The Transformation of the Psyche in British Primary Care, 1870–1970 9781780937267, 9781474211161, 9781780937199

Table of contents :
Cover
Title Page
Copyright Page
Contents
Acknowledgements
Preface
Chapter 1 The Emergence of the Unconscious
1 Myths of origins
2 A new approach
3 The unconscious and the presence of the past
4 From expectation to memory
5 French experiments in psychological healing
6 The uptake of psychological healing in British medical practice
7 Popular literature and the new witchcraft
8 Late Victorian psychotherapy
9 Conclusion
Chapter 2 The Healing Power of History
1 Psychology and the fabric of things
2 General practice and the rise of the extended self
3 The forensic culture of the extended self
4 Litigation, shock and the extended self
5 The material culture of the extended self
6 Electrophysiology and the extended self
7 The extended self and World War I
8 Psychological eclecticism
9 Rival doxa: The Medical Society for Individual Psychology
10 Institutional control of interpretation: The psychoanalytic establishment
11 A new kind of doctor: A new kind of patient
12 Arthur Watts and the making of the general practitioner psychiatrist
Chapter 3 The Social Consciousness
1 The age of anxiety
2 Stephen Taylor and the case history of Mrs Everyman
3 Suburban ethology
4 Surveillance medicine and psychiatric morbidity
5 Making social pathology visible: The Peckham Experiment
6 ‘My God Everyone’s in Hospital’: The emergence of the psychosocial
7 Doctors of society: Psychological reconstruction and World War II
8 The National Health Service and the new psychiatry
9 Harlow: A socio-psychiatric experiment
10 The reflexive logic of the psychiatric survey
Chapter 4 The Anxiety of Influence
1 Medicine and the art of living
2 Imagining influence
3 The infectious personality of the physician
4 The infectious physician as a basis for ethics
5 Insulating the physician
6 The exemplary physician
7 The personality of the doctor
8 The project of therapeutic friendship
Chapter 5 Placebo and the Problem of Truth
1 A different theatre and a different truth
2 Irony and rival systems of truth
Notes
Preface
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Bibliography
Archives
Official publications
Other reports
Primary periodicals and newspapers
Books and Articles
Unpublished theses and dissertations
Index

Citation preview

The Transformation of the Psyche in British Primary Care, 1880–1970

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The Transformation of the Psyche in British Primary Care, 1880–1970 Rhodri Hayward

LON DON • N E W DE L H I • N E W YOR K • SY DN EY

Bloomsbury Academic An imprint of Bloomsbury Publishing Plc

50 Bedford Square London WC1B 3DP UK

1385 Broadway New York NY 10018 USA

www.bloomsbury.com Bloomsbury is a registered trade mark of Bloomsbury Publishing Plc First published 2014 © Rhodri Hayward, 2014 Rhodri Hayward has asserted his right under the Copyright, Designs and Patents Act, 1988, to be identified as Author of this work. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage or retrieval system, without prior permission in writing from the publishers. No responsibility for loss caused to any individual or organization acting on or refraining from action as a result of the material in this publication can be accepted by Bloomsbury or the author. British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library. ISBN: HB: 978-1-7809-3726-7 ePDF: 978-1-7809-3719-9 ePub: 978-1-7809-3591-1 Library of Congress Cataloging-in-Publication Data A catalog record for this book is available from the Library of Congress.

Typeset by Deanta Global Publishing Services, Chennai, India

For Griffith and Llewelyn the sworn enemies of promise

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Contents Acknowledgements Preface

1 2 3 4 5

The Emergence of the Unconscious The Healing Power of History The Social Consciousness The Anxiety of Influence Placebo and the Problem of Truth

Notes Bibliography Index

viii x 1 31 61 91 117 133 213 259

Acknowledgements This book was written with the generous support, and sometimes active encouragement, of the Wellcome Trust. The greater part of the research was funded by a Fellowship (Grant no., 068387) to work at the Wellcome Trust Centre for the History of Medicine although I also gained much from a research associateship held at the Centre for Medical History at the University of Exeter. This book, as many will recognize, shows just how how much I have learnt from colleagues at those institutions: particularly Roger Cooter, Mark Jackson, Christopher Lawrence, Joseph Melling, Sonu Shamdasani and Michael Neve. Its overall conception however would not have been possible without the work of Mathew Thomson, Roger Smith, Graham Richards and Thomas Dixon. Mathew has perhaps done more than anybody to sketch out the shape of popular psychology in modern Britain and to demonstrate its implication in the broader social and cultural history of the state. I have learnt a tremendous amount from him. Roger, Graham and Thomas have each shaped my understanding of psychology demonstrating how it cannot be abstracted from language and history. I owe the insights in this work to the quiet brilliance of librarians and archivists at the Wellcome Library, Royal College of General Practitioners, the Bethlem Archive, the Rockefeller Foundation Archive at Tarrytown, the British Psychoanlytical Society Archive, the National Archives at Kew and the National Library of Wales. Likewise my understanding of this subject has been shaped by conversations with friends and colleagues. I am grateful that I had the chance to present material at the Psy Studies Seminar at the University of Cambridge; the Centre for Medical History, University of Exeter; the London School of Tropical Hygiene and Medicine History Seminar; the Centre for the History of Science, Technology and Medicine at the University of Manchester, the Department for Social Studies of Medicine at McGill University; the Society of Apothercaries; the Centre for Medical History, University of Warwick; and York University, Toronto. And I am glad to have received the advice of Fay Bound Alberti, Peter Barham, Tim Boon, Cornelus Borck, Ian Burney, Teri Chettiar, Sarah Crook, Ali Haggett, Sarah Hayes, Andrew Hull, Rob Kirk, Kenton Kroker, Alex McKay, Ben Mayhew, Chris Millard, Michael Neve, Ed Ramsden, Ben Shephard, Claudia Stein and John Toms.

