hospital-based care, and this was bound up with the experiences of the mental hospital as a therapeutic environment for patients recovering from a mental health crisis. Former patients unanimously felt that the mental hospitals were taken away from them without anything being put in their place, referring to the lack of available inpatient care in the current system. Crucially, both the social rehabilitation and spatial environment of the hospitals were remembered as providing therapeutic benefit, prompting former patients and retired staff alike to reflect on their preference for the care provided in the old system when compared to modern inpatient services. This reflects the research conducted by Csipze et al. on the perceptions of 116 inpatients of acute care in 8 acute wards in London as part of the PERCEIVE research programme (2007–2012).44 They found that patients were offered less time participating in social activities than 50 years ago in institutional settings. There was a consensus that the project of care in the community failed them due to the degree of oversight and neglect in the current system, echoing the experiences of rehousing former long-stay residents in the community in New Zealand, who were forgotten ‘in landscapes of despair.’45 James was an inpatient at Saxondale in the 1970s and subsequently an outpatient in the 1980s at the same hospital. Despite some experiences of bullying and excessive use of force by staff, he felt the care was much better in the old system than in the current system of inpatient care: ‘you were looked after then whereas now it’s much more dismissive.’ For James, the rehabilitation available in the old mental hospitals in terms of the recreational facilities and access to the extensive grounds were needed for recovery, which was lost in the new system of care:

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What has been lost with the closure of Saxondale is a sense of community and a sanctuary for voluntary patients, and what is left now is just horrible concrete in acute units.

James reflected on the loss of the hospital in terms of the absence of a place of sanctuary during the crisis in the current system: That’s a big loss to me, in terms of a place for recovering from illness, it was all just money and business and one fell swoop and they call it care in the community.

Jane, a patient at Mapperley hospital in the 1990s, felt the closure of the hospital was misjudged. She also associated the hospital closure with a form of loss: ‘unfortunately we lost the baby with the bathwater with blowing these institutions away.’ Moreover, Rodney, an inpatient at Saxondale hospital, felt that with the closure of the local hospitals ‘the whole dream of social and therapeutic activity in the community was knocked on the head,’ which he put down to cutbacks in mental health services in the late 1990s. He referred to the closure of the hospitals as having an ‘earth-shattering effect’ for mental health service users in need of a place of safety and sanctuary: The resources were all there and made available to patients are gone… That was a real loss because not only was the space and the sites where these big hospitals stood removed but the whole capacity to deal with the large scale mental ill health that we have in our society.

During the study’s iterative phase of planning for dissemination, Rodney was moved to tears when remembering a friend who remained uncared for in the community following the closure of Saxondale hospital. He felt the co-produced research about the Nottinghamshire mental hospitals to be the start of some real change in terms of rediscovering aspects of care that he and others found meaningful in the previous system of care, which was done away with during deinstitutionalisation. A critical aspect of care that featured largely in the oral histories was the open-door policy, namely the removal of locks on wards as well as hospital gates,46 which has been lost with the advent of community care. It was particularly poignant to hear ex-patients and informal carers describe the current inpatient acute units as prison-like environments. John, the son of a psychiatric doctor at Mapperley hospital, grew up on the hospital site

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from the mid 1940s onwards and witnessed the period in which the opendoor system was introduced in 1952.47 He is the main carer for his son, who is living in the community and has a serious long-term mental health condition. He fears for his son’s wellbeing once he is no longer able to care for him. John reflected on the impact of removing the open-door system in current inpatient settings: People were able to get out of the wards then, I think that’s a tragedy that we are back to the state of what it was before [the open-door system], I think it was a mistake, they haven’t got the grounds that the patients used to walk which used to be therapeutic, that has been taken away.

As the oral history extracts above attest, nostalgia in oral histories of institutional care helps to unravel how communities have experienced collective loss; it signifies the strategies used to foster a sense of continuity in the face of uncertainty.48 Closure of the hospitals meant the loss of not only the physical sites but also the hospital communities therein. Deinstitutionalisation obscured the complex meanings ascribed to the social and physical environment by the social groups that occupied the hospitals and what these provided for patients. The clinical and non-clinical staff who worked in the old, long-stay hospitals provided an array of less visible resources implicit in institutional life that were not retained in the new system of care. It evokes what Peter Barham predicted about the failure to acknowledge the interdependence of various elements of the caring system, which would result in ‘the creation of old problems in new places’ following the closure of the state mental hospitals.49 The government failed to create an infrastructure of support for the provision of non-institutional care following deinstitutionalisation, with the burden of care falling on the family, private and public institutions such as care homes and prisons.50 There is little investment in long-term therapeutic community-type services and support structures in the current British mental health system.51 Remembering the hidden legacy of the Nottingham mental hospitals emerged as a major motivator for ex-patients and retired staff to participate in this study. The oral histories put into question the progressive nature of mental health reform by evidencing the significance of the emotional attachment to the spatial and social aspects of care therein, overlooked during deinstitutionalisation and the transition to community care services. Through group discussions with ex-patients and retired

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staff, a collective consensus emerged about the need to preserve, celebrate, and share with a wider audience the intangible heritage of the local mental hospitals.52

The Function of Nostalgia in Oral Histories of Institutional Life Making reference to sociologist Fred Davis’ seminal study on nostalgia,53 geographer Katy Bennett states that the peculiarities of nostalgia rest in its relationship to present concerns, providing clues to the role it plays in reconstructing identity.54 The nostalgic memories attached to residential psychiatric care at Nottingham and other institutions provide evidence that ex-patients and staff returned to these memories, not solely as sources of alienation and oppression, but as a form of retrieval to find sources of identity, community, and belonging.55 Crucially, nostalgia in the oral histories of such care settings acts as a kind of resistance to strategic forgetting. It serves to legitimise a particular version of the past that has been denied to residents and staff alike due to the prevailing public perception of these institutions as custodial and outmoded, which in turn led to their demise. Sociologist Stuart Tannock sees the structure of nostalgia as an instance of positive evaluation of the past in response to a negatively evaluated present; in this sense, ‘nostalgia is a response to the experience of real abrupt discontinuities.’56 Nostalgia in narratives of residential psychiatric care serves as a testament to former residents’ sense of belonging. It allows the past to be read in new and productive ways, a process that may facilitate the recovery of previously overlooked historical experiences and practices. Nostalgia for the old system of care functions differently from dominant nostalgic narratives; it enables those who had positive experiences of care in the old system to express a yearning for and loss of access to a place of sanctuary and respite. It provides a resource for confronting the concerns of the present, the anxieties, fears, and frustrations to which nostalgia is a response—in this case the shortcomings of community care, and the loss of access to a place of safety and the close knit-communities that existed therein. The sense of loss of the hospital environment as a place of rehabilitation and the subsequent experience of neglect and isolation in the community coloured former patients’ longing for the social and spatial aspects provided in institutions. The hospital was perceived as an essential layer of inpatient care, concurring with other literature on the impact of deinstitutionalisation in the 1980s

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and 90s, which found that hospital-based mental health care continued to play a central role for some groups vulnerable to crisis, exposing the tensions inherent within the community care paradigm.57 It also concurs with the themes emerging in more recent literature, where the lack of access to appropriate care has been associated with neglect for people with long-term mental health problems.58 It echoes the views held by many psychiatrists today that the hospital provides valuable resources for protection and rest during a mental health crisis.59 Nostalgia enabled former residents to articulate the sense of loss they experienced as a result of the destruction of a site of memory and its material culture. Nostalgia in oral histories of residential care serves to simultaneously preserve a hidden and forgotten past and create an alternative site of memory for those who considered the institution a place of safety. These alternative representations of the care in the now closed mental hospitals are usually neglected within mainstream discourse, which tends to exclude experiences that diverge from the prevailing representation of institutional care practices as solely dehumanising. The seldom-heard nostalgic perspectives not only of ex-patients but also of retired staff and others, such as informal carers, who came into regular contact with the mental hospital in the twentieth century, offer the prospect of rectifying disparities within the historiography of psychiatry, according to which only certain accounts are held up as valid, at the expense of others.60 However, there are limitations inherent to the uses of memory as primary sources, which must be understood as rhetorical constructs rather than transparent windows onto past worlds. Since the cultural turn, oral historians have been acutely aware of the pitfalls of silences and conflations in oral testimony, such as conflicts of interest or unequal power relations that may be occluded in this process.61 Nostalgia in oral histories of institutional care should be challenged for its inherent disruptions, such as misremembrances and omissions, but it should also be recognised as a valid way of understanding the lived experiences of hidden and generally silenced historical actors. Nostalgia as a general structure of feeling appears to be pivotal to individuals and social groups who inhabited the mental hospitals in the mid-to-late twentieth century. In turning to the past to find sources for agency or belonging, negative elements may become less relevant to the need for legitimising helpful aspects of inpatient care in the face of an uncertain future. There was an obvious over-emphasis on the helpful aspects of care in the old system in expatients’ oral histories, and a clear lack of reference in the oral histories

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of former staff members to instances where staff had mistreated patients. Silences about specific areas of experience in oral history narratives are not only effects of oppression and control, as Luisa Passerini found in her research into the lives of working-class Italians during fascism who had collectively suppressed memories of the regime.62 Silence can also be a form of agency that can transpire through the multiple negotiations between the narrator and the researcher before, during, and after the oral history encounter.63 Life narratives are shaped by the social and political constructs available to narrators, and—while acknowledging their subjective nature—these narratives can expose what is at play. Both the need to preserve a past that has been largely neglected in the public domain as a consequence of the strategic forgetting of social and physical institutional spaces and the effect of an imagined audience in the form of future researchers accessing their oral histories may have affected what former patients and retired staff said and omitted to say. During the group feedback phase of the study, the broad themes that emerged from the analysis of the oral history interviews with former patients and retired staff were shared with all involved. Retired staff were conscious that they may have presented an overly optimistic view of their time working in the local mental hospitals. This conscious over-emphasis of what was helpful in the provision of care in the old system may have been a collective strategy to counter the imposed amnesia about hospitals as healthcare systems. Similarly, ex-patients who are still users of the psychiatric system may have emphasised the helpful aspects of care in light of the collective sense of dispossession and neglect in the current provision of mental health care, perceived to be largely fragmented. Ex-patients were well aware of the imposed public amnesia on the positive aspects of institutional care and repeatedly referred to those service users who had the loudest voices and were heard during the time of deinstitutionalisation at the expense of those who were concerned about closure and were ignored. It echoes the concerns of Peter Sedgwick 30 years ago in his attempt to defend state provision of mental health services in the face of deinstitutionalisation,64 and the recent shift of priorities within the survivor movement and their allies towards a defence of mental health services and disability benefits in the age of austerity.65 The interplay between these oral testimonies and individual and collective acts of remembering rests on the tensions at play in collective memory, namely how certain stories about the past become dominant at the expense of others, and how these grand narratives can be resisted by

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individual actors. Memories help to give meaning to our lives over time by bringing our past and current sense of identity in line with one another; thus, memory is both psychologically and socially framed.66 In particular, memory work from below can help to challenge the pervasive myth that psychiatric care was solely based on discipline and punishment by including accounts that balance this view. A key notion behind the preservation of heritage is a yearning for a more settled past.67 The strategic forgetting of the social history of institutional care seems to have played a key role in the desire to preserve the intangible heritage of institutions— an expression of individual and collective agency that has been largely denied in the public discourse. Nostalgia in narratives of hospital life functions to reclaim former patients and retired staff own social and cultural agency, staking a claim to a suppressed past. Understanding nostalgia as an analytical lens allows for an informed evaluation of the present by contrasting individual and collective past lived experiences. Nostalgia can therefore function as a strategy to cope with change and loss, but it can also enlighten and liberate as evidenced by Cashman’s ethnographic research. Nostalgia for the old system of mental healthcare offers some insights into how the past is invested with meaning by ordinary people who are denied agency in the making of history, revealing the social needs of these actors in the present, embodied in individual uses of the oral histories.68 Ex-patients and retired staff facilitated change at the local level by initiating communities of dialogue, re-enacting aspects of nostalgia for the old system of care through discussions about meaningful care practices as part of a process of recovering the legacy of the local mental hospitals.69 An important outcome of this study for ex-patients, staff, and their families has been the preservation of their testimonies for posterity through the production of a discreet public archive, containing interview transcripts, photographs, and other memorabilia.70

Conclusion As the analysis of the oral histories of residential psychiatric care in this chapter shows, nostalgia can be put to critical use to question the accepted wisdom of progress in mental health policy. The expression of nostalgia in relation to the social and spatial aspects of institutional care produces counter-narratives that lead to the uncovering of silences of memory and influence the cultural script. Memory is always selective, but accords with

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individual and collective lived experiences; in this sense, ‘nostalgia can be of service in the present when marshalled as an appeal for a better future.’71 Nostalgia for the old model of care in mental hospitals in the mid-to-late twentieth century serves to disrupt and problematise the prevailing view of institutional care as undesirable. Crucially, it sheds light on the ongoing legacy and impacts of deinstitutionalisation, such as the challenges faced in implementing the policy of care in the community for those in need of continuing care. It provides insights into social and material aspects of care in the old system that have been done away with deinstitutionalisation. Moreover, nostalgia as an analytical lens produces alternative representations of a contested past that exposes the current crisis in mental health provision where gaining access to a place of safety during a mental health crisis is not always an option.72 The unattainability of therapeutic practice in acute inpatient settings has been compounded as a result of rising demand for beds, coupled with the steady reduction of available beds.73 Oral historians interested in the social history of mental healthcare can play a crucial role in redressing the pervasive notion that progress is an inherent feature of mental health policy by enabling participatory memory work with communities whose experiences of the changing dimension of care across time have yet to be fully heard. Applied oral history allows for a multiplicity of standpoints to be included to create alternative sites of memory that speak to those who considered the mental hospital an essential layer of care. The application of participatory approaches to oral history is becoming an emerging practice to improve public policy in the twenty-first century.74 Social and political scientist Marella Hoffman refers to the ‘hidden gold’ of oral history, namely the wealth of local knowledge and expertise of otherwise disenfranchised groups that can be uncovered when co-producing oral histories, which can be utilised to improve public policy.75 The co-constructed oral histories of residential psychiatric care discussed in this chapter reveal meaningful aspects of the social and spatial dimensions of such care helpful for patient recovery, which in turn have important implications for contemporary mental health policy and practice. The recent review of the Mental Health Act 1983 makes specific recommendations for improving inpatient units, namely, to create a more social and spatial therapeutic environment in inpatient care.76 These recommendations reflect aspects of care that were available in the old system, revealed in the oral histories of ex-patients and retired staff.

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These findings could help effect practical change by helping to establish an evidence base for positive change in contemporary inpatient mental health provision.77 As historian Rob Ellis has pointed out, researchers in the humanities have only recently started to consider the value of co-producing research.78 Through genuine and sustained engagement with individuals and communities, researchers working across disciplines can call on participatory methodologies not only to produce situated knowledge that can restore a sense of the past that has been denied at an individual and collective level but also to help redress current issues in mental health provision. This process entails the call made by historian Roy Porter more than 30 years ago to shift our gaze to the experiences of those who received care in order to challenge conventional documentary history, which tells us very little about the patients’ interactions with the social and spatial context of life in psychiatric institutions.79 It demands a widening of the horizon so that the current concerns of the communities being researched can be taken into account. This in turn can produce locallygrounded histories which allow space for dissident narratives to emerge that can affect the national discourse. Applied oral history as a powerful tool for research and analysis must be accompanied by a critical evaluation of the interplay between individual and collective memory, the reconstruction of memory and narrative, and, crucially, the impact that co-producing oral histories can have on the lives of the respective individuals and communities. One of the key lessons that emerged from this study into the lived experiences of latter-day institutional care practices is the need to embed the priorities of the communities in the research process to produce research that responds not only to academic priorities but also to community agendas. It calls for developing reciprocal relationships with community groups to effect change through outputs that reflect the needs of all stakeholders. Acknowledgements Verusca Calabria’s doctoral research was possible due to receiving a Vice Chancellor’s Ph.D. scholarship from Nottingham Trent University. She would like to thank the participants for taking part in the study.

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Notes 1. Despo Kritsotaki, Vicky Long and Matthew Smith, Deinstitutionalisation and After: Post-War Psychiatry in the Western World (London: Palgrave Macmillan, 2016). 2. An example is Peter Townsend’s seminal social study of residential homes for elderly people. The study concluded that their depersonalising regime involved patients becoming institutionalised after a long stay in a residential institution, recommending the phasing out of this type of residential care (Peter Townsend, The Last Refuge: A Survey of Residential Institutions and Homes for the Aged in England and Wales (London: Routledge, 1962). 3. Kathleen Jones and A. J. Fowles, Ideas on Institutions (London: Routledge & Kegan, 1998); Raymond Jack, ‘Institutions in community care’, Raymond Jack (ed.), Residential versus Community Care (London: Palgrave Macmillan, 1984), 10–40; Peter Bartlett and David Wright, Outside the Walls of the Asylum: The History of Care in the Community, 1750–2000 (London: Athlone, 1999). Kritsotaki et al., Deinstitutionalisation and After. 4. Verusca Calabria, ‘With care in the community, everything goes: using participatory oral history to re-examine the provision of care in the old state mental hospitals’, Oral History, 50, 2022, 93–103. 5. Verusca Calabria, Di Bailey and Graham Bowpitt, ‘More than bricks and mortar: meaningful care practices in the old state mental hospitals’, Rob Ellis, Sarah Kendall and Steven J. Taylor (eds), Voices in the History of Madness: Patient and Practitioner Perspectives (London: Palgrave Macmillan, 2021), 191–208. 6. Michelle Winslow and Graham Smith, ‘Ethical challenges in the oral history of medicine’, Donald A. Ritchie (ed.), The Oxford Handbook of Oral History (New York: Oxford University Press, 2010), 372–392. 7. Paul Thompson and Joanna Bornat, The Voice of the Past (New York: Oxford University Press, 2017). 8. Oral history emerged in the UK as a distinct sub-discipline in the 1970s with the publication of Paul Thompson’s ‘The Voice of the Past’ (1978) and the formation of the British Oral History Society in the early 1970s, which helped turn oral history into an international movement, http:// www.ohs.org.uk. Accessed 1 Feb 2020. 9. Alessandro Portelli, ‘What makes oral history different’, Rob Perks and Alistair Thomson (eds), The Oral History Reader (Abingdon, Oxon: Routledge, 2015), 48–58. 10. Luisa Passerini, Fascism in Popular Memory: The Cultural Experience of the Turin Working Class (Cambridge: Cambridge University Press,

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11. 12. 13. 14. 15.