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Queen Mary has provided a supportive and deeply collegial environment in which to complete this work. I am very grateful to my colleagues, Thomas Dixon, Colin Jones and Barbara Taylor who read drafts of this work and to Miri Rubin, James Ellison, Virginia Davis and Julian Jackson for their constant encouragement. Roger Smith and Mathew Thomson provided valuable and generous comments on the manuscript and Leonie Gombrich made a brilliant and assured edit of the final draft. A small amount of material in this work has previously appeared in different form: ‘From Clever Hans to Michael Balint: Emotion, Influence and the Unconscious in British Medical Practice’ in Fay Bound-Alberti (ed.), Medicine, Emotion and Disease, 1700–1950 (Basingstoke: Palgrave, 2006): 144–68; ‘Desperate Housewives and Model Amoebae: the invention of suburban neurosis in inter-war Britain’ in M. Jackson (ed.), Health and the Modern Home (London: Routledge, 2007): 42–62; ‘Enduring Emotions: James Halliday and the Invention of the Psychosocial’, Isis: A Journal of the History of Science 100 [Special Issue on Emotional Economies of Science] (2009): 827–38.

Preface The idea of an implicit connection between our psychological well-being and our physical health has become commonplace in contemporary culture. Newspaper columnists and ‘lifestyle gurus’ encourage us to look for the seeds of our bodily ills in episodes of personal unhappiness. We all have little hesitation in attributing outbreaks of eczema or influenza to experiences of stress at work or episodes of diarrhoea or migraine to the emotional turmoil of our domestic lives. The body is widely seen as kind of witness or index of our personal travails. The materials of modern medicine allow us to treat our ailments as sources of moral guidance: they have become a kind of touchstone in which the sins or troubles of the past are made apparent in the flesh.1 This idea of our history somehow poisoning our relationships with our bodies has become a central dogma of new age and modern therapeutic writings.2 As best-selling authors such as M. Scott Peck, Harriet Braiker and Louise Hay argue, the relief of physical suffering can only be achieved through an honest confrontation with the darkest aspects of pathological past.3 The arguments promoted in these popular therapies seem to be borne out by strong epidemiological evidence. From the 1950s, investigations began to demonstrate an apparent correlation between emotional trials such as bereavement and separation and the onset of illness. The incidence of physical diseases, including cervical cancer, leukaemia and coronary heart disease, was shown in these studies to be much higher in individuals who were widowed or divorced.4 Although the experimental design of many such early studies has been severely criticized, the apprehension that episodes of loss, stress or guilt will result in subsequent physical suffering or even death remains with us to this day.5 Moral narratives that draw together life stories and physical conditions are not merely the didactic fables of lifestyle journalists or new age therapists. They have become central to academic work across the arts and the social sciences. Students in the medical humanities are taught that the achievement of coherence in our life narratives or the ways that we represent our personal past are crucial to the recovery of health and wholeness.6 Similarly, the political analyses

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that permeate the social history of medicine rest upon the idea that personal experience of injustice or misfortune shapes later episodes of illness. In bravura acts of narrative craftsmanship, authors such as Elaine Showalter, Karl Figlio and Carol Smith Rosenberg have shown how the episodes of hysterical distress manifested by Victorian housewives or World War I servicemen can be seen as forms of somaticized social protest against a set of intolerable conditions.7 These arguments, in turn, draw upon older studies in medical anthropology, such as those of Ioan Lewis, which linked illness and hysterical behaviour to the experience of social or political deprivation.8 The assumed naturalness of the connection between health, illness and personal history is underlined by the moral imperative implicit in the psychological or psychosomatic model. The threat of punitive physical illness hangs over those who fail to recognize or engage with aspects of their past. As the American psychotherapy group Hopeallianz announces on its website: ‘When you swallow your feelings, your body begins to digest itself. Ulcers, heart disease, cancer – all have been shown to have a relationship with stress. While stress may or may not create bacteria and cause renegade genes to mutate, it undeniably creates an environment that is welcoming and supportive of physiological processes that can – that will – ultimately kill you … when strong, sharp feelings are hidden deep inside like shameful secrets. The feelings tear at your organs and block the path that your blood wants to travel as it gives you life.’9 Although the metaphors used to sustain this position are unusually gruesome, the basic assumptions are rehearsed across the media and society. Facing the past has become central to the present-day management of health.10 Despite the apparent naturalness and ubiquity of the belief that history is the key to health, the premise itself rests on a number of technical and theoretical innovations. The easy elision in modern thought between the realms of the physical and the biographical has been made possible by the language of the unconscious: in our everyday speech and therapeutic practice, we imagine some sort of inner agent which records our experience and organizes its embodiment. The unconscious seems to be engaged in a constant commentary on our affairs. The smallest lapse of mind or slip of tongue indicates its persistent presence. As Freud noted when reviewing the early successes of psychoanalysis: ‘When I set myself the task of bringing to light what human beings keep hidden within them, not by the compelling power of hypnosis, but by observing what they say and what they show, I thought the task was a harder one than it really is. He that has eyes to see and ears to hear may convince himself that no mortal can keep a

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secret. If his lips are silent, he chatters with his fingertips: betrayal oozes out of him at every pore.’11 The idea of the unconscious as an inner agent that somehow knits together the present and the past is a comparatively recent innovation: an innovation which rests upon a mixture of theoretical assumptions, practical achievements and ideological exclusions. The effectiveness of this combination and its centrality in modern thinking has obscured the contingency of our current ideas of the unconscious. Nineteenth-century authors did not believe that the actions of the unconscious were dictated by historical events. Instead, they insisted that psychosomatic effects were generated through the individual’s sense of anticipation. The mechanism that governed the course of healing and illness was not the repressed sexual history imagined by the psychoanalytic pioneers but a form of ‘expectant attention’ described and modelled in physiological research. The first chapter of this book looks at these changing ideas of the unconscious in the prehistory of primary-care psychiatry. Drawing on a mixture of medical and literary sources, it shows how new ways of narrating illness and selfhood generated new demands in the medical marketplace, leading to the development of general practitioner psychotherapy.12 By the mid-twentieth century, the future-centred model of health and illness had largely been abandoned. The proponents of the new dynamic psychologies claimed that neurotic symptoms (both physical and mental) were caused by unresolved conflicts or traumas buried deep in the patient’s forgotten past. Doctors were encouraged to develop the interpretative skills of detectives, or historians, in an attempt to root out the pathogenic secret in the patient’s biography. At the same time, the novel conceptual framework and vocabulary developed in these psychological approaches created new ideas and objects for the practitioner to negotiate in his relationship with the patient. Phenomena such as ‘repression’, ‘lifestyle’, ‘suggestion’, ‘frustration’, ‘transference’ and ‘catharsis’ now entered medical analyses, providing new materials through which both patients and physicians could re-imagine the basis of their relationship and the nature of the healing process. My second chapter explores how these new psychodynamic concepts were deployed in general practice and served to shape both the professional and the personal identity of the primary-care physician. To a certain extent, the projects of general practice and the new psychology shared a mutually reinforcing agenda. The psychological emphasis on the medical significance of the patient’s personality and biography opened an area of expertise that was beyond the reach of the specialist and the hospital consultant. From the perspective of the

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new holistic therapies, even the smallest episodes in the patient’s biography, such as workplace squabbles or domestic upsets, could engender far-reaching pathological consequences. The new forms of analysis that the psychotherapeutic approach made possible did not simply change the work of primary care but also transformed the political significance of the discipline. In the 1930s, James Halliday, a practitioner working for the Scottish Department of Health, began to make estimates of the incidence of psychoneuroses among national insurance claimants.13 His aim was to establish the necessity of a psychosomatic approach by demonstrating the prevalence of mental distress and anxiety among patients presenting for rheumatic disease.14 Yet the significance of his epidemiological research was far broader for, as he argued, the distribution of psychological illness could be seen as a reflection of wider changes in the social conditions of the population. The establishment of this putative link between mental suffering and social organization turned the incidence of the psychosomatic disorder into an index of the effectiveness of government policy initiatives. In the third chapter of this book, I explore the role of general practitioners in the production of this epidemiological data and the implementation of new programmes of preventative psychiatry which ministered to the psychological health of the population. Community epidemiology and preventative psychiatry placed the family physician at the forefront of post-war planning and state formation, yet the statistical data produced as part of these new projects was to carry a profounder and more personal implication. By the early 1960s, the wide variations in the reported rates of psychological illness recorded by general practitioners were no longer understood as simple indices of local conditions such as poverty or insecurity. Instead, they were treated as artefacts that revealed the different diagnostic styles of individual physicians. A technique that had been developed to reveal the mental health of the wider population was transformed into an instrument that could reveal the doctor’s personal failings. This raised questions about the individual approaches of each general practitioner, with the result that the rhetoric of the new psychology was used to interrogate the personality of the family physician. This rising interest in psychological introspection and self-examination in general practice, which found its clearest expression in the work of Michael Balint, is explored in the fourth chapter. The magic of the psychological approach was that it made possible a whole series of new relationships between doctor, patient and illness as new pathological mechanisms were imagined and maps of influence charted out. Yet the creative potential of this emerging rhetoric was perhaps to prove its undoing. Throughout

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its existence, the idea of a psychological unconscious that determines our health has always been contested, and today we may be witnessing the concept’s final demise.15 Contemporary writers suggest that we are entering an age of ‘cosmetic psychiatry’: an age in which psychological health does not depend on the recovery of the self that has been lost, but is instead achieved through the creation of the identity that we want.16 The equation of healing with the recovery of our authentic identity has been abandoned. In cosmetic psychiatry, an eclectic package of pharmaceutical and therapeutic treatments are deployed to create a more effective or desirable self. This volume thus concludes with an examination of the rise of this instrumental approach to self-identity. Against accounts which argue that this sceptical perspective arose out of conflict with the Freudian or dynamic psychiatries, my final chapter demonstrates how, by so greatly extending the possibilities of influence, the new therapies eventually undermined the concept of an essential identity. From World War II onwards, there was a sense that almost every aspect of the medical encounter (from the presentation of illness through to the experience of cure) could be affected by the doctor’s mood, attitude or manner. Although we live in an age in which we seem to be turning to physicians and general practitioners with ever increasing frequency and in ever increasing numbers, the medical nature of our demands is far from clear.17 As recent surveys of primary care have revealed, the incidence of medically unexplained syndromes has vastly increased and such syndromes now occupy around a third of the general practitioner’s caseload.18 The physician’s role has moved beyond providing medical solutions to dealing with social and psychological problems, and the family doctor is held up as a kind of secular priest who makes possible new kinds of identity.19 The belief that personal history might provide some guide to our emotions has been replaced with the idea that the right emotions might lead us to discover new forms of personal history. The patient’s encounter with medicine – indeed, all our encounters – is now seen as a small act of theatre in which new roles are fashioned and new forms of character embraced.20 This shift away from psychological essentialism towards an instrumental conception of identity can be attributed to many causes. Scholars have identified a wide range of contributory factors, from economic globalization and social disruption to the emergence of new forms of media.21 Yet the role of medicine cannot be underestimated. As this book demonstrates, the language and techniques of modern medicine have become fundamental resources on which we draw in fashioning our own concepts of who we are.