16. 17.

18. 19. 20. 21. 22. 23.

24.

25.

26. 27. 28.

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1987); Alexander Freund, ‘Toward an ethics of silence? Negotiating offthe-record events and identity in oral history’, Anna Sheftel and Stacey Zembrzycki (eds), Oral History Off the Record (New York: Palgrave Macmillan, 2013), 223–238. Alessandro Portelli, The Death of Luigi Trastulli and Other Stories: Form and Meaning in Oral History (New York: Suny Press, 2010). Portelli, ‘What makes oral history different’, 69 Joan Tumblety, Memory and History: Understanding Memory as Source and Subject (Abingdon, Oxon: Taylor and Francis, 2013). Fred Davies, Yearning for Yesterday: A Sociology of Nostalgia (New York: The Free Press, 1969). David Lowenthal, ‘Nostalgia: dreams and nightmares’, David Lowenthal (ed.), The Past is a Foreign Country Revisited (Cambridge: Cambridge University Press, 2015), 31. Pierre Nora, ‘Between memory and history: les lieux de memoire’, Representations 26, 1989, 7–24. Julia Bennett, ‘Narrating family histories: negotiating identity and belonging through tropes of nostalgia and authenticity’, Current Sociology 66(3), 2018, 449–465. Stefan Ramsden, ‘The community spirit was a wonderful thing: on nostalgia and the politics of belonging’, Oral History 44, 2016, 89–97. Lowenthal, ‘Nostalgia’. Raymond Williams, Critical Perspectives (Cambridge: Polity Press, 1989), 62. Svetlana Boym, The Future of Nostalgia (New York: Basic Books, 2001), xvi Stuart Tannock, ‘Nostalgia critique’, Cultural Studies 9, 1985, 453–464. Katy Bennett, ‘Telling tales: nostalgia, collective identity and an ex-mining village’, Mick Smith and Liz Bondi (eds), Emotion, Place and Culture (Farnham, Surrey: Ashgate Publishing, 2009), 187–206. Kirsi-Maria Hytönen, ‘Hardworking women: nostalgia and women’s memories of paid work in Finland in the 1940s’, Oral History 41, 2013, 87–99. John Gabriel and Jenny Harding, ‘Reimagining Islington: work, memory, place and emotion in a community oral history project’, Oral History, 48, 2020, 31–44. Ray Cashman, ‘Critical nostalgia and material culture in Northern Ireland’, Journal of American Folklore, 119, 2006, 137–160. Mike Savage, ‘Histories, belongings, communities’, International Journal of Social Research Methodology, 11, 2008, 151–162. Verusca Calabria, ‘Insider stories from the asylum: peer and staff-patient relationships’, Joanna Davidson and Yomna Saber, Narrating illness: Prospects and Constraints (Oxford: Interdisciplinary Press, 2016), 3–12.

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29. Alun Joseph, Robin Kearns and Graham Moon, ‘Re-imagining psychiatric asylum spaces through residential redevelopment: strategic forgetting and selective remembrance’, Housing Studies 28, 2011, 135–15; Graham Moon, Robin Kearns and Alun Joseph, The Afterlives of the Psychiatric Asylum: Recycling Concepts, Sites and Memories (Abingdon, Oxon: Routledge, 2016); Carolyn Gibbeson, ‘Not just a building, a community: staff reflections on former historic asylum sites’, Oral History, 49, 2021, 49–48; Elizabeth Punzi, ‘Ghost walks or thoughtful remembrance. How should the heritage of psychiatry be approached?’, The Journal of Critical Psychology, Counselling and Psychotherapy, 19, 2019, 242–251. 30. Robin Kearns, Alun Joseph and Graham Moon, ‘Memorialisation and remembrance: on strategic forgetting and the metamorphosis of psychiatric asylums into sites for tertiary educational provision’, Social and Cultural Geography, 11, 2010, 731–749. 31. Ramsden, ‘The community spirit’. 32. Calabria, ‘Insider stories’; Diana Gittins, Madness in its Place: Narratives of Severalls Hospital, 1913–1997 (London and New York: Routledge, 1998). 33. Claire Cornish, ‘Behind the crumbling walls; the re-working of a former asylum’s geography’, Health & Place, 3, 1997, 101–110. 34. Hester Parr, Chris Philo and Nicola Burns, ‘That awful place was home: reflections on the contested meanings of Craig Dunain asylum’, Scottish Geographical Journal, 119, 2003, 341–360; Victoria Wood, Wil Gesler, Sarah E. Curtis, Ian H. Spencer, Helen Close, James Mason and Joe Reilly, ‘Therapeutic landscapes and the importance of nostalgia, solastalgia, salvage and abandonment for psychiatric hospital design’, Health & Place 33, 2015, 83–89. 35. Duncan Macmillan, ‘Mental health services of Nottingham’, International Journal of Social Psychiatry, 4, 1958, 5–9; Shulamit Ramon, ‘Professional theories and value preferences in the 50s’, Shulamit Ramon (ed.), Psychiatry in Britain, Meaning and Policy (London: Routledge, 2018), 60–93. 36. Verusca Calabria and Di Bailey, ‘Participatory action research and oral history as natural allies in mental health research’, Qualitative Research, O, 2021, 1–18 https://doi.org/10.1177/14687941211039963. 37. Service-user involvement in mental health research was embedded in the first National Service Framework for Mental Health. It has become an important feature of the discussions and planning related to current approaches to prevention, care and treatment in mental health and fits in with the current health policy agendas that calls for the design of services in partnership with service users. The National Service Framework for Mental Health, Modern standards and service models (London: Department of Health, 1999). 38. Calabria and Bailey, ‘Participatory action research’.

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39. Calabria et al., ‘More than bricks and mortar’. 40. Calabria, ‘With care in the community, everything goes’. 41. MIND, Herefordshire, Boots On and Out: Reflections on Life at St Mary’s Hospital by Ex-Patients and Staff (Great Britain: Logaston Press, 1995); Alison Craze, From Asylum to Community Care: A History of Brookwood Hospital Told by Those Who Lived and Worked There (Self-published, 2014) 42. Jane Hamlett, At Home in the Institution: Material life in Asylums, Lodging Houses and Schools in Victorian and Edwardian England (New York: Palgrave Macmillan, 2014). 43. Erving Goffman, Asylums: Essays on the Social Situation of Mental Patients and Other Inmates (Harmondsworth: Penguin, 1961), 76. 44. Emese Csipke, Clare Flach, Paul McCrone, Diana Rose, Jacqueline Tilley, Til Wykes and Tom Craig, ‘Inpatient care 50 years after the process of deinstitutionalisation’, Social Psychiatry and Psychiatric Epidemiology, 49, 2014, 665–671. A detailed description of the whole programme is given here: www.perceive.iop.kcl.ac.uk. Accessed 11 Sept 2020. 45. Alun Joseph and Robin Kearns, ‘Deinstitutionalisation meets restructuring: the closure of a psychiatric hospital in New Zealand’, Health & Place, 1996, 179–189. 46. The open-door policy was introduced at Mapperley hospital in 1952 and at Saxondale hospital in 1954. It represented a shift away from the biomedical model, questioning the validity of long-term hospitalisation, towards the acceptance of the psychological basis for mental ill health and early discharge (Shulamit Ramon, Psychiatry in Britain: Meaning and Policy (London: Croom Helm, 1985); Catherine Fussinger, ‘Therapeutic community, psychiatry’s reformers and antipsychiatrists: reconsidering changes in the field of psychiatry after World War II’, History of Psychiatry, 22, 2011, 146–163. 47. Duncan Macmillan, ‘Open doors in mental hospitals’, International Journal of Social Psychiatry, 2, 1956, 152–154. 48. Bennett, ‘Telling tales’. 49. Peter Barham, Closing the Asylum: The Mental Patient in Modern Society (London: Penguin, 1997), 15; Peter Barham and Ray Hayward, From the Mental Patient to the Person (London: Routledge, 2002). 50. Graham Moon, ‘Risk and protection: the discourse of confinement in contemporary mental health policy’, Health & Place, 6, 2000, 239–250; Nick Crossley, Contesting Psychiatry: Social Movements in Mental Health (London: Routledge, 2000), 58. 51. Helen Spandler, ‘A magazine for democratic psychiatry in England’, Tom Burns and John Foot (eds), Basaglia’s International Legacy: From Asylum to Community (USA: Oxford University Press, 2020), 205. 52. Former patients and retired staff asked to develop the findings of the study into an exhibition about the legacy of the local mental hospitals.

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56. 57.

58.

59. 60.

61. 62. 63.

64. 65.

66. 67.

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To this end, I applied and received a grant from the National Lottery Heritage Fund in January 2020 to coproduce a permanent exhibition of the intangible heritage of Nottingham Mental Health Provision. https:// www.mentalhealthcarememories.co.uk/. Accessed 1 April 2020. Davies, Yearning for Yesterday. Bennett, ‘Telling tales’. Sheena Rolph and Jan Walmsley, ‘Oral history and new orthodoxies: narrative accounts in the history of learning disabilities’, Oral History, 34, 2006, 81–91. Tannock, ‘Nostalgia critique’, 459. Sarah Payne, ‘Outside the walls of the asylum? Psychiatric treatment in the 1980s and 1990s’, Bartlett and Wright (eds), Outside the Walls of the Asylum, 244–265. Barbara Taylor, ‘The demise of the asylum in late twentieth-century Britain: a personal history’, Transactions of the Royal Historical Society, 21, 2011, 193–215; Helen Spandler, ‘From psychiatric abuse to psychiatric neglect’, Asylum, the Magazine of Democratic Psychiatry, 23, 2016, 7–8. R.A. Houston, ‘Asylums: the historical perspective before, during, and after’, The Lancet Psychiatry, 7, 2020, 354–362. Kerry Davies, ‘Silent and censured travellers? Patients’ narratives and patients’ voices: perspectives on the history of mental illness since 1948’, Social History of Medicine, 14, 2001, 267–292. Lynn Abrams, Oral History Theory (London and New York: Routledge, 2016). Passerini, Fascism in Popular Memory. Alexander Freund, ‘Toward an ethics of silence? Negotiating off-therecord events and identity in oral history’, Sheftel and Zembrzycki (eds), Oral History off the Record, 223–238. Peter Sedgwick, Psychopolitics First published London: Pluto Press, 1982 (London: Unkant Publishers, 2015). Mark Cresswell and Helen Spandler, ‘Psychopolitics: Peter Sedgwick’s legacy for the politics of mental health’, Social Theory & Health, 7, 2009, 129–147; Rich Moth, Joe Greener and Trish Stoll, ‘Crisis and resistance in mental health services in England’, Critical and Radical Social Work, 3, 2015, 89–101; Peter Beresford, ‘From psycho-politics to mad studies: learning from the legacy of Peter Sedgwick’, Critical and Radical Social Work, 4, 2016, 343–355; Philip Thomas, ‘Psychopolitics, neoliberal governmentality and austerity’, Self & Society, 44, 2016, 382–393. Alistair Thomson, Anzac memories: Living with the Legend (Clayton, Victoria: Monash University Publishing, 2013). Lowenthal, ‘Nostalgia’.

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68. The oral history study was informed by participatory action research, expatients and retired staff were encouraged to actively shape the research by reviewing, interpreting and disseminating the knowledge produced through the oral history interviews and off-tape individual and group encounters. 69. Examples include ex-patients setting up a group to research the social history of a local psychiatric day hospital and sharing their transcripts with others to increase awareness of the importance of having access to a welcoming environment during crisis (Calabria and Bailey, ‘Participatory action research’). 70. The oral history transcripts from the study, copyrighted to Verusca Calabria, are available from the Local Studies, Nottingham Central Library, Angel Row, Nottingham. The catalogue number of this collection is L36.48. 71. Cashman, ‘Critical nostalgia’. 72. Barbara Taylor, The Last Asylum: A Memoir of Madness in our Times (New York: Hamish Hamilton, 2015). 73. More than half of NHS hospital beds have been cut in the last thirty years (Leo Ewbank, James Thompson and Helen McKenna, NHS Hospital Bed Numbers: Past, Present, Future (London: King’s Fund, 2017). 74. Marella Hoffman, Practicing Oral History to Improve Public Policies and Programs (New York: Routledge, 2017). 75. Ibid., 3. 76. Simon Wessley, Modernising the Mental Health Act: Increasing Choice, Reducing Compulsion: Final Report of the Independent Review of the Mental Health Act, 1983 (London: Department of Health and Social Care, 2018). 77. Calabria, ‘With care in the community, everything goes’. 78. Rob Ellis, ‘Heritage and stigma. Co-producing and communicating the histories of mental health and learning disability’, Medical Humanities, 43, 2017, 92–98. Hidden Memories of Nottingham mental health care project: https://www.mentalhealthcarememories.co.uk. Accessed 8 July 2020. 79. Roy Porter, ‘The patient’s view: doing medical history from below’, Theory and society, 14, 1985, 175–198.

Personal Recollections

Talking Personality: Reflections on Historical Words, Diagnoses, and My Own Experience Barbara Norden

Introduction In this chapter, I reflect on the words and labels used since the end of the eighteenth century to define mental health conditions, and what we now call personality disorders. It then looks at my own personal encounters with words used to identify these conditions in more recent times. It also contains a critique of current terminology. My purpose is to examine our memories, both of diagnostic terminologies, and of other ways mental health conditions were described. I have included some words used to describe mental health conditions in the seventeenth century; words that were the legacy of some key thinkers such as Sigmund Freud and Emil Kraepelin; words that were recorded for posterity in the twentieth century in the diagnostic manuals and textbooks; and some of my own memories of mental health terminology and how it was used. The intention is to develop a more nuanced picture of the way mental health terminology is

B. Norden (B) University of Birmingham, Edgbaston, Birmingham, United Kingdom

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 R. Wynter et al. (eds.), Memory, Anniversaries and Mental Health in International Historical Perspective, Mental Health in Historical Perspective, https://doi.org/10.1007/978-3-031-22978-7_11

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understood: by professionals, by people using mental health services, and by others. ‘Personality’ is generally defined as the way we think and feel and behave, and the way other people see us. ‘Personality disorder’ is defined by the American Psychological Association in the 2013 version of the internationally influential Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition, or DSM-5), as ‘a way of thinking, feeling and behaving that deviates from the expectations of the culture, causes distress or problems functioning, and lasts over time’.1 This definition is a good deal less stigmatising than the term itself. This view of ‘disorder’ is a psychological rather than medical or a moral concept. ‘Disorder’ is also used as a medical term for some physical conditions, and behaviours that cause distress to others can be seen in psychiatry as the ‘symptoms’ of a ‘disorder’. But the word ‘disorder’ can be a judgement about someone’s behaviour, and medical training cannot guarantee complete neutrality about this. Repeated socially-unacceptable behaviour can be a sign of serious personality ‘disorder’, but the language can cross the line between psychiatric diagnosis and moral judgement. This can be stigmatising for anyone who has that label, even if their behaviour is only distressing to themselves.

Early History of Words and Meanings Personality comes from the Latin ‘persona’, which was in turn derived from the Greek word ‘prosopon’. This began as the name of the mask worn by an actor to identify the character they played.2 The word ‘personality’ was not part of medieval or early modern English; up until the eighteenth century, the closest concept to ‘personality’ seems to have been ‘temperament’. Physicians explained ‘temperament’ by referring to the ‘Four Humours’, which originated with Hippocrates and were later promoted by the second-century Greek physician Galen.3 These humours were thought to be bodily fluids that were the basis of a person’s mood: Blood (sanguine or cheerful), Bile (choleric or angry), Black bile (melancholic or depressed), and Phlegm (phlegmatic or relaxed).4 Temperamental problems, as well as physical illnesses, were thought to be caused by imbalances of these substances. The words sanguine, phlegmatic and melancholy can still be found occasionally; ‘humour’ now refers to a person’s ability to laugh at things; and we

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continue to use the word ‘temperament’, although today it is usually associated with bad temper and outbursts.