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1  Myths of origins In December 1910, David Eder, a Zionist socialist general practitioner from Golders Green, found himself engaged with a case of rheumatoid neck pain.1 His patient was a member of London’s burgeoning class of white-collar workers, a callow young book keeper complaining of physical debility and muscular strain.2 The usual treatment for cases of rheumatoid pain was the application of hot compresses and bed rest but Eder pursued a very different approach.3 He attempted to recover an origin for the physical pain in the unconscious memories of the patient. In twice weekly meetings over the course of 3 months, the unhappy clerk was subjected to a series of verbal examinations that drew upon the new continental techniques of free association and dream analysis: methods of psychodynamic investigation that had been developed by Sigmund Freud in Vienna and Carl Gustav Jung in Zurich.4 Eder recited stimulus words such as ‘tea’, ‘drop’, ‘rub’ and ‘cow’ to his patient and recorded the clerk’s responses and reaction times. The pattern of these reactions apparently revealed an ornate network of psychological fantasy that lay beneath this mundane presentation of physical pain. The patient, Eder believed, was involved in an unconscious protest against the monotony of clerkship, a protest that was further complicated by the presence of a number of incestuous and homosexual fantasies. The patient confessed that he had long harboured a strong sexual desire for his sister; a desire that Eder, following Freud’s example, interpreted as a cover for a deeper, unacknowledged, ‘mother complex’. The inner life that Eder happened upon in his investigations became the key to the patient’s recovery. As each aspect of his repressed story was reconstructed from the evidence of the association tests, the rheumatoid inflammation subsided. In the final session, Eder hypnotized his patient and informed the entranced clerk that he was cured.5 The pain disappeared; the illness had been removed.

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If, as Virginia Woolf famously claimed, ‘In or around December 1910, human character changed,’ then Eder’s work would seem to epitomize the process.6 Woolf attributed this transformation to the appearance of new forms of ‘character reading’, a technique that she thought was indispensable to modem existence: ‘It would be impossible to live for a year without disaster unless one . . . had some skill in the art. Our marriages, our friendships depend on it; everyday questions arise which can only be solved with its help.’ Eder’s treatment of the rheumatic clerk opened up a new way of reading character. It rejected the patient’s own portrayal of his life and condition in favour of an assumed narrative that could only be recovered through specialized techniques, such as free association and reaction tests. It introduced what the French philosopher, Paul Ricoeur, has aptly called a ‘hermeneutics of suspicion’, a form of interpretation in which every aspect of speech and behaviour was seen as a mendacious production that served to disguise our truer existence.7 This chapter examines how Eder’s method of reading character, a method adapted from the work of Freud and Jung, became the dominant way of viewing the world. The story is not straightforward. In the various versions that exist, Woolf ’s claim regarding the transformation of human character is usually yoked to the appearance of psychoanalysis – much as I have associated her pronouncements with Eder’s work.8 In these accounts, the gradual uptake of Freudian ideas is presented as a kind of shorthand for the development of a new psychological sensibility. Such a method has much to recommend it. It has the advantage of providing clear criteria through which something as elusive as a psychological sensibility can be pursued, but as we shall see, this clarity comes at a cost. It disguises the many processes – material, medical and theoretical – involved in the creation of a new psychological perspective and it reifies or reduces the rich culture of psychological medicine into a single coherent doctrine. As Woolf herself admitted, the transformation to which she referred was not uncomplicated. As she explained: ‘I am not saying that one went out, as one might into a garden, and there saw that a rose had flowered, or that a hen had laid an egg. The change was not sudden or definite like that.’9 Certainly ‘on or around 1910’ it was difficult to recognize the priority of any kind of psychological approach. Across the British Isles, different medical practitioners made very different assessments of the relationship between illness and character and of the nature of character itself. Although Eder’s search for the roots of psychological distress in the depths of the patient’s memory seems natural to us today, this was

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only one of a number of possible interpretations. The space of the psychological, as we will see, could be imagined in many ways and constituted through many materials, from magical influences to biological instincts. How is it that we have come to imagine our psychological enlightenment as the process of adopting the peculiar insights of psychoanalysis? The success of this reading rests on a set of myths: myths about the shape of our cultural history and the nature of our own identities. Nor do such stories obscure a true and authentic identity. Like all myths, they themselves have served to shape this identity, helping to make us who we are today. Narratives about the arrival of psychoanalysis in the United Kingdom, as Mathew Thomson has noted, tend to focus on the hostility of its reception, and in this story Eder’s experimental treatment takes a central place. As a putative point for the entry of psychological approaches into British medicine, such an origin myth serves the psychoanalytic establishment very well. As Thomson explains: ‘It situates the incorporation of Freud and psychoanalysis as central; it implies a radical break with the past; and it portrays the British as unwilling to listen – offering in their resistance what can be presented as ironic confirmation of the very Freudian account that they were at the same time objecting to.’10 Many commentators have found this ‘ironic confirmation’ in the reaction apparently occasioned by Eder’s attempt to present his material to the Neurological Section at the 1911 meeting of the British Medical Association (BMA).11 We are told that the section’s chairman, aghast at the story of ‘a polymorphic pervert’, walked from the room in silent censure and that the remaining audience members followed quietly in his wake. If this lecture was as an epoch-making event, few seemed to recognize its significance at the time. As Janet Oppenheim commented: ‘It was exceedingly difficult for the generation of British alienists born between 1835 and 1855, and trained before 1880, to accept Freud’s revision of the old psychiatric orthodoxies, no matter how inadequate these were to explain the workings of the mind.’12 Psychoanalytic writers often talk about the phenomenon of screen memory, in which a recollection serves to obscure a difficult or embarrassing event.13 Some such process seems to be taking place in recent references to Eder’s presentation. Although the story of a mass walkout at the BMA makes for an exciting and dramatic origin myth, it has little basis in fact. Discussions of Freud’s methods and ideas, as certain commentators have noted, were widespread in British medicine long before Eder’s presentation in 1911. Reviews of Freud’s papers had appeared throughout the 1890s and accounts of the psychoanalytic approach to

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hysteria had been given in Brain and the Journal of Mental Science.14 His work with Breuer on the cathartic method had been praised in William Crookes’ Presidential Address to the British Association in 1898.15 By 1910, many doctors had begun to experiment with a psychoanalytic approach: indeed, Henry Devine, an Assistant Medical Officer at Wakefield Asylum, provided an account of his use of the psychoanalytic method to decode patient fantasies to the same meeting at which Eder spoke, yet his contribution goes unmentioned.16 It is difficult to know if Eder’s talk was really met with shock or resigned familiarity.17 Certainly many of his colleagues claimed that the methods of psychoanalysis were already in use, and one month after his talk was published, Eder provided a long bibliography on the subject to his many inquirers in the British Medical Journal.18 The origin myth based on Eder’s presentation serves a deeper purpose. It lends the body of psychological thought (as we think of it today) a certain coherence: a coherence that few commentators would have recognized at the beginning of the twentieth century.19 By presenting the new psychology as a direct transmission from Vienna to England via the person of David Eder, the myth insulates the concepts and methods of the new discipline from the plethora of psychotherapeutic ideas that existed in fin-de-siecle Britain. Many authors, from Lancelot Law Whyte and Henri Ellenberger to Stanley Jackson and Sonu Shamdasani, have contested this insular history. They argue for an expansive history of the concept of the unconscious and its discovery, tracing the techniques of modern psychotherapy far beyond the central European innovations of the psychoanalysts, back into the romantic philosophy of Schelling and Schopenhauer and even further: onto examples of shamanic ritual and magical incubation.20 To a certain extent I endorse their claims, but I believe their arguments can be extended further. This manifold history did not simply involve a plethora of diverse attempts leading to insights into a single phenomenon: unconscious. Rather, this process of ‘discovery’ involved the constitution of different forms of unconscious with different aspects and capacities.21 This claim of many different kinds of unconscious may at first seem confusing, but this change and variation can be clearly demonstrated. The unconscious that we now imagine as a reservoir of our past experiences was once seen in quite different terms. Against our contemporary idea of the unconscious as a mixture of repressed memory and primeval desire, many mid-Victorian commentators believed that the unconscious involved the embodiment of anxieties and future hopes. It was a psychophysical process formed through the sense of anticipation.

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Driven by excitement or anxiety, our physical frame unwittingly traced in outline the pattern of our expectations.22 Our understanding of the relationship between the unconscious, time and body seems to have undergone a massive transformation, a transformation that has now been largely forgotten. Such oversight is to be regretted, for the idea of the unconscious (as we have seen) has become fundamental in the way we think about our health, our relationships and ourselves.

2  A new approach How did the modern concept of the unconscious emerge? How, in particular did it become synonymous with a repressed and determinative past? In using the term ‘emerge’, I make a radical claim. I do not see this history as simply the development by psychiatrists of a specialized language through which we could approach a hitherto unrecognized aspect of our lives; neither do I see this as a story of how the efforts of Freud and others led us into the discovery of a human unconscious, in much the same way that efforts by astronomers might lead us into the discovery of a hidden planet.23 As philosophers of science have made clear, the discovery of psychological objects (such as the unconscious or emotions) is a very different kind of process to the discovery of a lost or hidden physical object.24 The unconscious is not simply happened upon; rather, it is created in our naming of it. Our first tentative acts of description lend it character and quality. Whereas the features and properties of physical objects tend to constrain our description of them, psychological objects derive their specific features and properties – and, I would argue, their very existence – through the act of description.25 Although the existence of the unconscious is parasitic upon our descriptions of it, it would be wrong to abandon it as a mere fantasy or illusion. In our day-to-day activities we are often confronted with episodes in which the unconscious seems to generate very real effects. A troubled child might exhibit fears and phobias which seem resistant to logic or argument and which persist despite his expressed desire to overcome them. A middle-aged executive might succumb to skin complaints that disappear after the confession of a shameful secret. We might be troubled by a recurring dream, which we later see as the coded expression of some fear that we have always refused to acknowledge. Our lives are full of such moments and they claim a significance far beyond

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the mundanities of everyday experience. Reconciling these incidents with the idea that the unconscious is simply a ‘social construction’ would, at first, seem deeply problematic. The problem, however, lies not so much in this model of the unconscious as in our ideas about what a ‘social construction’ actually is.26 Traditional accounts of science and medicine rest on a division between words and the world. Scientists and physicians are seen as developing convincing descriptions of phenomena that they test through experiment in order to achieve an ever closer degree of approximation with nature. Within these accounts, reality is envisaged as a kind of touchstone or benchmark which we continually use to correct our theories and descriptions. Given our widespread faith in this model, it is perhaps unsurprising that constructionist accounts of scientific development are viewed with alarm. These accounts suggest that our descriptions of the world are, in the last analysis, guided by cultural biases and social interests rather than through engagement with reality.27 Although it sits uneasily with our commonsense view of scientific work, there are good logical and historical arguments in favour of the social constructionist account. No matter how many examples we gather in favour of a hypothesis, the shift from particular case to general rule – in logical terms – is always underdetermined.28 We can always find reasons, such as experimental error or unreliable testimony, which will allow us to reject aberrant evidence. As the sociologists Harry Collins and Trevor Pinch have shown, the resolution of scientific disputes can never be achieved solely through reference to the observable world. Phenomena are always bound up with our interests, our beliefs and our technologies of investigation: through such associations they can always be contested.29 While social constructionist accounts initially served well as explanations of why and how we maintain certain beliefs about nature, they seem less convincing as descriptions of laboratory practice and they leave unexamined the question of why beliefs were assumed to be stable while nature was contested.30 Experiments are not always carried out to test conjectures or establish theories; they are often open-ended. Different materials are combined and various techniques deployed simply in order to discover what kinds of effects might be generated.31 Moreover, this experimental engagement with nature is a messy and fecund process. It is not simply a matter of imposing our will or interpretations upon the world. Materials sometimes resist our experimental manipulations and the struggle with nature often provokes new theories and perspectives on the world.32 Close study of scientific activity reveals the emptiness of the distinction between