The Enlightenment At the end of the eighteenth and the beginning of the nineteenth century, the ‘humours’ system came under challenge from the new empirical philosophies, and related research. This was the beginning of a new discourse about what influences both our physical health and our individual characteristics and mental wellbeing. In the later eighteenth century, new ideas about mental health and its treatment began to emerge. The Quaker, William Tuke, addressed the less-than-humane treatment of the insane in some existing institutions by setting up The Retreat in York in 1792.5 Tuke developed a regime based on ‘moral treatment’, which did include persuading some patients to alter their behaviour. But moral treatment included looking at the impact of people’s beliefs on their emotional and psychological states. Patients were treated humanely, and the carers employed at The Retreat were expected to engage with them on a personal basis—‘moral’ being perhaps closer to what we now call ‘morale’.6 (English speakers confused the French words ‘moral’—temperament—and ‘morale’—morality—and this resulted in the English word ‘morale’—a belief in one’s own value and confidence in one’s ability to do what is expected). The French physician Philippe Pinel used similar strategies to Tuke’s with his patients at the Bicêtre in Paris.7 Pinel also introduced the concept of ‘manie sans delire’, or madness without delirium, an idea that had considerable influence on the English doctor James Cowles Prichard. In 1835 Prichard published his Treatise on Insanity, that included the term ‘moral insanity’, which he defined as ‘a morbid perversion of the moral feelings, affections, inclinations, temper, habits, and moral dispositions, without any lesion of the intellect, [or] maniacal hallucination’.8 In more modern terms, this describes a person who is neither delusional nor lacking in intelligence, but who does not show the feelings and responses we consider ‘normal’, and who does not control or modify their behaviour in the face of reason, social pressure, or moral instruction. This would seem to correspond with more recent concepts such as ‘psychopathy’ and ‘anti-social personality disorder’.9

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The Growth of Psychiatry Classifying mental health conditions, and looking on them in a more medical way, appear to have begun with Karl Kahlbaum’s Classification of Psychiatric Diseases, published in 1863.10 Kahlbaum had considerable influence on Emil Kraepelin, who was believed to have established the difference between schizophrenia (originally called ‘dementia praecox’) and melancholia (which was later seen as depression).11 But Kahlbaum does not appear to have described what we now call personality disorder: Kraepelin appears to have been the first to use the term ‘psychopathy’ for a distorted personality. This term, derived from ancient Greek, had previously been used for mental illness in general.12 Psychopathy had already ‘gone public’ in 1885 when the British Pall Mall Gazette quoted Russian psychiatrist Ivan Balinsky’s explanation of what it called ‘the new malady’.13 There has been a long-standing debate about how the term psychopathy relates to what we now call antisocial personality disorder—the two terms overlap, but there are some differences in the theories about what they mean.14 In the latter half of the nineteenth century, psychiatry became closely connected with the emerging discipline of neurology. The Austrian ‘father of psychoanalysis’, Sigmund Freud, began his career as a neurologist, and this influenced his initial use of the term ‘neurosis’. He continued to use the word after he had shifted to a focus on personality formed by experience. His early theories were based on what he believed to be the erotic feelings and experiences of babies and young children—something that frequently made him unpopular with contemporaries. Sadly, his early insight that familial sexual abuse was not uncommon, and could seriously affect later mental wellbeing, was effectively suppressed by others in his social circle.15

Focus on Categories and Personality ‘Types’ The late nineteenth and early twentieth century saw an increase in diagnostic labels and personality ‘types’. Carl Jung’s Psychological Types (first published in Germany in 1921)16 introduced ideas like introversion and extraversion, which have remained popular. Austrian psychotherapist Alfred Adler wrote about ruling, leaning, avoiding, and socially-useful types, although he did not really see individuals as being defined by a type.17 But it was Jung’s ideas that influenced Katharine Briggs and

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her daughter Isabel Briggs Myers, whose 1944 Type Indicator Handbook defines four kinds of personality, and then puts together some of the features to create sixteen types.18 This too has been popular, although challenged by experts.19 In the 1950s, cardiologist Meyer Friedman and Ray Rosenman researched the impact of people’s attitudes and behaviour on their cardiovascular problems. Friedman wrote a paper about this in 1977,20 establishing an aggressive and competitive A type and a more relaxed B type, but this work has also been considerably challenged by further research.21 Practising mental health professionals do not always consider categories and labels to be very helpful. A group of English- and Spanishspeaking researchers conducted an international survey of psychiatrists’ and psychologists’ views of classification for the World Health Organisation (WHO).22 They summarised the clinicians’ view that ‘the most important purposes of a classification are to facilitate communication among clinicians and to inform treatment and management’. But a large number of those who were interviewed felt that schizotypal disorder, schizoaffective disorder, dissociative disorders, and personality disorders were problematic and stigmatising labels that did not really support the clinician in treating the patient. They also found the schizophrenia label stigmatising, because of its association with ‘split personality’.23 The WHO’s International Classification of Diseases (ICD), which includes mental health diagnoses, was launched in 1948. The first edition of the US Diagnostic and Statistical Manual of Mental Disorders (DSM) was published in 1952, listing the categories that were medically accepted in the United States at the time. The first DSM did not include categories of personality disorder—these began to appear in the re-issues of DSM over the following half-century, resulting in the current situation of ten diagnostic labels spread across three categories: suspicious, emotional and impulsive, and anxious. The intended meanings of anti-social, avoidant, dependent, obsessive compulsive, and paranoid personality disorders will be fairly clear to those who are being diagnosed. Histrionic, narcissistic, schizoid, schizotypal, and borderline personality disorders may need more explaining. ‘Histrionic’ and ‘narcissistic’ are based on Greek, and it may be that they are used as a way to avoid telling someone something about themselves that they might find offensive—that they are putting on a show or being self-centred. These are descriptions of the more obvious aspects of the

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person’s behaviour, but there is generally a good deal more to it than that. ‘Schizoid’ and ‘schizotypal’ personality disorder are technical terms, and one has to read the DSM explanation to understand the difference between them. They may be more problematic now, because ‘schizophrenia’ is falling out of favour (it can be translated as ‘split brain’, and for many years it has been confused with dissociative identity, or ‘split personality’).24 Nowadays this term is often being replaced by ‘psychosis’. ‘Borderline’ personality disorder started out as meaning that the person was on the borderline of a psychotic illness, but the diagnosis is also applied to people who have no psychotic episodes. Its main feature is difficulty managing emotions, and the International Classification of Diseases uses a more descriptive name, ‘emotionally unstable’ personality disorder.25 It has also been suggested that in some people, the ‘borderline’ could lie between emotional instability and bipolar illness.26 The 2013 publication of DSM-5 followed a long debate, pitting the use of these categories against the idea of a more flexible dimensional classification; the latter has been included as an appendix and is receiving further study.27

My Experience: Words, Behaviour and Mental Health While knowing the history of these terms and concepts is vital to developing a more nuanced understanding of psychiatry, this is only part of the story. Words and diagnostic criteria are not confined within a textbook, or a doctor’s office, but escape into the world where they can affect patients’ perceptions of themselves, as well as the attitudes of others. I grew up in the United States during the 1950s, and this was a time when psychoanalysis was revered there. When I was still a child, I came across words like ‘ego’, ‘defence mechanism’, and ‘neurosis’. My father was constantly saying that there was something ‘wrong’ with me and that I was being ‘difficult’. When I was in my teens, he was looking for some form of mental health treatment for me. My mother suffered with anxiety and depression, and this was probably passed on to me, but apparently, it did not fully explain my behaviour. For much of my childhood, I was either angry with my father, or angry with myself for being ‘wrong’—or both. Later, I decided that I

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wasn’t the one causing the problems, that my father was just a very difficult man, showing no empathy and constantly criticising me. But more recently, I began to wonder whether both my father and I could both have been somewhere on the autism spectrum. This would undoubtedly have affected the way he was behaving toward me, but it would also have influenced my behaviour that he found so difficult. I tried for several years to get an assessment and a diagnosis, and finally, in 2022, I was given one, with a positive result. Of course, when I was a child, no-one could have recognised autism in either of us—it was mostly considered to be a learning difficulty, and ‘intelligent autism’ was called Asperger’s Syndrome. Now, there is beginning to be some recognition of the people in between, whose autism is not that obvious. My father worked for a pharmaceutical advertising company in New York. He was the Creative Director of the Medimetric Institute, one of the companies created by Arthur Sackler (recently the Sackler family have been strongly criticised for promoting addictive opiate medicines).28 In 1958, when I was 11, the company gave him a job in Germany, because he spoke German—he was of German-Jewish origin. We lived for a while in Frankfurt-am-Main, and in 1961, when I was 14, my father was given another job in London, and we moved there. In London I began reading my father’s books about psychoanalysis and psychiatry—a few books written by Sigmund Freud, and a book called The Cardboard Giants, a book written in 1952 by Paul Nackett about his experience in a psychiatric hospital.29 I found the books very interesting, and they inspired me to seek a career as a psychoanalyst. But I was also using the books as a way to figure out what was ‘wrong’ with me. I learned a great deal about Freud’s views of a child’s psychological state, particularly ‘identifying’ with one of the parents (wanting to be like the parent), and having early experiences of sexual feelings. But I was also learning about psychiatric diagnostic terminology. I could see that psychoanalysis was not much favoured by British psychiatrists in the NHS. Anxiety, depression, schizophrenia, and manic depression (nowadays bipolar) were the main words. Psychoanalysis was private and expensive and not often part of the NHS, so the word ‘neurosis’ was rarely used. Around this time, I encountered the term ‘character disorder’. I was spending some time at local meetings with a group called the Bridge Circle, led by a man called Alfred Reynolds (originally Reinhold Alfred, from Budapest).30 He had written a collection of philosophy essays called

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Pilate’s Question, which was discussed in the group.31 A young man who attended this group invited me out for a coffee; he was socially awkward, but my own social awkwardness prompted me to take the opportunity with him. After we left the café, he took hold of me and rubbed up against me. Boys had tried this on me before, but this time there was something about it that did not really feel sexual. When I mentioned this to our psychoanalyst neighbour, my father’s friend Peter (born Frederick) Kräupl-Taylor,32 he said I should stay away from this young man because he had a ‘character disorder’. The words sounded to me like a moral judgement being used as a psychiatric diagnosis. After a while, I realised there were a few ‘camp’ men in the philosophy group, and that perhaps it was partly being used as a kind of cover for gay men to meet in a respectable setting. What I didn’t know back then was that some men who were involved in this group were later known as authors of books challenging the structure of society—for example, Nicholas Walter and Colin Wilson.33 As for the young man I had gone out with, he may not have been socially very competent, but neither was I. My guess would be that he was desperate to experience sexual arousal with a woman, as a way out of some of the distressing consequences of being a gay man at that time.

Education and Psychoactive Medication After I finished my O-Levels at a local private school, I was sent to the Sixth Form class at a Quaker boarding school in Saffron Walden in Essex. When I got my A-Level results, the headmistress of the school concluded that I was bright and that I should go to Oxford or Cambridge. At Oxford, I was interviewed at Lady Margaret Hall for a course in Philosophy, Politics, and Economics. The interview did not work out very well, but they asked me whether a new degree course, Philosophy, Psychology, and Physiology, might suit me. I was very pleased about this—I had wanted to be a psychoanalyst, but I had given up on that when I discovered that I would have to have a medical degree. To study psychology seemed like a good choice. A few months after I started at Oxford, I became very depressed, and I was sent to see a psychiatrist. I tried to tell him about the way my childhood and my father’s behaviour had affected my mental health, but the psychiatrist would not listen to this. He just wanted me to tell him

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how I felt in the present—he diagnosed me with anxiety and depression and prescribed Tryptizol (amitriptyline) and Librium (chlordiazepoxide). A few days later I took the prescribed dose of Tryptizol, and I slept for 18 hours, missing a tutorial and finding myself in trouble. The Dean, who was dealing with this, insisted that Tryptizol could not make me sleepy—even the psychiatrist had told her it could only make me ‘a little tired’—and they said they were sure that I must have taken illegal drugs. (Many years later, people were advised to leave work for at least a week while their bodies adjusted to the effects of medicines like amitriptyline.) Shortly afterwards I tried the Librium, and it had a paradoxical effect— it made me extremely anxious when I was trying to take the train home to see my parents. My father had to pick me up from Didcot Station, and the travel home with him was very unpleasant. But he did arrange for me to receive ‘psychoanalytic psychotherapy’ with an American therapist living in Oxford. I survived for a while without using the medication, but I became very depressed again shortly before the third year exams—I couldn’t complete one of the exam papers because of my mental state, and as a result I was given a ‘Pass’ degree. Meanwhile, I had become involved with the local Simon Community, which had taken over a building that used to house railway workers, and they were using the small rooms to house homeless men. When I left Lady Margaret Hall, I was given a bedroom, was involved in cooking meals for everyone, and received £7 a week. I continued working with Anton Wallich-Clifford, the founder of the Simon Community,34 for a year or two, in Oxford, London, and Hastings, and then I returned home to my parents. I found a few short-term jobs, and then worked for Kensington and Chelsea Welfare Department, which was just changing its name to Social Services—my role was Social Work Assistant. I had wanted to study to be a social worker, but my Pass degree would not allow me to do that. I went to live in North Kensington and stayed with the social work job for a little over two years, but I was not very happy with ‘the system’, so I left the job. I applied for unemployment benefits, and involved myself once again in full-time voluntary work—but this time it was all about ‘alternative’ mental health strategies, which were popular in the 70s.

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Alternatives to Psychiatry I was involving myself in the movement that included R. D. Laing’s antipsychiatry projects,35 encounter groups, gestalt therapy, Reichian orgone energy,36 and a variety of other eclectic approaches. A good number of local people were involved, and we set up our own local group called COPE (Community Organisation for Psychiatric Emergencies) in West London. We had a helpline and a meeting space, but our main project was the ‘crisis house’, where people in a mental health crisis could stay for up to six weeks, as an alternative to hospitalisation. The house we used for this was provided by the Greater London Council, and it was managed by four members of COPE, including myself.37 Unfortunately, after a few years of working at the COPE Crisis House, I found that I was having my own crisis, and I decided that I had to leave. We called it a crisis rather than a ‘mental breakdown’, and the word ‘crisis’ has become very popular over the years, perhaps because it is less stigmatising than a ‘breakdown’. We also disliked the term ‘mental disorder’; like me, most of the people in this group saw the word ‘disorder’ as judgemental. The term we adopted was ‘mental distress’, which is sometimes used now. We were not happy with ‘character disorder’ or ‘personality disorder’, although ‘psychopath’ and ‘sociopath’ were common currency. We preferred ‘sociopath’, possibly because most of us believed that ‘society’ was at fault in some way. We did not yet have our own term to describe those of us who had received mental health treatment, such as ‘service user’; we were still ‘patients’.38 During this time, charitable organisations were emerging to deal with mental health issues, problems with welfare benefit payment, homelessness or poor housing, community representation, and other things. Some people involved in setting up these organisations were referred to as ‘creative psychopaths’.39 The term was sometimes applied to enthusiastic individuals who had already bent or broken a few rules in settingup organisations, and who were later accused of skimming off some charitable funding for personal use.

Moving On When I recovered from my depression in 1975, I found a paid job at Task Force, a London organisation set up to recruit young volunteers to visit and assist older people. Then, in 1980, I moved from London to

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Birmingham, and worked at one of the alternative bookshops, called the Peace Centre. When it lost its funding and closed down in 1985, I was having yet another crisis. I was afraid to apply for disability benefit for my mental health problems, because what I understood then was that a person claiming benefit for a mental health diagnosis might never again be accepted for paid work. For a while, I found temporary jobs or received unemployment benefit and income support. Finally in 1990, I found a job with Birmingham branch of the UK charity MIND, as a care worker at their mental healthcare homes. In 1994, I was accepted at Birmingham University to study for a Social Work Masters. I then tried for several years to get a social work post, while continuing with part-time work for MIND, but no-one would accept me—whether it was because of my age (I was 50 in 1997), my rather complicated work history, or just the way they saw me at interviews, I don’t know. I finally concluded that I should accept Disability Living Allowance, but I still wanted to work, and eventually in 2003 I found work with South Birmingham Mental Health Trust (later Birmingham and Solihull Mental Health Fountation Trust), in the User Voice team.

Personality Disorder---Is That Really Me? For a long time, I did not know that my medical notes contained a letter from the psychotherapist I had seen at Oxford, saying that I had a personality disorder. I was shocked when I heard this—my GP had never mentioned it, and I only found out in the 1990s, when I had a reason to read my notes—my involvement in a court case against the pharmaceutical company Wyeth, about their promotion of benzodiazepine tranquillisers. Those of us who had been prescribed benzodiazepines for a while knew that they were addictive, but this was still being denied by the medical services and the pharmaceutical companies.40 The Oxford psychotherapist was American. At first, I thought that because he was working in the UK, he might have been reluctant to use the word ‘neurosis’ about me. But after studying personality disorder, I concluded that I had features that would fit the Diagnostic and Statistical Manual terms ‘borderline’, ‘obsessive–compulsive’, and ‘avoidant’.41 ‘Borderline’ was confusing, because it was supposed to be on the borderline of psychosis, and I had never had anything that resembled a psychotic episode. The alternative term in the International Classification of Diseases manual—‘emotionally unstable’—seemed a better way to

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describe my condition.42 There seems to have been no evidence at this time that I could be autistic—and although autism may be one way to understand my personality, there might also be other personality problems based on my relationship with my father. During the 1990s, when I was working for Birmingham MIND, I came across the term ‘service user’—a person who was using mental health services. I thought these words sounded a bit awkward, but someone explained to me that they had been adopted because ‘patient’ meant that the person with a mental health condition was passive, and had no power to improve their condition. It implied that any healing was up to the ‘agent’, the psychiatrist—and that was not fair to people who were learning how to deal with their own difficulties. I had encountered the term ‘survivor’, and I thought that made sense in terms of having experienced mental health difficulties. But I thought ‘client’ was a good way to describe someone actually using a mental health service. I was told this was not an acceptable term, because clients were people who chose to use a service or people who paid for a private service, and this could not include people who were admitted to the hospital involuntarily—‘sectioned’ under the Mental Health Act. All this seemed to be based on a desire to introduce more positive terminology, although a study conducted a few years later found that people using the services preferred ‘patient’ or ‘client’ to ‘service user’.43 There were also some rather strange names for services and job roles. In 2003, my job with Birmingham and Solihull Mental Health Trust was called ‘Service User Development Worker’. I didn’t like the idea that I would be somehow ‘developing’ the service users, but I was told that I was taking it too literally; it was just current employment jargon being used for creative jobs like this one. But some of us preferred to be ‘service user involvement workers’. My main role there was to visit the Day Centres in South Birmingham, of which there were still quite a few back then. I would report back at meetings about what the service users said about the services—whether good or bad. They were also invited to meetings, and they could contact us personally about anything they thought we should know. User Voice had its own monthly meetings, and there was also a variety of meetings we attended with the mental health professionals and the administrators working in the area we represented. For a while, it seemed to me that people at the meetings were listening to us with great interest. But then I realised that after the meetings they

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were having to focus on other things, such as NHS reports about changes in services, administrative and financial issues, and anything except what we had reported to them. We would have to repeat and repeat what we were saying in order to get anything improved for the service users. In 2010, I was recruited by the ‘Personality Disorder Knowledge and Understanding Framework’, an NHS training project, to be a service user trainer who could work alongside clinician trainers delivering the course.44 The course became very popular, I enjoyed my involvement in the training, and I was paid well for it—unfortunately, after a few years, all the funding had disappeared, and much of the training was done by service users in receipt of benefits who received the small payment they were allowed to have.

Words and Acronyms ‘Personality Disorder Knowledge and Understanding Framework’ training was too long to repeat, so it was usually called ‘PDKUF’, or ‘KUF’, spoken as one word—which sounded as though we were teaching people how to use handcuffs! Shortly afterwards, the psychiatric liaison team at the hospital Accident and Emergency services in Birmingham was renamed RAID—Rapid Access Interface and Discharge.45 Not a name that would reassure someone who arrived there expecting help with their mental health crisis, if they didn’t know what the initials stood for—it could have been interpreted as a police raid! It does seem that people who are embedded in an organisation, or a system, will often assume that because they know what a term means, the people who want to use their service will know it too. Words that are used to describe a person’s condition may begin as positive or neutral, but when associated with something people find disturbing, they can become disturbing too. If the word refers to something that can appear awkward or difficult about a person, or about the services provided for them, then it will probably end up with a stigma attached to it. Words like ‘handicapped’, ‘simple’ or ‘elderly’ all started out as more kindly replacements for the words that had been used previously (such as crippled, stupid, old, and so on), but these words gradually acquired a similar stigma to that which the older words had. Words like ‘idiot’ and ‘moron’ were derived from Greek, and ‘imbecile’ came from Latin, and it is possible that, like ‘narcissistic’ and ‘histrionic’, they were

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used both as a professional-sounding term and as a way to avoid direct insult to the person concerned—but they later became insults.46 Currently, ‘service user’ is being replaced by ‘expert by experience’ and ‘lived experience practitioner’. These can be seen as positive descriptions of people whose mental health issues have led them to activism. But, like the ‘Knowledge and Understanding Framework’, these phrases have a length which makes them a bit uncomfortable to use in a conversation. This leads to abbreviations—acronyms—such as EBE and LEP. And acronyms themselves are a problem. If they are used at meetings without being explained, they become part of a jargon, and this can lead to people feeling that they are left out, or that they don’t know enough to be involved in the project.