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theory and practice.33 As the philosopher Joseph Rouse has noted: ‘Theorizing is as much practice as any other aspect of scientific work.’34 The old boundaries between what was called the ‘context of discovery’ (in which new hypotheses are generated) and the ‘context of justification’ (the rules used to decide on hypotheses) have largely collapsed.35 One way of looking at scientific work is to see it as a process of ‘co-constitution’ in which our representations of nature and experimental interventions are transformed through our engagement with the world.36 Yet the world with which we engage experimentally is not the independent, corrective nature imagined in positivist accounts of science. Rather, it is a world that is itself constituted through this encounter with scientific practice. The information produced in the laboratory emerges through specific configurations of instrumentation and technique which produce or isolate selected objects within a closely controlled system. Thus, the cloud chamber patterns produced by cosmic rays owe their existence to this contingent combination of tools, theory and technique.37 Similarly, in the clinical encounter, the production of diagnostic signs such as pulse rate or electro-encephalograph (EEG) tracings depends upon a similar intersection of practical skills, instruments, training and knowledge.38 This work on the history and philosophy of scientific experimentation provides us with a useful set of models and techniques in our analysis of our ideas on the unconscious. As with cloud chambers or EEG tracings, the unconscious should be seen as product of experimental labour. As we shall see, it is made manifest through the development of specific techniques and within these manifestations it generates very real effects. Yet it would be wrong to assume from these effects that the unconscious can be regarded as some kind of independent entity. The unconscious, I want to make clear, can have no existence outside of the network of therapeutic theories and investigative practices that sustain it. It is an ‘emergent phenomenon’ which gains character and attributes through the experimental, theoretical and therapeutic interventions of both patients and practitioners.39 One last point needs to be made before turning away from the issue of the co-constitution of scientific objects, theories and practices. The observer must also be seen as an outcome of these transformative episodes of co-constitution. Learning to interpret a system of signs or adopting new technologies opens up new perspectives and makes possible new forms of thought. As anthropologists, psychologists and sociologists have demonstrated, the emergence of new media (such as print) or technologies (such as the locomotive engine) provide new ways of ordering and recovering our ideas and new metaphors for imagining their

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relationships and connections.40 This reflexive relationship creates particular difficulties for sciences such as psychology and psychoanalysis.41 The description and naming of different attitudes, behaviours and emotions – and of course our distinction between these three categories themselves – provides us with a new vocabulary through which we constellate and analyse the flux of our experience.42 Yet there is no independent reference for these experiences. As we have noted, they are created in the act of naming. The unconscious, as we shall see, has no existence outside the language and practices that sustain it.

3  The unconscious and the presence of the past Over the last three decades, historians have developed sophisticated narratives to describe the transformation of selfhood in the modern world. Yet the close attention paid to the shifting meaning of subjectivity has not been matched any parallel interest in the changing shape of the unconscious. This is surprising, since the unconscious undergoes a series of changes in the nineteenth century which are every bit as dramatic as the mutations undergone by modern subjectivity. Although references to an unconscious state were commonplace in the English language from the early eighteenth century, it was from the beginning of the nineteenth century that the word began to take on a new and more complex significance.43 The term ‘unconscious’ originally referred to an unaware, concussed or sleeping individual. However, the appearance of new religious, scientific and medical practices in ancient regime Europe generated novel uses of ‘unconscious’ to describe personal actions.44 Perhaps the most famous of these new practices was Franz Anton Mesmer’s development of his system of magnetic healing. Certainly Mesmer’s work, in which he used wands and chemical tubs to control the flow of magnetic forces in his patients’ bodies, has been held up as an epochal moment in the history of psychological healing.45 It is seen as the moment at which the therapeutic possibilities of the unconscious were first made manifest. Although most psychologists and psychotherapists have been quick to dismiss the theatrical and theoretical framework which grew up around Mesmer’s practice – and few have adopted his lilac robes, hazel wands or rhetorical invocation of planetary influences – the facts of the mesmeric cure are believed to stand for themselves.46 As the pioneering psychiatrist Bernard Hart stated in 1926: ‘the observations upon which the magnetisers built their theories were actual facts, facts which could be repeated and tested indefinitely

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and, moreover, facts which were new, or at any rate newly appreciated. The theories were no doubt fantastic but the facts were sound, and it was upon these facts that the building of psychopathology ultimately began.’47 Hart’s assessment has been repeated many times. Eleven years after his pronouncement, Clifford Allen, a psychotherapist at Charing Cross Hospital, complained that Mesmer’s discoveries in ‘morbid psychology’ had been lost due to the absence of any scientific method which would have allowed the facts to stand for themselves.48 In  1944, in her commercial biography of Mesmer, Margaret Goldsmith stressed how close his experiments had brought him to the insights of modern psychotherapy. As Goldsmith noted, any reader of Mesmer’s memoirs must feel ‘that now, or on the next page, or even on the page after, he will finally, by a sudden flash of insight, grasp the power behind his magnetism; that he must at last realise the existence of the vital factor in human behaviour, in sickness and in health – that is to say the mental factor: the power of the mind over the body’.49 This insistence on the soundness of Mesmer’s discoveries and their priority over his theories was reiterated in the biography produced by Vincent Buranelli in 1975. Buranelli argued that ‘Mesmer’s tragedy was that he had the right facts and the wrong theory. If he had not had the theory of animal magnetism he might have realised that his cures were psychological and might have carried the Western mind forward into psychosomatic medicine at a single bound.’50 The position propounded by Buranelli and others is now a commonplace, but it is not clear that it is correct. Despite the enthusiasm of these commentators, it is difficult to see what exactly these ‘sound facts’ are. Mesmer’s practices involved the magnetic production of physiological crises in clients suffering from various forms of internal obstruction.51 A wooden baquet (a tub of iron filings), iron and hazel wands, the mesmerist’s limbs, hemp rope and bottles of magnetized water were used to introduce the magnetic current into the sufferer’s body.52 Successful induction would lead, as Alan Gauld has noted, to ‘tears, laughter, gastric disturbances, coughing, loss of consciousness and convulsions resembling those of epilepsy’.53 The behaviour of Mesmer’s patients, their methods of cure and the meanings attached to their magnetized behaviour are very different to the problems, theories and interpretations extant in psychotherapeutic and psychoanalytic practices two centuries later. When Mesmer’s doctrines arrived in England, they were understood as a form of therapeutic domination. The language of magnetism had long been used in verse and prose to represent uneven power relationships.54 This poetic

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fantasy of untrammelled and fascinating authority persisted into the first English demonstrations of animal magnetism. In 1792, the pioneer English mesmerist, John Ball, described the therapy as a form of mental control. It involved, he claimed, the inexorable projection of magnetizer’s thoughts into a pliant object, arguing that ‘neither the size of the body, its strength, or figure impede [it] – all give way’.55 Likewise the anonymous author of The Wonders and Mysteries of Animal Magnetism [1790] portrayed the therapeutic process as a kind of contest, advising practitioners to ‘apply all the strength and power of your mind and will to the part affected, with the utmost energy that you are master of ’.56 George Winter, who attended classes on animal magnetism during the height of its popularity, depicted the process as the transfer of the physician’s atmospheric emanations into the patient’s body to overcome internal obstructions.57 The magnetizer’s activity, as one critic noted, instituted a new kind of power relationship in which the ‘patient is absolutely, soul and body, under the dominion of the person who has thrown her into this crisis’, maintaining a state of ‘torpid insensibility’.58 The drama of the mesmeric act lay in the new forms of authority it instituted. Elizabeth Inchbald’s farce Animal Magnetism (first performed at Covent Garden in 1788) explored the comic potential of uncontrolled influence as the mesmerist’s wand was passed between characters.59 It is clear that these early descriptions of unconscious activity are very different from our modern understanding of the unconscious and its operations. Instead of being seen as an independent entity, ‘unconscious’ describes only a certain quality of behaviour inspired in the unwitting subject.60 It designates an uneven power relationship. This connotation of the unconscious was clearly established in the popular literature of Victorian Britain. It persisted into the second wave of mesmerism in the 1830s and went on to become a standard device in novels such as Wilkie Collins’s The Moonstone (1868) and George du Maurier’s Trilby (1893): novels in which characters were depicted as innocent pawns in the grip of mesmeric forces, unconsciously performing nefarious actions which ran counter to their beliefs and interests.61 To some extent, this sense of enchantment remains with us today. We all feel occasionally that we are somehow led astray by unconscious wishes or unacknowledged desires. The crucial difference, however, is that we no longer perceive this distraction as engineered by outside forces. Rather, we are led astray by our own repressed fears and memories. The unconscious is seen as a wilful agent that lies deep within the self. The transformation of ‘unconscious’ from magical adverb to deceiving agent was to a large extent achieved through medical investigation. Although

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this transformation was a slow and contested process, there is a strong English candidate for its point of origin. This is the investigation undertaken in  1799 by the fashionable Bath physicians James Haygarth and William Falconer into the effectiveness of a quack nostrum known as ‘Perkins Patent Tractors’.62 The patent tractors had been developed in Connecticut in the early 1790s as tools for electrical healing. They were simple metal rods but in the advertisements of their promoters, William Perkins and Charles Cunningham Langworthy, they became a wondrous cure working on Galvanic principles to remove persistent pain.63 Haygarth and Falconer were underwhelmed by these claims and responded by setting up an experimental trial using wooden sticks and clay pipes in an attempt to replicate the effects that had been achieved with the patent tractors.64 The success rate for tractors and the dummy instruments was shown to the same. It was an example, as Falconer had long insisted, of the ‘wonderful effects the passions of hope and faith, excited by mere Imagination, can produce upon diseases’.65 In this description, that magical power of domination which had once belonged to the magnetizer was now assumed by the subject’s passions and imagination: the body bears the impress of the mind.66 Haygarth’s and Falconer’s investigation has been held up as the ‘first to carry out a single blind clinical trial using a placebo’.67 My interest, for the purposes of this book, is in their parallel innovation in psychological rhetoric. Their interpretation fuses the concepts of ‘imagination’ and ‘unconscious’ so that a new conception of the unconscious is born: an unconscious that picks up most of the qualities that once characterized the quack nostrum. John Campbell Colquhoun, a champion of the possibilities of mesmeric clairvoyance, quoted with approval Casimir Chardel’s complaint that whereas once all physical phenomena were ‘ascribed to the immediate agency of Divine power . . . At present, the imagination plays nearly the same part; and in physiology appears to be the cause of all that is otherwise inexplicable.’68 The Scottish philosopher, Dugald Stewart concurred: ‘For my own part, it appears to me, that the general conclusions established by Mesmer’s practice, with respect to the physical effects of the principles of sympathetic Imitation and of the faculty of Imagination (more particularly in cases where they cooperate together) are incomparably more curious than if he had actually demonstrated the existence of his boasted fluid: Nor can I see any good reason why a physician who admits the efficacy of the moral agents employed by Mesmer should, in the exercise of his profession, scruple to copy whatever processes are necessary for subjecting them to his command, any more than he would hesitate about employing a new physical agent.’69