Can We Create a More Focused Terminology? ‘Disorder’ is still such a common medical term, including Personality Disorder, Autism Spectrum Disorder, Eating Disorder, Bi-polar Disorder, and suchlike. Sadly, when used about those with mental health issues or learning difficulties, epilepsy or autism, it can sound like a judgement.47 People prefer that others behave in an ‘orderly’ fashion, but disorderly behaviour is not always the sign of a mental health issue. There are other signs of a damaged personality: high levels of distress when nothing is happening, difficulty with maintaining relationships, and inability to lead a functional life. While labels and categories are important as a way of explaining a person’s mental state, it might be helpful if the labelling of people’s personality issues could become clearer and more objective. Ideally, a psychiatric label is a way of identifying what kinds of interventions could help a person. Yet for many years, a personality disorder label was just the opposite. People with that diagnosis were turned away from mental health services because they ‘did not have a mental illness’—and the label did not even give them a proper explanation of what they did have. We have now moved toward greater acceptance that these conditions can and should be treated. But a label is more useful when it is clearly understandable, not only between doctor and doctor but also to those in treatment, their families, and non-medical supporters. The person receiving treatment can also encounter pseudo-diagnostic words, such as ‘attention-seeking’ and ‘manipulative’, which have sometimes been used by psychiatrists as grounds for a diagnosis. Unfortunately, they are then passed on to other staff and to carers, and are used

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as a stigmatising description of the person concerned.48 These words are judgemental, and they do not really explain a person’s condition. Behaviour that gets attention will have been learned early, usually because a child’s needs were not met unless they made a fuss. Manipulating someone—pushing their buttons—will also probably have been learned early; most likely there would have been a close adult who behaved that way, or one who only responded to that sort of behaviour from someone else. Many professionals now hesitate to use the PD label, because it is known to be stigmatising. And stigma can be enough of a problem when there is a physical disability or a long-term condition, like autism, that makes a person ‘different’. People who used to be called ‘subnormal’ are now referred to as having ‘difficulties’ or a ‘disability’—not a ‘disorder’. ‘Complex trauma’ is a term currently favoured by some professionals as a replacement for personality disorder, because it doesn’t have the same judgemental undertone, but unfortunately it is difficult for people to understand. We might consider terms like ‘emotional disability’ or ‘behavioural dysfunction’ or ‘difficulties’. Whatever terms are used will probably acquire some level of stigma eventually, but it would be better to avoid words that contain a clearly judgemental meaning. People diagnosed with personality disorder can be read as annoying and distressing and difficult to work with. A diagnosis of anti-social personality disorder may be the result of violent behaviour, and a considerable number of people in prison have that diagnosis—although not always because of violence.49 But this represents a small minority of personality disorders. Mental health issues can be reported in news about incidents of violence—this can lead to people being afraid of others who have mental health problems, or being afraid to admit that they themselves have them. Fortunately, celebrities are now speaking out publicly about their mental health issues, and this seems to have made it more acceptable to be honest about it. Of course, mental health workers have feelings, and there is nothing wrong with venting anger and distress about the clients they are working with, as long as it is done in a safe space—in fact this is a way of preventing the worker from responding in a ‘disordered’ way to the client. But it seems to me that problems arise when words that include an unspoken judgement find their way into diagnosis. These words can stop people from seeking help, for fear of judgement, and they can create unconscious

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prejudice among clinicians and other mental health workers toward the people they are dealing with.

A Summary What we now call ‘personality disorder’ became a focus of medical attention in the early−nineteenth century, and it has been redefined and re-categorised ever since. While there is no doubt that individuals who are categorised in this way can be challenging, some of the words being used to describe them are both stigmatising and confusing. Rigid categorisation can itself create problems by excluding individuals who are ‘between categories’. The inadvertent inclusion of moral judgement in diagnosis can lead to unjustified assumptions on the part of mental health professionals, family, and carers. It is worth re-examining the words being used to describe and define these conditions, to make them more explanatory and less stigmatising. Words change over time, as does their usage, but by remembering the history of some of these terms—and closely interrogating their continued use—we might create a space where both healthcare professionals and service users feel they are speaking the same language.

Notes 1. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). American Psychiatric Association. (2013). 2. Patrice Pavis, Dictionary of the Theatre, Terms, Concepts and Analysis. Trans. Christine Shantz (Toronto: University of Toronto Press, 1998), 47. 3. E. J. Kempf, ‘From Hippocrates to Galen’, Medical Library and Historical Journal, 2(4), 1904, 292–307 and 631–634. 4. Lee Anna Clark, ‘Mood, Personality, and Personality Disorder’, Richard Davidson (ed.), Anxiety, Depression, and Emotion (Oxford: Oxford University Press, 2000), 171–200. 5. Samuel Tuke, Description of the Retreat, an Institution Near York for Insane Persons of the Society of Friends (York: William Alexander, 1813). 6. ‘Morale’, Online Etymology Dictionary, https://www.etymonline.com/ word/morale?ref=etymonline_crossreference (accessed: 26 August 2022). 7. Philippe Pinel, A Treatise on Insanity. Trans. D. D. Davies (London: Cadell and Davies, 1806; 1801). 8. James Cowles Prichard, A Treatise on Insanity and Other Disorders Affecting the Mind (London: Sherwood, Gilbert and Piper, 1835).

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9. James Horley, ‘Emergence and Development of Psychopathy’, History of the Human Sciences, 27 (5), 2014, 103–110. 10. Karl Kahlbaum, Die Gruppierung der psychischen Krankheiten und die Einteilung der Seelenstörungen (Danzig: Verlag von A. W. Kafemann, 1863). 11. Emil Kraepelin, Psychiatrie, ein Lehrbuch fuer Aerzte und Studeirende (1896), in Lifetime Editions of Kraepelin in English (Bristol: Thoemmes Press, 2002). 12. Marc-Antoine Crocq, ‘Milestones in the History of Personality Disorders’, Dialogues in Clinical Neuroscience 15 (2), 2013, 14–53. 13. Andrew Roberts, ‘Mental Health History Words’, Andrew Roberts’ Home Page, http://studymore.org.uk/mhhglo.htm (accessed: 7 March 2021). 14. Robert Hogan, John Johnson, Stephen Briggs (eds), Handbook of Personality Psychology (San Diego: Academic Press, 1997). 15. Jeffrey Moussaieff Masson, The Assault on Truth, Freud’s Suppression of the Seduction Theory (New York: Farrar, Strauss and Groux, 1984). 16. Carl Jung, Psychological Types (London: Routledge, 2016; 1923). 17. Anon., ‘Alfred Adler’s Personality Theory and Personality Types’, Journal Psyche Blog, http://journalpsyche.org/alfred-adler-personality-the ory/ (accessed: 08 August 2022). Online post with no date given—publications between 1994 and 2010. 18. Chong Yang, George Richard, and Martin Durkin, ‘The Association Between Myers-Briggs Type Indicator and Psychiatry as the Specialty Choice’, International Journal of Medical Education, 7, 2016, 48–51. 19. Sven Barnow, Elisabeth A. Arens, Simkje Sieswerda, Ramona DinuBiringer, Carsten Spitzer and Simone Lang ‘Borderline Personality Disorder and Psychosis: A Review’, Current Psychiatry Reports, 12(3), 2010, 186–195. 20. Meyer Friedman, ‘A Behavior Pattern: Some of Its Pathophysiological Components’, Bulletin of the New York Academy of Medicine, 53(7), 1977, 593–604. 21. Chong Yang, George Richard, and Martin Durkin, ‘The association between Myers-Briggs Type Indicator and Psychiatry as the specialty choice’, International Journal of Medical Education, 7, 2016, 48–51. On the historical and social aspects of ‘Type A’ personalities, see for example Elianne Riska, ‘From Type A man to the hardy man: masculinity and health’, Sociology of Health & Illness, 24, 2002, 347–58. 22. Rebeca Roblesa, Ana Fresán, Spencer C.Evans, Anne M.Lovell, María Elena Medina-Mora, Mario Maj and Geoffrey M. Reede, ‘Problematic, absent and stigmatizing diagnoses in current mental disorders classifications: Results from the WHO-WPA and WHO-IUPsyS Global Surveys’, International Journal of Clinical and Health Psychology, 14(3), 2014, 165–177.

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23. Ibid. 24. J.Deltito, L. Martin, J.Riefkohl, B.Austria, A.Kissilenko, P.Corless, and C. Morse ‘Do patients with borderline personality disorder belong to the bipolar spectrum?’, Journal of Affective Disorders, 67(1–3), 2001, 221– 228. 25. International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) (Geneva: World Health Organisation, 1994; 2019), https://icd.who.int/browse10/2019/en (accessed: 11 August 2022). 26. Deltito et al., ‘Do Patients with Borderline Personality Disorder Belong to the Bipolar Spectrum?’. 27. Thomas A. Widiger and Timothy J. Trull, ‘Plate Tectonics in the Classification of Personality Disorder’, The American Psychologist, 62(2), 2007, 71–83. 28. See for example, Patrick Radden Keefe, Empire of Pain: The Secret History of the Sackler Dynasty (London: Picador, 2021). 29. Paul Nackett, The Cardboard Giants (London: Victor Gollancz, 1953). 30. For information about the context of Reynolds and the group see: Nicolas Walter, ‘Anarchism in Print: Yesterday and Today’, Government and Opposition, 5(4), 1970, 523–540, esp. 529. 31. Alfred Reynolds, Pilate’s Question: Articles From ’The London Letter’, 1948–1963 (London: London Letter, 1964). Later published in Alfred Reynolds, Pilate’s Question: Twenty years of articles, essays and sketches (1950–1970) (London: Cambridge International Publishers, 1982). 32. For more information, see: ‘Obituary: F. Kräupl-Taylor’, British Medical Journal, 298 (1989), 1173–1174. 33. Nicholas Walter (1934–2000) anarchist and atheist author, and peace activist. Colin Wilson (1931–2013), philosopher and author of fact and fiction, associated with the ‘Angry Young Men’. 34. For more on the Simon Community and see: Barbara Collins and Kieran McKeown, Referral and Settlement in the Simon Community: a report of the study (Dublin: Simon Community, 1992); Ian Hart, Dublin Simon Community 1971– 1976: an exploration (Dublin: Economic and Social Research Institute, 1978). 35. For discussion, see: Nick Crossley, ‘R. D. Laing and the British antipsychiatry movement: a socio-historical analysis’, Social Science and Medicine, 47(7), 1998, 877–889; Nick Crossley, Contesting psychiatry: Social movements in mental health (London: Routledge, 2006); Zbigniew Kotowics, R. D. Laing and the Paths of Anti-Psychiatry (London: Routledge, 1997). 36. See Michael Mannion, ‘Historical Perspective Wilhelm Reich, 1897– 1957’, Alternative and Complementary Therapies, 3(3), 1997, 194–199.

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37. For more about COPE and its context, see: Peter Campbell, ‘From Little Acorns—The Mental Health Service User Movement’, Andy Bell and Peter Lindley, Beyond the Water Towers: The unfinished revolution in mental health services, 1985–2005 (London: Sainsbury Centre for Mental Health, 2005), 73–82; Nick Crossley, ‘Mental Health, Resistance and Social Movements: The Collective-Confrontational Dimension’, Health Care Journal, 61(2), 2002, 138–152; Crossley, Contesting psychiatry. 38. For more on language and its use relating to mental healthcare, see, for example: B. J. Brown and Paul Crawford, ‘Personality Disorder in UK Mental Health Care: Language, Legitimation and the Psychodynamics of Organized Surveillance’, Rick Iedema (ed.), The Discourse of Hospital Communication. Palgrave Studies in Professional and Organizational Discourse (London: Palgrave Macmillan, 2007); Crossley, Contesting psychiatry; Sharon Ann Gilfoyle, ‘Mind your language!’, Mental Health and Social Inclusion, 21(1), 2017, 47–52; Michelle O’Reilly and Jessica Nina Lester, Examining Mental Health through Social Constructivism: The Language of Mental Health (London: Palgrave Macmillan, 2017); Rebecca Wynter and Leonard Smith, ‘Introduction: historical contexts to communicating mental health’, Rebecca Wynter and Leonard Smith (eds), ‘Communicating Mental Health’ special issue, Medical Humanities, 43(2), 2017, 73–80, 75. 39. The term was coined by the prominent twentieth-century Scottish psychiatrist David Kennedy Henderson (1884–1965)—D. K. Kennedy, Psychopathic States (New York: W. W. Norton and Company, 1939). For more, see, for example: Susanna Shapland, ‘Defining the Elephant: A History of Psychopathy, 1891–1959’ (Birkbeck, University of London: Unpublished PhD thesis, 2019). 40. For more, see: Michael Behan (Beat the Benzos), ‘Memorandum submitted by Michael Behan (PI 64)’, 30 August 2004, Select Committee on Health Minutes of Evidence (Session 2004–2005), 25 November 2004 https://publications.parliament.uk/pa/cm200405/cms elect/cmhealth/42/4112520.htm (accessed: 11 August 2022). 41. Diagnostic and Statistical Manual of Mental Disorders . Fourth Edition (DSM-IV) (Washington, DC: American Psychiatric Association, 1994). 42. International Statistical Classification of Diseases, https://icd.who.int/bro wse10/2019/en (accessed: 11 August 2022). 43. Rebecca McGuire-Snieckus, Rosemary McCabe and Stefan Priebe, ‘Patient, client or service user? A survey of patient preferences of dress and address of six mental health professions’, BJPsych Bulletin, 27(8), 2003, 305–308. 44. For more on this training, see: Julie Davies, Mark Sampson, Frank Beesley, Debra Smith and Victoria Baldwin, ‘An Evaluation of Knowledge and Understanding Framework Personality Disorder Awareness Training: Can

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47.

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a Co-Production Model be Effective in a Local NHS Mental Health Trust?’, Personality and Mental Health, 8(2), 2014, 161–168. ‘Rapid Assessment Interface and Discharge’, Birmingham and Solihull Mental Health NHS Foundation Trust (launched in 2014), https:// www.bsmhft.nhs.uk/our-services/urgent-care/rapid-assessment-interfaceand-discharge/ (accessed: 11 August 2022). See n.34. The historical language around learning disabilities is discussed in many specialist histories, however, see, for example: the recent commemorative issue of the British Journal of Learning Disabilities (Ian Davies, Edurne Garcia Iriate, Simon Jarrett, Kelley Johnson, Timothy Stainton, Liz Tilley, Jan Walmsley (eds), ‘Special Issue: 50 years of the British Journal of Learning Disabilities: The power of the past’, British Journal of Learning Disabilities, 50(2), 2022—see especially Simon Jarrett and Elizabeth Tilley, ‘The history of the history of learning disability’, 132–142); Alex McClimens, ‘Language, labels and diagnosis: An idiot’s guide to learning disability’, Journal of Intellectual Disabilities, 11(3), 257–266. A vast amount has been written on ‘personality disorder’, labelling and stigmatisation—see, for example: Matthias C. Angermeyer and Herbert Matschinger, ‘The Stigma of Mental Illness: Effects of Labelling on Public Attitudes Towards People with Mental Disorder’, Acta Psychiatrica Scandinavica, 108(4), 2003, 304–309; Ron B. Aviram, Beth S. Brodsky, and Barbara Stanley, ‘Borderline Personality Disorder, Stigma, and Treatment Implications’, Harvard Review of Psychiatry, 14(5), 2006, 249–256; Ehud Bodner, Sara Cohen-Fridel, and Iulian Iancu, ‘Staff Attitudes Toward Patients with Borderline Personality Disorder’, Comprehensive Psychiatry, 52 (5), 2011, 548–555; Oliver Bonnington and Diana Rose, ‘Exploring Stigmatisation Among People Diagnosed with Either Bipolar Disorder or Borderline Personality Disorder: A Critical Realist Analysis’, Social Science & Medicine, 123, 2014, 7–17; Glyn Lewis and Louis Appleby, ‘Personality Disorder: The Patients Psychiatrists Dislike’, British Journal of Psychiatry, 153(1), 1988, 44–49; Bertha Rogers and Emma Dunne. “They Told Me I Had this Personality Disorder… All of a sudden I Was Wasting Their Time’: Personality Disorder and the Inpatient Experience’, Journal of Mental Health, 20(3), 2011, 226–233; Clare Shaw and Gillian Proctor, ‘Women at the Margins: A Critique of the Diagnosis of Borderline Personality Disorder’, Feminism & Psychology, 15(4), 2005, 483–490. Ibid. Ibid.

‘If Your Memory Serves You Well’: Reflections on Becoming a Psychiatrist Allan Beveridge

Introduction Writing in 1949, radical Scottish psychiatrist R. D. Laing recognised the slippery and potentially unreliable nature of memoir, calling attention to ‘the business of distorting the Past. Forgetting, distorting, glamorizing, glorifying, idealizing, belittling, romanticizing – how obliging, how malleable the Past is’.1 In his own accounts, Laing presented himself as the hero of his narrative.2 He deliberately set out to mythologise his story, as Sigmund Freud had done before him.3 Henri Ellenberger eloquently analysed the ‘Freudian legend’, whereby Freud depicted himself as the lone hero daring to bring unwelcome truths to an uncomprehending and hostile audience.4 Both Laing and Freud minimised the contributions of others in order to magnify their own role. Carl Jung, in his autobiography, Memories, Dreams, Reflections (1963) concentrated on his psychic life, claiming that it did not matter if the story he was telling

A. Beveridge (B) Royal College of Physicians of Edinburgh, Edinburgh, Scotland, UK e-mail: [email protected]

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 R. Wynter et al. (eds.), Memory, Anniversaries and Mental Health in International Historical Perspective, Mental Health in Historical Perspective, https://doi.org/10.1007/978-3-031-22978-7_12

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was true; rather, he wanted to be faithful to his own ‘myth’ of himself.5 In contrast to Jung, the German professor of psychiatry, Emil Kraepelin, in his Memoirs, revealed little in the way of his innermost feelings, concentrating on the outward events of research and clinical work.6 In more recent times, leading British and European psychiatrists have been interviewed about their careers, in Psychiatrists on Psychiatry (1982) and Talking About Psychiatry (1993).7 Such collections, though interesting, feature no women and fit into the ‘Great Man’ narrative of the history of medicine. All these examples demonstrate that reminiscences by clinicians about their careers cannot be accepted unproblematically. We must take account of the deficits and distortions of memory, and the tendency of the narrator to self-mythologise and portray themselves as they would like to be seen, rather than how they actually were. Pertinent, too, are literary concepts of narrative, such as that of the ‘unreliable narrator’, where the person telling the tale may inadvertently provide the reader with an entirely different impression of events than the one they hoped to convey.8 All of these considerations, of course, apply to the following description of my own early career. I will mainly concentrate on my training to be a psychiatrist in the period between 1980 and 1984, but I will also briefly mention my time at medical school and my final position as a Consultant Psychiatrist. This era saw the continuance of the move of care from the hospital to the community and the creation of psychiatric units in district general hospitals.9 Although more psychological therapies were developed during this time, psychiatry placed increasing emphasis on physical factors such as brain pathology, genetics, and medication.10 The number of psychiatric diagnoses increased greatly and, contrary to popular perceptions, many psychiatrists, myself included, were dismayed at the creeping psychopathologisation of everyday life.11 The proportion of women in psychiatry increased markedly and generally there was greater ethnic diversity amongst the ranks of psychiatrists. Attempts were made to improve the rights of patients by reforms of the Mental Health Acts in both Scotland and England, by the formation of advocacy groups, and, not least, by service users themselves.12 Roy Porter, though, noted a paradox: while psychiatry had reformed its old institutions and now offered a wider range of therapies, the public had responded with a resurgence of suspicion and lack of confidence in psychiatrists.13

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In what follows I will discuss my training to become a psychiatrist, not just in terms of the standard psychiatric education of the time, but also in terms of my own explorations of history and the humanities, and wider society’s interactions with psychiatry, especially in terms of politics and the media.

Beginnings I can’t really remember when I first started to think of becoming a psychiatrist, but I do remember thinking about a career in medicine when I was at school in the 1970s. I didn’t come from a medical family and the only doctor I knew was the family GP, Dr Hay. He was a kindly, avuncular man who enjoyed talking to his patients, and his cheerful but concerned approach was appealing. His job seemed to be the type of work I’d like to do: talking to people, finding out about their lives and their stories, and, hopefully, helping them. In popular representations of doctors in the cinema and television of the time, they were usually portrayed as virtuous, caring, intelligent, and idealistic men—and they were invariably men. The television series M*A*S*H was particularly attractive: Hawkeye, the wisecracking, irreverent, anti-establishment surgeon who, nevertheless, was a principled and conscientious doctor, always doing his utmost for his patients. Less radical and, indeed, quite couthy, was the BBC series Dr Finlay’s Casebook, this time set in a Scottish village, but which also showed the doctor in an admirable light as a young, passionate clinician doing his best for his community. Alongside my interest in medicine, I also seriously thought of going to art school, but this was frowned upon by teachers and my parents. Alright as a ‘hobby’, they said, but you couldn’t make a career out of it, which I grudgingly had to concede. Unless you were wonderfully talented, which I wasn’t, it was probably true.

Medical School So it was, then, that in October of 1974, I made my way to the University of Glasgow to embark on the study of medicine. As a rather lonely and bookish youth, the prospect was both exciting and daunting. I had read about intellectual circles, such as the Existentialists on the Left Bank of Paris in the postwar period, and hoped university would be like that: young people passionately discussing art, literature, and politics in cafes and bars, and perhaps even the chance of romance. There had been no

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intellectual circle at my school or, if there was one, I wasn’t part of it. Sitting in a house in the suburbs of Glasgow, reading Penguin classics, my father’s old paperbacks on socialism and communism, my mother’s volumes of the Romantic poets, and borrowing books from the local public library on Freud and Marx; there seemed to be no one to discuss all this stuff with. I had read that in previous times medical men—again it was always men because women weren’t permitted to study medicine until the end of the nineteenth century—were expected to be learned in the humanities. This was held to confer wisdom on the doctor and contribute to a greater understanding of the psychological and emotional aspects of their patients. During the period when I was studying at Glasgow, there was little support for this notion. In fact, reading non-medical texts was considered frivolous and a distraction from the serious business of medicine. Students who had previously read literature stopped doing so. They often cited lack of time as a reason, but there was a general medical culture which militated against it. Medical education has long been recognised as a process by which the neophyte is indoctrinated with the largely conservative values of the medical profession. Years after I left medical school, and too late for me, there emerged the discipline of the Medical Humanities, which argued that exposure to the arts could lead to more rounded doctors. Glasgow was to make a major contribution to these developments with the work of Robin Downie, a professor of philosophy, and the clinicians Kenneth Calman and Jane Macnaughton.14 On our first day at medical school, in the opening welcome lecture, we were told we were the crème de la crème of the University. But this was also a burden, we were warned. Much was expected of us, and we would have to live up to the trust invested in us by behaving as hardworking and upright students. On the first day, then, we were told of our exalted position, and in the following years were given the impression that other occupations were of lesser worth. Indeed, medicine wasn’t merely an occupation, or even a profession: it was a calling. I was to notice in the coming years that when we had lectures by non-doctors, such as sociologists or psychologists, the class paid less attention or respect to the speaker. Generally, Glasgow University at this time did not accord with my adolescent dreams of like-minded individuals exploring the world of literary and political culture. In those days a great many students lived at home and this contributed to university feeling more like an extension

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to school than a major milestone in becoming an adult. At that stage there were separate student unions for males and females, and a beer bar, to which women were refused entry. Here, men would profess to be bigots and to be proud of it, and football, rather than philosophy, was the favoured topic of conversation. Frankly, women were missing nothing by their exclusion from this place, and the more sensitive males (of which I liked to think I was one) sought refuge in the women’s union, the Queen Margaret, which also permitted the entry of men. It was there that I met Margaret, my future wife, who was, refreshingly, not a medical student, but an arts student. The first two years of medical school were the ‘pre-clinical’ years and consisted almost entirely of lectures. Two hundred students crammed into a hall to hear hour-long lectures on biochemistry, physiology, and anatomy. It was often hard to take adequate or accurate notes, as the usual format consisted of the lecturers delivering one Gradgrindian fact after another. Medical school seemed to be an exercise in rote learning. Fortunately, medical school has changed since then, and students now see patients from the outset of their studies, thus giving them a context for the medical facts they will have to learn. In the third year, students embarked on the clinical phase and entered the wards. At last, we were getting to see patients, and this reminded me why I had applied to medicine in the first place. In fourth year, students undertook their placement in psychiatry. This was something I had been looking forward to. I’d been reading books on psychiatry and novels and plays about madness by Fyodor Dostoevsky, Nikolai Gogol, Georg Büchner, and August Strindberg. I read a little Freud (who was barely mentioned in the curriculum) and was interested in his idea that, if one was well-versed in the mysterious ways of the mind, one could discover, in apparently random actions and words, psychological insights about people of which they themselves might be unaware. Such access to secret knowledge has always been appealing to intellectuals or would-be intellectuals. More appealing than Freud, at this stage, was Carl Jung, who seemed to offer the key to unlocking the mysteries of world religions and, unlike the determinedly secular Freud, concerned himself with the spiritual. But the most interesting person to me was R. D. Laing, who was still a cultural force in the mid 1970s. For any would-be intellectual, Laing was one of the authors whom you had to read and be informed about. There was a series called Fontana Masters, which were short books on the leading thinkers and figures of the time, such as Che Guevara, Albert

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Camus, Martin Heidegger, Marshall McLuhan, Jean Piaget, and, most significantly, Laing. What made Laing especially attractive was that, unlike the other major players, he came from Scotland, in fact from my hometown of Glasgow. He had studied medicine at Glasgow and his first and most famous book, The Divided Self (1960), was based on the patients he saw as a junior psychiatrist in Glasgow hospitals.15 Further, when his work was mentioned by lecturers on our psychiatric course, they did so with disdain for his anti-establishment position, which, of course, made him all the more attractive.16 My attitude to Laing was mixed. On the one hand, here was this hip, erudite, and radical psychiatrist, who was portrayed (not least by himself) as having an uncanny ability to talk to mentally distressed people. In The Divided Self he had drawn on existential philosophy and European literature to demonstrate that the supposedly nonsensical utterances of the mad were understandable if one took the trouble to see the world from their point of view. On the other hand, Laing’s work seemed to imply that psychiatrists were agents of social control, locking up and sedating anyone who was different or who expressed unconventional ideas. Did I really want to do the bidding of the bourgeois order by medicalising the misfits and the marginalised? Like many young people at that time, especially in Glasgow, I was left wing. We tended to side with the underdog. Many left-wing critiques of psychiatry were condemnatory. At the mildest end, mental illness was seen as the result of poverty and the inequities of society. At the more extreme end, as articulated by the Marxist antipsychiatrist David Cooper,17 it was held that the very nature of capitalism itself drove its citizens crazy, and that psychiatrists were there to prop up ‘the system’ by incarcerating all those who rebelled against or expressed disquiet about the prevailing order. I remember talking to a member of a revolutionary socialist party who was also a psychiatric nurse. Instead of confirming the left-wing view of the evils of psychiatry and the barbarity of its ‘treatments’, he said that mental illness was a real and often terrible experience for the sufferers and that electroconvulsive therapy (ECT), viewed as one of the most despicable of therapies by anti-psychiatrists, actually worked. A few years later, I read Psychopolitics by the Trotskyist, Peter Sedgwick, who said much the same thing.18 He also accused the anti-psychiatrists of harbouring a deeply romanticised view of mental illness, something that I was becoming increasingly aware of. Romanticised views of madness have a long history and did not begin with Laing. However, during this period

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he had a great influence on the arts and the media, and the mentally ill were often portrayed as gentle, misunderstood visionaries, crushed by an uncaring and intolerant society. In parallel with this depiction went the portrayal of psychiatrists as insensitive, rather sinister figures, more interested in establishing their power over patients than understanding them. Ken Loach’s 1971 film Family Life was a good example of this. Despite this, I found my psychiatry placement very interesting and felt that this was for me. In the general hospital, doctors and medical students wore white coats, but in psychiatry this was not required. It helped to emphasise the difference between psychiatry and general medicine. Later, when we had medical students attached to the unit where I worked (from the late 1980s onwards), it was clear that many students found psychiatry unsettling. For them, there did not seem to be the same certainties and the same body of objective facts as in general medicine. Students felt that they ‘had to be doing something’, like taking blood or rushing round the ward, examining patients. Psychiatry seemed to involve just sitting and talking to patients for lengthy periods. Unlike patients on medical and surgical wards, who were generally middle-aged or elderly, many psychiatric patients were young and the same age as the students. It was thus much more difficult to be detached from their problems. It was easier to deal with an 80-year-old man with bronchitis, than a 19-yearold woman who was severely depressed. These encounters could stir up the student’s own psychological and emotional difficulties. Later, when I became a Consultant in 1987, it wasn’t unusual for students to seek me out privately, and cautiously reveal their problems, hoping for re-assurance that they ‘weren’t going mad’. For me, though, I found I liked psychiatry. Talking to patients in depth was what I was interested in. By finding out about their personal and family history, their relationships, and their work, it was much easier to see the patient as a person rather than a collection of signs and symptoms. The strange mental worlds that many of the patients inhabited were also intriguing. I was relieved that I liked psychiatry, as I wasn’t sure what else I could have done. The different placements in the clinical years give the student the chance to see what branch of medicine suits them. For many, it is a process of exclusion: identifying the speciality that doesn’t appeal. For me, I’d narrowed it down to psychiatry or general practice, which also involved talking to patients and finding out about their background, though I thought the amount of time allotted was far too short and there was also the pressure to see a large number of patients in quick succession.

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The choice of psychiatry can be a controversial one. Doctors in other disciplines might try to put the student off, by saying it wasn’t ‘real’ medicine and that psychiatrists weren’t ‘proper’ doctors. Students who they found unconventional were sometimes told that psychiatry seemed to be their obvious destination. Parents, although proud that their offspring were studying medicine, sometimes expressed disapproval of the choice of psychiatry, though my parents didn’t, at least not to me.

Starting Psychiatry I started psychiatric training on 1 August 1980 at the Royal Edinburgh Hospital. It felt like liberation. I’d just completed the year of house jobs in medicine and surgery, wearing a white coat, running around busy wards, taking blood, ordering tests, and having disrupted nights thanks to oncall duties. Now, the Royal Edinburgh seemed to work at a more civilised pace, where one was expected to spend time talking to patients, who all had fascinating stories to tell and intriguing, if at times disturbing, mental worlds to describe. The Royal Edinburgh was a large, sprawling campus which had grown out of the old nineteenth-century Royal Edinburgh Asylum (REA), opened in 1813. Many of the buildings were named after figures from psychiatry’s past, so it was a good place for a young psychiatrist with an interest in history to train. The former West House, which catered largely for pauper patients, was now MacKinnon House (named after the first Physician Superintendent of the REA) and there had been the addition of new buildings, such as the Andrew Duncan Clinic, which contained the acute wards and outpatient clinics.19 Up on the hill in separate grounds was the old private wing of the asylum, which had been renamed the Thomas Clouston Clinic and which provided further acute wards. Built in 1892 at the instigation of Physician Superintendent, Thomas Smith Clouston, in order to attract private patients, this was a large Gothic array of buildings with towers, turrets, a wood-panelled grand hall, and underground tunnels linking the various wards.20 When on-call at night, it seemed safer to go to the wards overland, rather than through the long, deserted tunnels. Being on-call on your own at night in a big hospital, when all the other psychiatrists have gone home, induces a feeling of vulnerability and anxiety as to what one is going to be called to do or deal with. Long, empty underground corridors increased this sense of vulnerability.

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I spent four years at the Royal Edinburgh, rotating around the different disciplines, such as general psychiatry, forensic psychiatry, old age psychiatry, child psychiatry, and psychotherapy. Trainees started on a general psychiatry ward. The day began with ‘the Kardex’, when the nurses would outline tasks for the junior doctor, such as interviewing patients or relatives, making phone calls to other agencies, or carrying out physical examinations. The nurses would report back on how the patients had been during the previous 24 hours, commenting on any changes in their mental state or behaviour. In Asylums, Erving Goffman suggested that behaviour that was unremarkable outside the hospital could be regarded as evidence of mental illness if exhibited inside the hospital.21 He claimed that this could explain all apparently mad behaviour, which I think is greatly overstating the case, but there is, nevertheless, an element of truth in his assertion. People are perceived very differently if they are a psychiatric patient, and especially if they are in hospital. Every week there was the ward round, when the Consultant and staff would ‘review’ the inpatients. Unlike the medical equivalent, which involved the clinical team going round the beds of all the patients, in psychiatry the patients were brought into a meeting room where staff sat around a table. On such occasions there could be six to 10 members present. The patient would then be interviewed, usually by the Consultant. I always thought this was an unsatisfactory arrangement, both for patients and staff. It was inhibiting for the patient, who was being asked to talk about their innermost thoughts and fears in front of a roomful of people, some of whom they might not know. Some staff would be taking notes, others might have lost interest and be staring out the window. I remember a poor patient apologising to me after one such meeting because she thought she must have bored the medical student who was sound asleep throughout her interview. Patients with paranoid thoughts could get more suspicious and manic patients could become even more exuberant and loquacious. Such meetings were not good for staff either, as it was difficult to have a productive or sensitive interview with so many people looking on. Later, when I became a Consultant, I tried to ensure that there were as few people in the room as possible and that the patient was given a choice about whether they preferred to be interviewed on their own. The rotation scheme at the Royal Edinburgh offered placements with Professor Henry Walton and Professor Robert Kendell, whose wards each offered diametrically opposed clinical experiences. Professor Walton had

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carried out pioneering work on alcoholism, maintaining that addiction was related to a person’s personality and emotional difficulties. He thus favoured a psychotherapeutic approach. Professor Kendell had written influentially on the classification of psychiatric disorders, in particular schizophrenia and depression. As ever, trainees tried to find out about potential placements by speaking to those who had been there before. I knew from his lectures that Professor Walton was a very cultured man, as comfortable discussing Rembrandt as phenomenologist Edmund Husserl, and able to bring his wide knowledge to bear on questions in psychiatry. I learnt that his ward was run along individual and group psychotherapy lines and that the patients, who were mainly young women with eating disorders, stayed for several months. The daily group therapy sessions were grand, dramatic affairs. Patients and staff sat in a circle, while there was an outer circle of observers (or should that be spectators?). The ceremony was conducted by Professor Walton, who made Freudian interpretations about the patients’ utterances, appearance, and demeanour. These were often of a startlingly sexual nature, for example telling a young man that the keys he wore attached to his belt were a form of phallic exhibitionism. Walton spoke of penetrating ‘the psychic crust’ of a patient’s psychological defences, and was reported to be rather pleased if the patient was reduced to tears. That meant ‘real’ psychotherapeutic work was being done. The sessions reminded me of the depictions of Jean-Martin Charcot’s clinical demonstrations at the Salpêtrière, where theatricality and showmanship were the order of the day, and where patients were expected to ‘perform’.22 As in nineteenth-century Paris, so in twentieth-century Edinburgh young women played a major part in these demonstrations. I didn’t like the sound of this, particularly the notion of breaking the patient’s ‘psychic crust’. Setting out to upset the patient didn’t seem to me like a very caring or therapeutic approach. I was also dubious about making Freudian-based remarks to the patient, which often seemed to be offensive and left the patient bewildered. I remember a Freudian-minded colleague telling her patient that she was treating the therapist like a toilet, because she was ‘dumping her shit’ on her. Professor Kendell’s ward favoured a more biomedical approach, involving careful diagnosis, medication, and ECT. In the weekly ward meetings, attended by a large cast of staff, the trainee would ‘present’ the new patients and was expected to give a comprehensive and detailed case

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history, which would be scrutinised and, if necessary, have its shortcomings highlighted by Kendell. It sounded like an intimidating experience. I knew from his lectures, which were remarkably clear and informative, that Kendell was, nevertheless, a rather austere and remote figure. He had trained at the Maudsley Hospital in London. Partly financed by a bequest from the nineteenth-century alienist Henry Maudsley, it opened in 1923 and was considered the premier centre for psychiatric research in Britain.23 There was a tradition that Chairs of psychiatry throughout Britain were largely filled by men (it was invariably men at this time) who had trained there. The dominant figure in the postwar years at the Maudsley was Aubrey Lewis, who had a great influence, for good or bad, on those who worked with him.24 Much has been written about Lewis by his former trainees.25 He appears to have been a formidable character, whose interrogation of his trainees’ clinical opinions and case presentations could be ruthless, relentless, and adversarial. Some claimed that this provided excellent training and enabled them to be clearer thinkers. Others, though, spoke of the paralysing anxiety they felt in their encounters with the Great Man. One described wetting himself in terror. I have never been convinced that the best way to learn is in a climate of fear and public humiliation. Kendell’s style sounded rather too close to that, and I decided not to go there, either. Sadly, teaching by instilling fear has long been a part of the tradition of medical education, though this has improved in recent times. I thought it was especially inappropriate in psychiatry, which deals with the ‘soft’ data of emotions and psychological states. It is important to listen to the impressions of all staff, not just psychiatrists, to build up a picture of the individual patient and their problems. So it is crucial that people feel comfortable expressing their opinions. The trainee psychiatrist is faced with a bewildering variety of models of mental illness.26 There is the biological model, where the symptoms of psychiatric illness are seen as the manifestations of underlying physical or genetic factors. From this, it follows that the treatment should be physically based, such as medication or ECT. There is the psychodynamic model, where symptoms are seen as the expression of unresolved psychic conflicts. The appropriate treatment is to explore these conflicts by talking about them. There is the social model, which sees the problems of the individual as the result of factors in society, such as poverty, poor housing, unemployment, and prejudice. The task is thus to address the patient’s social problems. Another model is the existential one, which

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attempts to see the world through the eyes of the patient: one should not impose one’s explanations or values on the patient, but, instead, attend to the patient’s own narrative. What should the trainee do? Choose one model, or try elements from all the models? Apply particular models to particular patients, depending on their problems? Deciding between these competing and often opposing models took place in the context of the wider hospital culture where senior psychiatrists promoted particular models. They undoubtedly influenced me, but this depended, to some extent, on how I found them as people and how they approached their patients. I picked up what seemed to be good ways to interact with patients, and, also, at times, ways not to speak to patients. Clinicians favouring a biological model would see themselves as cutting through the psychobabble of the psychotherapists and being more aware of the physical underpinning of mental illness. They would tell exemplary tales where patients had undergone fruitless months of talk therapy, only to be re-assessed and found to have a serious psychiatric illness that responded readily to medication. The psychologically-minded psychiatrists would see themselves as more sensitive to their patients’ psychic conflicts and the personal nature of their problems. They, too, had their exemplary tales, whereby a patient, who had been subjected to a vast array of physical treatments, later revealed their troubled thoughts to a psychiatrist who had taken the trouble to actually listen to them, and, as a consequence, emerged with their conflicts resolved (and medication free). These opposing views were aired at the weekly case conferences where all the hospital psychiatrists would meet and a patient would be presented. Competing explanations would be proffered and sides taken. Of course, this is a bit of an over-simplification. Most psychiatrists were not dogmatically in one camp or the other, and preferred to describe themselves as ‘eclectic’. This was a favoured term, often used to distinguish British psychiatrists from American ones, who were perceived as fanatically embracing Freudian psychoanalysis in the postwar period, only to completely reject it and fanatically embrace biological psychiatry in the 1970s. Sensible British psychiatrists, it was claimed, avoided such unseemly passions and quietly chose aspects from all the models, though the examples of Professors Walton and Kendell might be felt to undermine such self-congratulatory claims.27 The question about which model to adopt takes place as you are seeing patients and trying to work out what, if anything, you can do

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to help. I remember when I started seeing patients, slowly realising that I wasn’t going to solve a patient’s problems in one session. It would take time. I also learnt that the goal was not necessarily cure, which rarely happened in psychiatry, or indeed in medicine more generally. I found that, when seeing patients over an extended period, both psychiatrist and patient adjusted the goal of treatment, and generally came to agree—if agreement was reached—on more modest expectations. Initially I felt that if only I found the right combination of medication, or made a telling interpretation of psychological problems, or suggested changes in social circumstances, all would be well. I thought other psychiatrists were probably doing this routinely. Of course, it’s not like that. It came as a relief that such expectations of the psychiatrist as an all-knowing, miracle-working clinician were totally unrealistic. In fact, I found that the most important factor was the quality of the relationship between psychiatrist and patient. It’s no use devising daring pharmacological cocktails if the patient doesn’t relate to you, doesn’t take their prescription, and doesn’t come back to see you. Many psychiatric patients have long-term conditions and are not necessarily going to get dramatically better. Seeing the same psychiatrist, who takes an interest in them and knows their background, on a regular basis over a long period is of more value than having medication constantly changed or being subjected to what can seem like intrusive and provocative interpretations. Unfortunately psychiatric training involves the junior psychiatrist rotating to different placements every six months. This is not only bad for the trainee, who does not experience the value of long-term follow-up, it is also bad for the patient who sees a succession of new doctors and rehearses their story repeatedly. Seeing patients also demonstrated to me that one did have to be eclectic. Patients presented with such a variety of problems that one could not stick rigidly to one model. And different patients wanted different therapies. Not every patient thought it was good to talk, not everyone accepted medication. And, indeed, not everyone wanted to see a psychiatrist.

Psychotherapy One fundamental aspect of psychiatry training was the teaching of psychotherapy. This was based on Freudian theory. A good example of the approach at this time was to be found in the pages of the recommended

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textbook, Individual Psychotherapy and the Science of Psychodynamics by David H. Malan.28 Its model of psychodynamic psychotherapy was a reductionist one: symptoms and behaviour were secondary to unconscious mechanisms. For example, if the patient was late for the session, this represented unconscious hostility to the therapist, whose task it was to interpret this and inform the patient. I was uneasy with this. What if the patient had just missed their bus? The reductive nature of this model, where apparently random behaviour always had to be the product of unconscious forces, was not persuasive to me and seemed to do away with free will, spontaneity, and serendipity. The model also saw the therapist as a blank screen onto which the patient projected their fantasies and unresolved psychic conflicts. This was tied in with the notion of ‘transference’, whereby it was postulated that the patient was not interacting with the actual person of the therapist but with significant figures from their past, such as their mother or father. For example, if the patient made critical remarks about the therapist, it was not because the therapist had been unhelpful, but because the patient was actually dealing with the unconscious projection of their father. Again, I was troubled by this. It seemed to exonerate the therapist from any untherapeutic behaviour, whilst pointing the finger of blame at the patient and their unresolved relationship problems. It also seemed to ignore the ‘here and now’ of the clinical encounter and the actual behaviour of therapist and patient. Perhaps the patient was critical of the therapist because he or she were being disagreeable. Another feature of psychotherapy training was the weekly seminars run by senior registrars. These seemed impossibly arcane affairs, where participants would make forbiddingly esoteric and opaque interpretations of a patient’s presentation. There were many uncomfortable periods of silence, when the leading figures adopted the posture of deep, agonised thought, before uttering another recondite interpretation. I thought I must be quite stupid as I couldn’t understand any of this. I also thought that psychotherapists must be extremely clever. I had difficulty in relating these discussions to the patients I was seeing. Later I realised that, like many professional groups, psychotherapists adopted a language that was not easily accessible to the uninitiated and that it was a means of keeping others out and lending mystique to their chosen field. Years later I encountered a similar phenomenon with some historians of psychiatry, who wrote in a way that was difficult to understand unless one was familiar with the current academic jargon. To be fair to psychotherapists, I also

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met many psychotherapists who shunned all attempts at mystification or obfuscation, and spoke to their colleagues and their patients in a perfectly understandable language. Indeed, an ability to talk to the patient in a language that they can readily understand is a basic requirement of being a doctor, I would have thought. And to be fair to medical historians, scholars such as Roy Porter wrote and spoke in a thoroughly engaging, accessible, and inclusive manner.

Postgraduate Teaching As well as the clinical work, there was the postgraduate course run by the Department of Psychiatry of the University of Edinburgh. It was held on Wednesday and Friday afternoons in the academic unit of the hospital, the Kennedy Tower (named after Professor of Psychiatry Alexander Kennedy), where we’d receive lectures from psychiatrists, many of whom were acknowledged experts in their fields. I was particularly struck by Dr Tom Walmsley, who in his first lecture said, “Welcome to psychiatry, the most fascinating branch of medicine.” I’d never heard this kind of sentiment before. Usually one was made to feel faintly apologetic about psychiatry and view it as inferior to the rest of medicine. But Dr Walmsley was right: psychiatry is the most fascinating branch of medicine, at least in my eyes. Dealing with the extremities of the human condition; in the nature of relationships; existential questions about the meaning of life and one’s identity; the role of society in creating mental distress, and the physical and biological aspects of psychiatric illness, psychiatry overlaps with many disciplines, such as philosophy, ethics, history, politics, the arts, psychology, and medicine. Dr Walmsley proved to be a very erudite and witty lecturer, whose tutorials encompassed Søren Kierkegaard, Don Quixote, psychoanalysis, and, crucially for me, the history of psychiatry. He became an early role model. When you start out in psychiatry, you have to work out what kind of psychiatrist you want to be, or rather can be. I thought a psychiatrist, as well as developing clinical skills, should also be well-read and knowledgeable about the humanities and the history of psychiatry. R. D. Laing was still on my mind when I started psychiatry, despite my ambivalence about him. He seemed to epitomise the psychiatrist as a sensitive being, listening intently to his or her patients and trying to make sense of what initially appeared obscure or meaningless. That seemed a worthy practice to emulate. The implication in Laing’s writings that he was more sensitive

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than his lumbering, unimaginative contemporaries also appealed to my vanity as it has done to other would-be Laingian psychiatrists. However, after spending a short time in psychiatry, one is quickly disabused of this conceit and realises that one does not possess magical abilities to penetrate the mysteries of madness or to fully comprehend the cries of tortured souls. As part of their rite of passage at the Royal Edinburgh, trainees had to make a presentation at the weekly journal club, attended by senior as well as junior psychiatrists. I had chosen the subject of the art of the mentally ill. It combined my interest in art and psychiatry. I had recently acquired Artistry of the Mentally Ill by Hans Prinzhorn, a German psychiatrist and art historian whose classic book, originally published in 1922, featured the artwork he had collected from asylums around Europe. However, I was told that this subject was a bit too offbeat for the journal club, which favoured more conventional, mainstream psychiatric topics. Nevertheless, I continued to be interested in this subject throughout my subsequent career. Instead of the art of the mentally ill, I chose another subject which also interested me, the disturbances in language manifested in patients with schizophrenia. This involved looking at how linguistic theories had been applied to elucidating psychotic speech. My talk led to completing an MPhil on the subject, a qualification offered on the postgraduate course. I continued my interest in the language of madness. It was a subject that also greatly exercised Laing. Laing took issue with the philosopher-psychiatrist, Karl Jaspers, who, in his magnum opus, General Psychopathology, argued that psychosis was essentially ‘un-understandable’: there was an abyss of incomprehensibility between sanity and insanity.29 Laing felt this was a defeatist approach, and countered that, if one took the trouble, one could begin to understand the communications of mad people. It is an abiding question in psychiatry. Does one regard the apparently nonsensical talk of some psychotic patients as fundamentally meaningless, an ‘empty speech act’ as German Berrios would have it?30 Or is that to disrespect and dismiss the patient? Is the Laingian endeavour to find meaning in madness a more humane response? Or is that a wildly romantic and inevitably doomed venture? These questions preoccupied me while I was seeing patients with psychosis, and I found no easy answers. I was more inclined to the Laingian position of at least trying to make sense of what the patient was saying, but I had to concede that I found the speech of some patients unfathomable. I was also aware of

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the dangers of reaching a pseudo-understanding by applying a theoretical framework that seemed to offer the key. Psychoanalytical explanations of psychosis fell into this category. Translating a patient’s language into that of Freudian symbolism seemed to further obscure the subject, rather than illuminate it. Later, I became interested in Michel Foucault’s notion that the true voice of madness could be discerned in the work of a handful of select European writers, such as Friedrich Nietzsche, Friedrich Holderlin, ¨ Gérard de Nerval, and Antonin Artaud.31 Was this, though, another romanticised view of mental suffering? How relevant was a study of these writers to everyday psychiatric practice? I looked at these issues in a paper I later wrote about Gérard de Nerval and his account of his descent into madness.32

The Medical Humanities It was at the Royal Edinburgh that I first became aware that the hospital retained its case notes from the nineteenth century. Large, leather-bound volumes, they were held in the basement of the hospital, though they have long since been transferred to the more suitable environment of the Lothian Health Services Archive at the University. Like most people looking at historical documents for the first time, I found it exciting and it made me feel much closer to the experiences of nineteenth-century asylum patients, their mental worlds, and their social circumstances. As a psychiatrist, I was struck by how similar the symptomatology was to that of today. Patients described delusions and hallucinations, and the only difference was that, whereas modern-day patients spoke of computers, the internet, and space travel, their nineteenth-century predecessors spoke about gas pipes, mesmerism, and telephones. Later, I was to make a study of these case notes and, during the process, discovered a collection of over 1,000 letters by patients.33 These provided a wonderful window into the world of the patient and helped me to follow Roy Porter’s injunction to study and write about ‘history from below’.34 It also chimed with my perspective as a psychiatrist with an existentialist-inspired ambition to see the patient’s predicament through their eyes, rather than seeing them as an object of the ‘medical gaze’. Studying the history of psychiatry also helped clinical work in other ways.35 It demonstrated how much the specific historical period in which psychiatry found itself shaped its beliefs and assumptions about human beings. It showed how ideas about the nature of mental illness, that were

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once taken for granted, could subsequently be discarded, leading me to be more cautious about the validity of our current ideas. When I started at the Royal Edinburgh in 1980, the use of aversion therapy to try and change the sexual orientation of gay men was coming to an end as it was felt to be misguided. Instead, patients were encouraged to get in touch with gay support organisations and accept their sexuality, rather than see it as ‘pathological’ and in need of ‘treatment’.36 I think my interest in other fields in the humanities, such as literature, art, and philosophy also helped me as a psychiatrist. It makes you more reflective about clinical practice and provides another means, beyond psychiatric textbooks, of understanding mental disturbance from the sufferer’s point of view. With particular regard to art, which I have continued to pursue in painting and drawing throughout my medical career, I came across this observation from the medical historian Ludmilla Jordanova, who suggested that there were parallels between the work of the artist and the clinician: ‘before an artist, every sitter is in some sense a patient’, a person to be looked at repeatedly.37 Likewise, clinicians act as portraitists, building up a picture from facial expressions, gestures, gait, and so on.

The Personal Is Psychiatric Becoming a psychiatrist does not take place in a vacuum: the rest of one’s life is going on at the same time. As well as trying to establish myself as a psychiatrist and work out what kind of psychiatrist I wanted to be, there were the tasks that everyone faces in their early 20s: trying to become a fully-fledged adult, find a partner, set up home, and the existential questions of who I was, where I was going, and what was the purpose of it all. When I started psychiatry, I’d just married and we’d moved from Glasgow to our first flat in Edinburgh. There were, in the psychiatric jargon, a lot of ‘life events’ to navigate. In A Fortunate Man, his portrait of English GP John Sassall, John Berger stated that he did not want to discuss the doctor’s wife and family as he was only interested in what the doctor did in his clinical work.38 However, it is not so easy to neatly separate the two spheres, especially in psychiatry where one’s work is concerned with relationships and family, and where some kind of understanding of oneself is important. One relates psychiatric theories and the life stories or ‘histories’ of patients to one’s own circumstances and upbringing. Indeed, there is a common basis to much of human experience, such as growing up, love, friendship,

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loneliness, parenthood, loss, and separation. You bring your own experiences to understanding patients, and, in turn, their experiences affect you. I remember feeling rather clueless during my child psychiatry placement. This was in the days before my wife and I had children and raised the question of how much experience of life one needed before one could become a psychiatrist. I recall one psychiatric authority advising that you should be at least 35 years old before starting a career in psychiatry. In contrast, I wondered: is age irrelevant if you have an interest in your fellow human beings and a concern for their troubles? I hoped so, as I was only 23 when I started psychiatry. I was also aware that doctors generally came from a privileged background and had no experience of the kinds of lives many of their patients led. I saw middle-class socialist doctors attempting to relate to working-class people, but ending up patronising them, either because they had romantic notions of the ‘noble proletariat’ or because they saw them as representative types, rather than as individual people. Likewise, those from the political right could entertain judgmental notions of a ‘feckless underclass’ and write off everyone from a lowlier background than themselves. My Royal Edinburgh days came to an end when I passed the professional exam to become a Member of the Royal College of Psychiatrists (MRCPsych), which led to higher training and eventually becoming a Consultant Psychiatrist at the Queen Margaret Hospital in Dunfermline.

Aftermath and Final Reflections Narrative therapy maintains that it can be good for people to tell their story. It helps them to make sense of their life and see a structure and pattern to it that may not have been initially apparent to them. I have certainly found this to be true in writing this memoir. My time at the Royal Edinburgh Hospital was, in many ways, the most crucial stage in my professional life and shaped what kind of psychiatrist I became. Looking back, the elements of my future career were all there: an existential approach to patients, an interest in the history of psychiatry, and a recognition of the importance of the medical humanities in understanding the mentally ill. I was lucky to be able to continue my exploration of these areas for the rest of my time as a psychiatrist. The resurgence of interest in the history of psychiatry took place early in my career and I was able to see the major figures, such Roy Porter, Andrew Scull, and German

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Berrios give talks, as well as read their work. I was able to participate in the field, in part because the Scottish historical archives were so rich, especially in material relating to the patient’s perspective. The reawakening of interest in the medical humanities also occurred during this period, and I was able to write on the subject and organise conferences involving psychiatrists and writers, such as Alasdair Gray, James Robertson, and Bernard MacClaverty. My interest in art led me to become the Psychiatry and Pictures Editor of the British Journal of Psychiatry. From my early attempts as an adolescent to find a community of like-minded individuals, I eventually found it after I became a Consultant, when such a community gradually evolved in our hospital, epitomised by the weekly Friday seminars on psychiatry and its relation to art, literature, philosophy, ethics, cinema, politics, or, indeed, anything that people wanted to talk about. In his book on John Sassall, Berger concluded that the doctor was ‘a fortunate man’. The way my career in psychiatry turned out, I could say the same about me. Acknowledgements Thanks as ever to my wife, Margaret, for reading a draft of this chapter and for all her support over the years.

Notes 1. R. D. Laing in a letter to Marcelle Vincent, 29 September 1949. Cited in Bob Mullan, R.D. Laing: Creative Destroyer (London: Cassell, 1997), 72. 2. See R. D. Laing, Wisdom, Madness and Folly. The Making of a Psychiatrist 1927–1957 (Edinburgh: Canongate, 1998; 1985); Allan Beveridge, Portrait of the Psychiatrist as a Young Man. The Early Writing and Work of RD Laing 1927–1960 (Oxford: Oxford University Press, 2011). 3. Sigmund Freud, An Autobiographical Study (New York: Norton, 1963). 4. Henri Ellenberger, The Discovery of the Unconscious: The History and Evolution of Dynamic Psychiatry (New York: Basic Books, 1970). 5. Carl Gustav Jung and Aniela Jaffe, Memories, Dreams, Reflections, trans. Richard and Clara Winston (New York: Pantheon Books, 1963). 6. Emil Kraepelin, Memoirs, trans. C. Wooding-Deane (Berlin, Heidelberg: Springer-Verlag, 1987). 7. Michael Shepherd (ed.), Psychiatrists on Psychiatry (Cambridge: Cambridge University Press, 1982); Greg Wilkinson (ed.), Talking About Psychiatry (London: Gaskell, 1993). 8. For a discussion of the application of literary techniques to psychiatry, see Allan Beveridge, ‘The Benefits of Reading Literature’, Femi Oyebode

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10. 11. 12.

13.

14.

15. 16.

17.

18. 19.

20.

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(ed.), Mindreadings: Literature and Psychiatry (London: Royal College of Psychiatrists, 2009), 1–14. See Nick Bouras and George Ikkos (eds.), Mind, State and Society: Social History of Psychiatry and Mental Health in Britain 1960–2010 (Cambridge: Cambridge University Press, 2021) for an overview of this period. See David Healy, The Creation of Psychopharmacology (Cambridge, MA: Harvard University Press, 2002). See, for example, Pat Bracken et al., ‘Psychiatry Beyond the Current Paradigm’, British Journal of Psychiatry, 201, 2012, 430–434. John Turner et al., ‘The History of Mental Health Services in Modern England: Practitioner Memories and the Direction of Future Research’, Medical History, 59(4), 2015, 599–624, emphasise that the rise of patients’ movements has been the most important development in the recent history of the mental health services. Roy Porter, ‘Two Cheers for Psychiatry! The Social History of Mental Disorder in Twentieth Century Britain’, Hugh Freeman and German Berrios (eds.), 150 Years of British Psychiatry. Vol. 2. The Aftermath (London: Athlone, 1996), 383–406. Robin Downie held the Chair of Moral Philosophy at the University of Glasgow. Along with Sir Kenneth Calman he championed the role of the medical humanities in the education of healthcare professionals. Calman served as Chief Medical Officer in both Scotland and England. Jane Macnaughton is Professor of Medical Humanities at Durham University. Beveridge, Portrait of the Psychiatrist. An idea of the curriculum at this time can be gleaned from Malcolm Ingram, Gerard Timbury, and Robert Mowbray, Notes on Psychiatry, 5th edn (Edinburgh: Churchill Livingstone, 1981). David Cooper was a South African psychiatrist who moved to England where he joined forces with R. D. Laing. Cooper coined the term ‘anti-psychiatry’ in his book, Psychiatry and Anti-Psychiatry (London: Tavistock, 1967). Peter Sedgwick, Psychopolitics (London: Pluto Press, 1982). Andrew Duncan, a Professor of Medicine in Edinburgh, visited the poet Robert Fergusson when he was confined in Edinburgh’s ‘Bedlam’ in 1774 and was so appalled by his treatment that he launched an appeal to open a more humane institution. This led to the opening of the REA in 1813. Allan Beveridge, ‘Edinburgh’s Poet Laureate: Robert Fergusson’s Illness Reconsidered’, History of Psychiatry, 1, 1990, 309–329. On Clouston, see Allan Beveridge, ‘Thomas Clouston and the Edinburgh School of Psychiatry’, German Berrios and Hugh Freeman (eds.), 150 Years of British Psychiatry 1841–1991 (London: Gaskell, 1991), 359–388.

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21. Erving Goffman, Asylums: Essays on the Social Situation of Mental Patients and Other Inmates (Harmondsworth: Pelican, 1968; 1961). 22. See Andrew Scull, Hysteria: The Biography (Oxford: Oxford University Press, 2009), 104–130. 23. On the Maudsley Hospital, see Patricia Allderidge, ‘The Foundation of the Maudsley Hospital’, Hugh Freeman and German Berrios (eds.), 150 Years of British Psychiatry 1841–1991 (London: Gaskell, 1991), 79–88. The REA was apparently nicknamed the ‘MacMaudsley’. 24. On Aubrey Lewis, see Michael Shepherd, A Representative Psychiatrist: The Career, Contributions and Legacies of Sir Aubrey Lewis, Psychological Medicine Supplement 10 (Cambridge: Cambridge University Press, 1986). 25. For a range of opinions on Lewis by colleagues and trainees, see Shepherd, Psychiatrists on Psychiatry, and Wilkinson, Talking About Psychiatry. 26. For an account of the different schools during the period when I was training, see Leston L. Havens, Approaches to the Mind: Movement of the Psychiatric Schools from Sects to Science (Boston: Little, Brown and Co., 1973). 27. There are several explanatory models of the history of psychiatry. There are linear models of progress, such as Gregory Zilboorg’s A History of Medical Psychology (New York: W. W. Norton & Co., 1941), who saw psychiatry as evolving out of the darkness and ignorance of previous times to the ‘Golden Age’ of Freud. Edward Shorter, in A History of Psychiatry: From the Era of the Asylum to the Age of Prozac (New York: John Wiley and Sons, 1997), likewise charted a story of progress, but in his account it was biological psychiatry that triumphed. Michel Foucault’s Madness and Civilization: A History of Insanity in the Age of Reason, trans. R. Howard (London: Tavistock Publications, 1967), challenged the very idea that the history of psychiatry was a narrative of progress, arguing that psychiatry had introduced more sophisticated forms of control. K. W. M. Fulford, Tim Thornton, and George Graham (eds.), in The Oxford Textbook of Philosophy and Psychiatry (Oxford: Oxford University Press, 2006), suggest a dialectical narrative in which psychiatric theory zigzags between physical and psychological explanations of insanity. 28. David H. Malan, Individual Psychotherapy and the Science of Psychodynamics (London: Butterworths, 1979). 29. Karl Jaspers, General Psychopathology, trans. J. Hoenig and M. W. Hamilton (Manchester: Manchester University Press, 1963). 30. German E. Berrios, ‘Delusions as ‘Wrong Beliefs’: A Conceptual History’, British Journal of Psychiatry, 159, 1991, 6–13. 31. Foucault, Madness and Civilization. 32. Allan Beveridge, ‘The Madness of Gerard de Nerval’, Medical Humanities, 40, 2014, 38–43.

‘IF YOUR MEMORY SERVES YOU WELL’: REFLECTIONS …

301

33. Allan Beveridge, ‘Madness in Victorian Edinburgh: A Study of Patients Admitted to the Royal Edinburgh Asylum Under Thomas Clouston, 1873–1908’, History of Psychiatry, 6(1 and 2), 1995, 21–54 and 133–156. 34. Roy Porter, ‘The Patient’s View: Doing Medical History from Below’, Theory and Society, 14(2), 1985, 175–198; Allan Beveridge, ‘Life in the Asylum: Patients’ Letters from Morningside, 1873–1908’, History of Psychiatry, 9, 1998, 431–469. 35. For an account of my experiences of studying the history of psychiatry, see Allan Beveridge, ‘The History of Psychiatry: Personal Reflections’, Journal of the Royal College of Physicians of Edinburgh, 44, 2014, 78–84. 36. Roger Davidson, ‘Psychiatry and Homosexuality in Mid-Twentieth Century Edinburgh: The View from Jordanburn Nerve Hospital’, History of Psychiatry, 29(4), 2009, 403–424. 37. Ludmilla Jordanova, ‘Portraits, Patients and Practitioners’, Medical Humanities, 39, 2013, 2–3: 3. 38. John Berger, A Fortunate Man: The Story of a Country Doctor (London: Allen Lane, 1967).

Index

A acronyms, 271, 272 Adler, Alfred, 262 advocacy groups, 102, 280 aging, 16 Allderidge, Patricia, 9, 28, 300 Allen, Thomas, 142, 143, 155 Alzheimer, Alois, 16, 17 Alzheimers Disease, 16 American Horror Story (TV series), 10 American Medico-Psychological Association, 50 Anderson, J.W.T., 51, 61 Angel, Katherine, 18, 34 anniversaries, 2, 3, 8, 18, 19, 93, 100 anthropology, 106 anti-psychiatry, 268, 276, 299 Arbeiter-Zeitung (newspaper), 115, 131 archaeology, 12, 30, 126 architecture, 12, 93 archives and libraries

Barbados National Archives, 143, 155 Library of Psychoanalysis, Sigmund Freud Museum, Vienna, 124 Lothian Health Services Archive, 295 art, 121, 124, 130, 216, 225, 281–283, 285, 294, 296, 298 art therapy, 216, 238 Artaud, Antonin, 295 Aspergers syndrome, 265 Assmann, Aleida, 11, 29, 63 Assmann, Jan, 11, 29, 43, 58 asylums and hospitals abuses within, 40 admission to, 18, 195 Agra Central Asylum, India, 53 Ahmedabad Asylum, India, 40, 46 Alexandra Hospital, Cape Town, 183 in America, 12 architecture and design, 93

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 R. Wynter et al. (eds.), Memory, Anniversaries and Mental Health in International Historical Perspective, Mental Health in Historical Perspective, https://doi.org/10.1007/978-3-031-22978-7

303

304

INDEX

Barbados Lunatic Asylum, 21, 141, 155 Bethlem Asylum, London, 4, 9 Bicêtre Hospital, Paris, 261 Bielefeld Epileptic Colony, Germany, 5 Borough of Nottingham Lunatic Asylum (Mapperley Hospital), 24, 232 Brookwood Asylum, Surrey, 164 building programmes, 10, 236 Caterham Asylum, Surrey, 196 cemeteries, 22, 159 Central State Hospital, Indiana, 23 Charité Hospital, Berlin, 96, 98 closure, 10, 212–216, 222–225, 240–243, 253 Colaba Asylum, India, 46 Colney Hatch Asylum, London, 13 Committees of Visitors, 47 Danvers Lunatic Asylum, Massachusetts, 10 deaths within, 225, 153 design, 159 Dharwar Asylum, India, 40, 46, 50, 60 and disease, 48 Enniscorthy District Lunatic Asylum, Ireland, 2 Ewell Epileptic Colony, London, 5 fees for, 164 in Germany, 105, 110 Grahamstown Lunatic Asylum, South Africa, 184 Hanwell Asylum, London, 5 Holloway Sanatorium, Surrey, 22, 160, 164, 170, 176 Hyderabad Asylum, India, 40, 46 in India, 19, 42, 45, 51 Institute for Imbecile Children, South Africa, 22, 184. See also

Grahamstown Lunatic Asylum, South Africa Kingston Asylum, Jamaica, 142 Larkana Asylum, India, 46 Larue D. Carter Memorial Hospital, Indianapolis, 223 Lincoln Lunatic Asylum, Lincolnshire, 5 Maudsley Hospital, London, 1, 289 McLean Asylum for the Insane, Massachusetts, 2 Military Psycho-hygienic Institute, Serbia, 74 Mississippi State Lunatic Asylum, Mississippi, 13 Naupada Asylum, India, 46 Newcastle-upon-Tyne City Lunatic Asylum, Tyne and Wear, 165 nomenclature, 43, 45, 54, 55, 57 Old Somerset Hospital, Cape Town, 186 Ontario Hospital School, Canada, 213 overcrowding in, 151 Poona Asylum, India, 44 Queen Margaret Hospital, Dunfermline, 297 Radcliffe County Asylum, Nottinghamshire (Saxondale Hospital), 24, 232 Ranchi Mental Hospital, India, 43 Ratnagiri Mental Hospital, India, 40 relationships within, 96, 296 re-use and redevelopment of, 12 Royal Edinburgh Asylum, Edinburgh, 24, 286 Salpêtrière Hospital, Paris, 288 as sanctuaries, 239, 242 Somerset Hospital, Cape Town, 2 in South Africa, 183

INDEX

staff, 5, 14, 40, 44, 47, 52, 57, 174, 193, 194, 213, 215, 219, 221, 224, 236, 240, 243, 287, 288 Staffordshire Lunatic Asylum, Stafford, 2, 13 Stromness Hospital, Australia, 2 superintendents, 39, 42, 43, 47, 48, 51, 52, 55, 56, 94, 141, 286 Surrey County Asylum, Surrey, 165 The Retreat, York, 6 in urban and rural areas, 93, 95 wards, 10, 48, 194, 286 West Riding Lunatic Asylum, Yorkshire, 2, 162 Willowbrook State School, New York, 218 Yerawada Central Asylum, India, 19, 42, 44, 52 Austria, 21, 116, 118, 123, 124 autism, 8, 265, 270, 272, 273 aversion therapy, 2, 296 Azoulay, Ariella, 196, 198, 206

B Baldessari, John, 121 Balinsky, Ivan, 262 Barbados, 2, 139–144, 148–150, 153, 156 Barham, Peter, 243 Barry, J.P., 46, 50, 59, 60, 62, 63 Barthes, Roland, 161, 177 Battie, William, 91, 101 Bayh, Evan, 212, 217, 218, 221, 226 Bedlam (film, 1946), 9 Ben-Moshe, Liat, 218, 228 Bennett, Katy, 244 Bennett, Sarah, 12, 30 Berger, John, 296, 298 Berrios, German, 33, 294, 298 Betlheim, Stjepan, 71, 74, 87

305

Bhattacharyya, Anoushka, 43, 47, 58–60 Binswanger, Ludwig, 99, 108, 111, 112 bipolar disorder, 278 Birmingham, University of, 269 bodies, 12, 15, 16, 43, 153, 164, 169, 187, 193, 194, 196, 211, 236, 267 Bonaparte, Marie, 130 Bonhoeffer, Dietrich, 98 Bonhoeffer, Karl, 98, 111 books, 11, 18, 29, 50, 52, 57, 79, 101, 105, 116, 118–120, 124, 127, 128, 130, 131, 159, 162, 265, 282, 283 Brandt, Willy, 102 Bridge Circle, London, 265 Briggs, Katharine, 262 Briggs Myers, Isabel, 263 Brink, Cornelia, 105, 110, 112–114 British Broadcasting Corporation (BBC), 6, 27 Brock, Arthur, 53, 54, 62 Brookes, Barbara, 34, 163, 178 Brown, Elspeth, 171, 175, 180 Browne, W.A.F., 4, 5 Büchner, Georg, 283 Burghardt, Madeleine C., 213, 224, 226 Butler, Judith, 124 Bychowski, Gustav, 120

C Calabria, Verusca, 23, 24, 35, 213, 219, 226, 229, 249–253, 255 Calman, Kenneth, 282, 299 Calzolari, Pier Paolo, 121 Camus, Albert, 284 Care Quality Commission, 8 carers, 236, 242, 245, 261, 272, 274

306

INDEX

Caruso, Igor, 68, 76 Cashman, Ray, 235, 247 Char, René, 130 Charcot, Jean-Martin, 288 charity, 96 children, 22, 23, 75, 78–80, 149–151, 161, 183–194, 196, 198, 199, 202, 203, 229, 262, 297 class, 47, 73, 103, 125, 144, 145, 147, 148, 164, 170, 235, 246, 266, 282, 297 classification systems, 50, 143, 191, 262–264, 269, 288 clothing, 30, 42, 52 Clouston, Thomas Smith, 286 colonialism, 46, 67, 82 Commissioners in Lunacy, 142 Committee for the Protection of People’s Health, Yugoslavia, 70 communicative memory, 39, 40, 42, 48, 57, 59 communism, 68 Communist Party, Yugoslavia, 65 community-based care, 105, 212, 214, 227, 231 Community Organisation for Psychiatric Emergencies (COPE), London, 268 concentration camps, 123 Conolly, John, 5, 7 Cooper, David, 284, 299 Crichton-Browne, James, 162, 178, 181 Csipze, Emese, 241

D Dannemann, Adolf, 97, 111 Davis, Fred, 244 day centres, 270 de Nerval, Gérard, 295

death, 15, 23, 66, 93, 95, 96, 98, 100, 101, 104, 107, 114, 121, 150, 153, 161, 187, 211–214, 216, 218, 219, 222–225, 240 degeneration theory, 16, 110. See also heredity Degkwitz, Rudolf, 102, 103, 113 deinstitutionalisation, 13, 14, 23, 102, 106, 212, 213, 215, 217, 224, 225, 228, 236, 239, 242–244, 246, 248 delusion, 145, 150, 153, 164, 180, 295 dementia, 16, 18, 34, 145, 262 dementia praecox, 53, 54, 262 depression, 262, 264, 265, 267, 268 Derrida, Jacques, 121 Detlefs, Gerald, 105, 113, 114 Dhunjibhoy, J.E., 43, 44, 51, 54, 59 Diagnostic and Statistical Manual of Mental Disorders (DSM ), 260, 263, 264, 274, 277 diagnostic labels, 22, 262, 263 Diamond, Hugh Welch, 162, 165, 178 Dorner, ¨ Klaus, 91, 101, 103, 106, 108 Digby, Anne, 8, 27, 178 Dostoyevsky, Fyodor, 283 Downie, Robin, 282, 299 dreams, 117, 131, 228, 242, 281 Dr Finlay’s Casebook (TV series), 281 Duncan, Andrew, 299 Du Plessis, Rory, 22 Dwyer, Ellen, 212, 213, 225, 226, 229

E East India Company, 40, 46, 47 Eastoe, Stef, 185, 196, 202–204, 206 Edinburgh, University of, 293

INDEX

education, 22, 72, 75, 81, 110, 184, 197–199, 266, 281, 289, 299 Eghigian, Greg, 69, 85, 86 Ellenberger, Henri, 108, 279 Ellis, Rob, 18, 27, 30, 32, 34, 160, 177, 226, 249, 250, 255 emotions, 11, 12, 235, 238, 264, 289 Engelman, Edmund, 119, 120, 127, 132 Engels, Friedrich, 68 Enquête-Commission, West Germany, 102, 103 epilepsy, 5, 145, 185, 188, 189, 194, 272 Ernst, Waltraud, 43, 44, 51, 59, 203 eugenics, 5, 16, 100, 204 euthanasia, 100 F family, 16, 20, 22, 46, 68, 77–79, 83, 93, 100, 117–119, 121–127, 146, 148, 160–162, 172–177, 181, 187, 188, 192, 198, 218–221, 236, 238–241, 243, 265, 274, 281, 285, 296 family history, 16, 285 Family Life (film, 1971), 285 Federn, Paul, 120 Feiersinger, Werner, 121 Fichtl, Paula, 119 Field, Albert, 143, 144, 150, 151, 153 film, 10, 218, 228 Fisher, Lawrence, 150, 157 Flemming, Carl Friedrich, 95, 110 food, 46, 144, 187, 192, 221 forgetting, 11, 12, 19–22, 63, 66, 77, 159, 160, 162, 174, 235, 236, 244, 246, 247, 252, 279 Foster, Don, 183, 202 Foucault, Michel, 9, 28, 295, 300 Fowler, Corinne, 3, 26

307

Franklin, Bridget, 13, 31, 132 Freud, Alexander, 123 Freud, Anna, 117–120, 125, 130, 132 Freud, Ernst, 117 Freud, Martha, 117 Freud Museum, London, 118 Freud, Sigmund, 17, 115–119, 121, 123, 124, 130–135, 259, 262, 265, 279. See also Sigmund Freud Museum, Vienna Friedman, Meyer, 263, 275 Fromm, Erich, 68, 81 Fulford, Bill, 18, 34 G Gandhi, Mohandas Karamchand (Mahatma), 56 Gardiner Hill, Robert, 5, 7 Gast, Ursula, 104, 114 General Paralysis of the Insane (GPI), 15 General practitioners (GPs), 269 geography, 3, 252 Germany, 21, 91, 92, 94, 97, 99–104, 106, 111, 116, 262, 265 Gibbeson, Caroline, 14, 32, 252 Glasgow, University of, 281, 282, 299 Goffman, Erving, 287, 300 Gogol, Nikolai, 283 Gombrich, Ernst H., 130 Gramsci, Antonio, 68 Grant Medical College, India, 47 Gray, Alasdair, 298 Grayfoot, Major, 50 Greenlees, Thomas Duncan, 22, 23, 184, 187, 189, 193, 194, 202, 204 Green-Lewis, Jennifer, 161, 177 grief, 219, 224, 240 Griesinger, Wilhelm, 20, 91–111 Guevara, Che, 283 Guinea, West Africa, 81

308

INDEX

Güse, Hans-Georg, 101, 104, 109, 110, 112

H Hacker, Friedrich, 118, 132 Hall, John, 18, 34 Hamlett, Jane, 12, 30, 180, 253 Hayward, Rhodri, 18, 34 Head, Henry, 17, 149 Heidegger, Martin, 284 Heine, Linda, 211, 212, 219, 225 hemp, 19, 40, 58 Hemp Commission Report (1894), 19, 40 Henderson, W.G.H., 50, 51, 61 Herbart, Johann Friedrich, 99 heredity, 53, 71 Herold, Georg, 121 Herzog, Gunter, 103, 105, 113 Hickman, Clare, 12, 30 Highsaw, June, 211, 219, 226 Hill, Charles, 50 Hirsch, Marianne, 161, 172, 174, 175, 177, 180, 181 historical geography, 3, 30 Hoche, Alfred E., 96, 110 Hoff, Paul, 105, 109, 114 Hoffman, Marella, 248, 255 Holderlin, ¨ Friedrich, 295 Holloway, Thomas, 164 Holzer, Jenny, 121 homelessness, 214, 222, 268 Horney, Karen, 68 hospitals. See asylums and hospitals humoral system of medicine, 44 Hunter, Richard, 17 Husserl, Edmund, 288 Hustvedt, Siri, 124 Hutson, Charles, 143–152, 157 hysteria, 10

I identity, 160, 163, 196, 215, 219, 220, 223, 225, 229, 234, 235, 244, 247, 264, 293 idiocy, 186, 203, 204, 206 imbecility, 186, 203, 204, 206 India, 2, 19, 40, 42–45, 47, 48, 50–58, 62, 203 Indian Medical Service (IMS), 47, 56, 57 intellectual and learning disabilities, 183–186, 191, 195, 203 historical terminology, 186 International Classification of Diseases (ICD), 263, 264, 269 International Psychoanalytic Association, 120, 124 Interpretation of Dreams, The (book, 1900), 117, 131 intersubjectivity, 233 Italy, 4, 102

J Jackson, Mark, 33, 195, 206 Jakovljevic, Vladimir, 76, 80–82 Jaspers, Karl, 294, 300 Jehangir, Cowasji, 46 Jerotic, Vladeta, 78 Johnson, Lyndon B., 21, 118 Johnson, Samuel, 6 Jordanova, Ludmilla, 296 Joseph, Alun, 13 journals British Journal of Psychiatry, 298 British Medical Journal (BMJ), 53, 54 Indian Medical Gazette, 53 West Riding Medical Reports , 181 Julius, Dezider, 71 Jung, Carl, 262, 275, 279, 283

INDEX

K Kabakov, Ilya, 121 Kahlbaum, Karl, 262 Kapila, Shruti, 45 Kardelj, Edvard, 77 Kearns, Robin, 13 Kendell, Robert, 287–290 Kennedy, Alexander, 6, 7, 27, 293 Kierkegaard, Søren, 293 Kiesler, Frederick, 121 Kiesler, Lillian, 121 Klajn, Hugo, 71–74 Klaus, Josef, 118 Kosuth, Joseph, 121 Kraepelin, Emil, 97, 111, 259, 262, 275, 280, 298 Kräupl-Taylor, Peter (Frederick), 266 Kuhn, Annette, 161 Kuhn, Roland, 99

L Laehr, Heinrich, 102, 103 Laing, Ronald D., 20, 268, 276, 279, 283, 284, 293, 294, 298, 299 Lamentable Brother (radio programme, 1948), 6 Lamington, Lord, 49 language, 11, 24, 48, 50, 71, 84, 92, 121, 128, 130, 260, 274, 292–295 Lazarus, Moritz, 95, 110 legislation County Asylums Act (1808), 2 Government of India Act (1919), 43, 45 Indian Lunacy Act (1912), 55 Indian Lunacy Act (India Act VI, 1912), 56 Indian Lunatic Asylum Act (1858), 46 Local Government Act (1888), 18

309

Lunacy Act (1845), 141 Mental Health Act (1983), 248 Mental Treatment Act (1930), 7 Leonhard, Karl, 91 Leuenberger, Christine, 76 Leupold-Löwenthal, Harald, 119, 120 Lewis, Aubrey, 289, 300 libraries, 120, 122, 124 Loach, Ken, 285 Lobner, Hans, 120 Lombroso, Cesare, 16 London County Council (LCC), 5 loss, 17, 25, 160–162, 184, 187, 194, 224, 234, 238, 241–245, 247, 297 Lost Trades of Islington project, 235 M M*A*S*H (TV series), 281 Macalpine, Ida, 17 MacClaverty, Bernard, 298 Macnaughton, Jane, 282, 299 Malan, David H., 292, 300 mania, 145, 151 Marcuse, Herbert, 80, 87 Marinelli, Lydia, 121 Marxism, 68, 75, 76 material culture, 12, 21, 235, 245 Matic, Vojin, 77, 79, 80, 82, 87 Maudsley, Henry, 289 McConaghy, W., 49, 50 McLuhan, Marshall, 284 medical education, 282, 289 ‘medical gaze’, 295 medical humanities, 282, 295, 297–299 Medimetric Institute, New York, 265 memory, 2, 3, 5, 8–13, 15, 17–19, 21, 23–25, 46, 50, 53, 119, 126, 131, 140, 145, 146, 149, 160, 161, 164, 170, 174, 185, 199, 213, 233–236, 245–249, 280

310

INDEX

Mental Health Trusts, 269, 270 Mental Patients’ Union (MPU), 2 Mette, Alexander, 91, 100, 108, 111 Mickle, William Julius, 15 Millard, Chris, 18 Mills, James, 44 MIND charity, 269 Minde, M., 183 Moon, Graham, 13 Morel, Benedict Augustin, 16 Morley, John, 48 museums, 14, 15, 21, 118, 119, 121–125, 127, 130, 131, 133 mutism, 185, 188, 193 Myers-Briggs Types, 275 myth, 5, 9, 10, 18, 118, 247, 280

N Nackett, Paul, 265, 276 narrative, 3, 6, 9, 12, 14, 15, 18, 19, 22–25, 70, 93, 95, 102, 104–107, 120, 144, 173, 190, 191, 212–216, 218, 219, 224, 225, 233–237, 244, 246, 247, 249, 279, 280, 297 National Health Service, 2 National Health Service (NHS), 6, 265, 271 nationalism, 57 National Trust, 3 neglect, 108, 185, 213, 218, 225, 238, 241, 244–246 Neisser, Clemens, 97, 98 Nelson, Elizabeth, 23, 240 neurology, 17, 92, 99, 262 New Zealand, 13, 241 Nietzsche, Friedrich, 135, 295 Niketic, Bosko, 70 Nikolic, Nikola, 20, 69, 70 non-restraint, 5, 98, 100, 141 Nora, Pierre, 234

Norris, William, 5 Northern Ireland, 235 nostalgia, 10, 23, 24, 212, 213, 215, 219, 220, 223–225, 232–236, 238, 241, 243–245, 247, 248 nurses, 46, 50, 190, 192, 198, 214, 216, 219, 220, 222, 223, 239, 240, 287 O obeah, 149, 150 occupational therapy (OT), 238, 239 open-door policy, 236, 242 oppression, 80, 224, 244, 246 oral history, 18, 24, 212–215, 232, 233, 236, 238, 243, 246, 248, 249 Overbeck-Wright, A.W., 53 Oxford, University of, 266, 267, 269 P Pain, Nesta, 6, 8 Pall Mall Gazette, 262 Panse, Friedrich, 99 paralysis, 185, 188, 189, 193 Passerini, Luisa, 246 Paton, Diana, 149 Peace Centre, Birmingham, 269 Pelman, Carl, 96 PERCEIVE research programme, London, 241 personality disorders, 259, 263, 273 Personality Disorder Knowledge and Understanding Framework, 271 personality ‘types’, 262 Pessler, Monika, 21, 121 philanthropy, 44 Philo, Chris, 12 photography, 160–166, 172–174, 176, 196

INDEX

phrenology, 16 Phu, Thy, 172, 175 physiognomy, 178 Piaget, Jean, 284 Picard, Walter, 102 Pinel, Philippe, 91, 101, 261 polio, 189 Pomian, Krysztof, 119 Pope-Hennessy, John, 140 Porter, Roy, 11, 25, 249, 280, 293, 295, 297 post mortem, 15, 16 post-traumatic stress disorder (PTSD), 17 prejudice, 21, 144, 146, 187, 274, 289 Prichard, James Cowles, 261 Prinzhorn, Hans, 294 psychiatry biological, 69, 70, 107 child, 287, 297 in clinics, 94 colonial, 44, 45 custodial, 95, 103 in general hospitals, 280, 285 under the Nazi regime, 98 as a profession, 17, 25 radical, 20, 80 social, 66, 67, 69, 98, 100, 101, 105, 106 terminology, 265 training, 52, 93, 286, 291, 292 transcultural, 67, 81 in university hospitals, 97 western, 51–53, 57 psychoanalysis, 11, 17, 21, 53, 66, 68, 75–81, 84, 99, 107, 115–118, 120, 122, 123, 125–128, 131, 264, 265, 290, 293 psychopathy, 261, 262 psychosis, 264, 269, 294

311

psychotherapy, 43, 52, 66, 78–80, 82–84, 106, 287, 288, 291, 292

Q Quakers, 8, 261, 266

R race, 9, 144 racism, 21 Rajpal, Shilpi, 45 record-keeping, 3 re-enactment, 12, 124 religion, 9, 131, 160, 283 remembrance, 2, 13, 19, 117, 160–162, 164, 169, 172–174, 176, 177, 236 resistance, 19, 20, 43, 45, 51, 55, 65, 69–71, 74, 78, 81, 100, 105, 146, 224, 244 restraint, 5, 16, 143, 146 Reynolds, Alfred (aka Reinhold Alfred), 265 riots, 144 Rivera, Geraldo, 218 Robertson, James, 298 Roper, Michael, 11 Rose, Gillian, 161, 172, 174–176 Rosen, George, 10, 28 Rosenman, Ray, 263 Rössler, Wulf, 104, 105 Roth, Michael S., 10, 11 Royal College of Psychiatrists, 297 Rudd, Anthony, 215 Rutherford, Sarah, 12

S Sackler, Arthur, 265 Sacks, Oliver, 107 Sandbichler, Peter, 121 Sargent, William, 17

312

INDEX

Sassall, John, 296, 298 Savage, Mike, 235 schizophrenia, 53, 262–265, 288, 294 Schmacke, Norbert, 101, 104 Schmiedebach, Heinz-Peter, 103, 104 Schnitzler, Arthur, 130 Scholz-Strasser, Inge, 121 Schrenk, Martin, 100, 101, 105 Scull, Andrew, 9, 22, 50, 55, 159, 297 Sedgwick, Peter, 284, 299 seizures, 72, 73, 188, 193 service users, 3, 18, 25, 237, 242, 246, 268, 270–272, 274, 280 Session 9 (film, 2001), 10 sexual abuse, 262 sexuality, 296 Shaftesbury, Lord (Anthony Ashley-Cooper), 7 Shaw, Major W.S.J., 19, 42–44, 47, 52–57 Shelby, Lydia, 211 shell shock, 11, 17 Shepherd, Anne, 164 Shepherd, Jade, 160 Showalter, Elaine, 11 Sigmund Freud Foundation, 123 Sigmund Freud Museum, Vienna, 21, 115–135 silence, 215, 233, 245–247, 292 Simon Community, Oxfordshire, 267 slavery, 139 Snake Pit, The (film, 1948), 9 socialism, 65, 68, 69, 71, 75–77, 282 Socialist Patient Collective (SPK), 103 Society for Psychiatric and Nervous Diseases, Berlin, 97 Society of German Naturalists and Physicians, 94 sociology, 83 sociopathy, 268 Sommer, Robert, 96

Sontag, Susan, 161 sources. See also archives and libraries; journals annual reports, 22, 44, 57, 184, 186, 189 casebooks, 22, 163, 185, 195 clippings, 22 interviews, 212 letters, 117–119, 123, 171, 175–176, 198, 269, 295 magazines, 22 obituaries, 93 photographs, 22, 163, 195 superintendent’s journals, 74, 143 South Africa, 2, 22, 183, 184, 202 Soviet Union, 20, 65, 66 space, 5, 9, 12, 18, 19, 22, 44, 57, 59, 101, 120, 121, 123, 124, 126, 143, 173, 177, 189, 191, 204, 236, 238, 242, 246, 249, 268, 273, 274, 295 sport, 239 Stalin, Joseph, 66 Steiner, Claude, 80, 87 Stevenson, Christine, 12, 30 stigma, 7, 14, 32, 223, 225, 227, 236, 271, 273, 278 Strindberg, August, 283 suicide, 148, 164, 224 survivor movement, 246 Systeme du Docteur Goudron et du Professeur Plume, Le (film, 1912), 9

T T4 programme, 16 Tadic, Nevenka, 79, 80, 82, 86, 87 Tannock, Stuart, 244, 251, 254 Tansley, Arthur, 120 Task Force, London, 268 Taylor, Barbara, 25, 29, 35, 254, 255

INDEX

Taylor, M., 51 temperament, 260, 261 temporality, 161, 173 The 1619 Project, 3, 26 theatre, 168 theft, 146 Thomson, Mathew, 18, 34 time, 3–6, 10, 15, 17, 19, 22, 25, 53, 55, 56, 79, 99, 107, 115, 117, 122, 124–127, 130, 139, 142, 144, 153, 161, 168, 171, 173, 188, 197, 199, 214–216, 220, 222, 224, 234, 236, 238, 239, 246–248, 260, 263–268, 270, 280–286, 289–291, 297 Topp, Leslie, 12, 33 Traska, Georg, 118, 132 trauma, 11, 17, 18, 72 treatment, 1 ‘common-sense’, 39, 42, 48, 51, 56, 57 electroconvulsive therapy (ECT), 284 exercise, 162 indigenous, 56 insulin, 43 malaria, 43 moral, 30, 42, 261 pharmaceutical, 265 seclusion, 101 talking, 117 work, 53 Tschapeller, Wolfgang, 121 Tuke, William, 6, 8, 261 Turner, John, 18, 34, 299

313

voluntary patients, 7, 57, 164, 175, 242

U uncanny, 125, 126, 133, 284

W Wallis, Jennifer, 12, 28, 31, 33, 35 Walmsley, Tom, 293 Walter, Nicholas, 266, 276 Walton, Henry, 287, 288, 290 war Cold War, 67, 84 First World War, 11, 12, 17, 18, 33, 98, 106 ‘partisan hysteria’, 72, 74, 83 Second World War, 65, 66, 70, 83, 86, 99, 105, 212 ‘war hysteria’, 68 Wengler, Bernd, 104, 114 West, Franz, 121 West Indies, 139, 141, 142, 153 Westphal, Carl, 95, 110 What Asylums Were, Are, and Ought to Be (publication, 1837), 4 Wheatley Hill, County Durham, 234 Williams, Raymond, 234, 251 Wilson, Colin, 266, 276 Winter, Jay, 12, 29, 31 women, 2, 13, 123, 147, 161, 162, 172, 173, 175–177, 225, 235, 280, 282, 283, 288 World Federation for Mental Health, 116 World Health Organisation (WHO), 263 Wunderlich, Carl, 95, 110 Wyeth pharmaceutical company, 269 Wynter, Rebecca, 12, 25–27, 30, 33, 57, 229

V Verwey, Gerlof, 92, 108, 109

Y Yanni, Carla, 12

314

INDEX

Yugoslavia, 19, 20, 65–67, 69–71, 75, 76, 80–83, 85 Yugoslav People’s Army, 71

Z Zeller, Gerhart, 100, 112 Zweig, Stefan, 130