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Stewarts’s directives were widely accepted by the medical profession. The phenomena of animal magnetism became objects of intense scrutiny, but were stripped of their metaphysical associations. The Manchester physician, James Braid, recast the process as a technique – which he named ‘hypnotism’ – in which attention was concentrated upon an object.70 As he wrote in the Medical Times in 1844, hypnotism could be seen as an exalted form of close attention. Just as physiological changes in the production of saliva or milk could be achieved by thinking, respectively, about a child or meal, so could more dramatic physical effects be produced through the focused attention of the hypnotic.71 In the writings of elite practitioners, including Sir Henry Holland (1788–1873), who became physician in ordinary to Queen Victoria in 1853, John Millingen (1762– 1862), superintendent of Chatham and Middlesex Asylums, and Benjamin Brodie (1783–1862), president of both the Royal Society and the Royal College of Surgeons, the imagination and attention were celebrated as psychological panaceas that could induce temporary anaesthesias, quench haemorrhages, soothe the viscera and hasten the process of wound healing.72 In their arguments, the powers of expectant attention and the imagination were extended through their co-option of the phenomena they sought to explain. Confronted with a new wave of plebeian healing movements including electro-biology, spiritualism and homeopathy, Braid, Holland and their colleagues argued that these fashionable cures were effective insofar as they generated new patterns of expectation.73 As Holland noted: ‘The attention urged to seek for local sensations has no difficulty in finding them. They generate one another; and are often, as we shall afterwards see, excited by the mere expectation of their occurrence.’74 Similarly popular amusements and devices that had been developed to demonstrate the powers of homeopathic forces or animal magnetism were transformed through this rhetoric into experimental demonstrations of the unconscious effects of expectation.75 By the middle of the nineteenth century, this idea of the plastic powers of the anticipatory imagination had been taken up in popular literature and Christian theology.76 The sudden and medically improbable death of Christ on the Cross was explained through reference to his mental suffering. Writing in 1822, the Scottish divine, David Russell, explained that Christ died ‘as a consequence of the extreme pressure of mental torture, it literally broke His heart’.77 A quarter of a century later, the Methodist physician, William Stroud combined contemporary physiology and theological exegesis to attribute the sudden death of Christ to his disappointment at the withdrawal of his Father’s presence.78 Drawing upon the gospels of Mark and Matthew and the works of anatomists including Charles

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Bell and Edward Haller, Stroud argued that Christ ‘endured agony so intense’ that it ‘occasioned sudden death by rupture of the heart’.79 In these medical and theological writings on the power of expectation, two factors become apparent. First, arising from the bodily practice of expectant attention, we can see that it is the intensity of the experience which generates the physical effect and second, we can see that such intense experiences carry a pathological risk. Expectations, as many physiologists and alienists warned, could escape the will and control of the subject and take on a life of their own. As Holland and Brodie developed their patrician model of embodiment, a younger generation warned of the psychopathological consequences of undisciplined expectations. Ideas emboldened by long attention could become obsessional, escaping the control of consciousness and in turn usurping the control of the body. These theories received their clearest articulation in the work of W. B. Carpenter, a mental physiologist at University College London and Thomas Laycock, Professor of Medicine at Edinburgh. In a series of essays on the dangers of overindulgence in mesmerism and spiritualism, Carpenter warned that ‘[t]he continued concentration of the attention upon a certain idea gives it a dominant power, not only over the mind, but over the body; and the muscles become involuntary instruments whereby it is carried into operation . . . ’.80 This concept of ‘ideo-motor action’, in which self-willed or automatic thoughts took control the bodily organs, provided a basic framework for understanding the course and generation of illness.81 Carpenter believed that the hypochondriacal obsession with an organ would upset its normal operation. He claimed that ‘the constant direction of the attention to its supposed root [an imagined harm] has the tendency to alter the organic action of the part, and induce real disease in the stead of which that which was at first imaginary.’82 At their most extreme, such mental prepossessions could take up a life of their own, dominating their subjects’ minds and leading them into insanity.83 The unconscious was born of the powers of the imagination.84 Perhaps, the most engaged and detailed discussion of the somatic effects of expectancy were generated by the new condition of ‘railway spine’.85 Although the various paralyses of railway spine are now often considered to be a kind of precursor to post-traumatic stress disorder and a condition produced through the repressed terror of the locomotive accident, Victorian commentators understood it as an effect of the expectation of damage and pain.86 This argument received its most compelling presentation in the medical statements put forward by physicians defending the railway companies against accident compensation claims.87 Herbert Page, the surgeon to the London and North West Railway

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Company attributed the various paralyses exhibited by crash victims to the fear and terror induced by the drama of the locomotive disaster. As Page noted, ‘the loud noise, the hopeless confusion, the cries of those who are injured; these in themselves, or more especially if they occur at night or in the dark, are surely adequate to produce a profound impression on the nervous system.’88 This model persisted into the twentieth century, with insurance company physicians claiming that media coverage and new compensation regimes sustained a series of pathological expectations that generated and prolonged new hysterical injuries.89 In 1914, William Thorburn, President of the Neurological Section of the Royal Society of Medicine (RSM), explained to his members that even the slightest injury, such as that suffered by a farmer toppling from a dog cart, could be turned into long-term suffering through an ill-judged prognosis. As Thorburn noted, the railway injury already came freighted with lurid ideas and a dread weight of expectation: Railway collisions, their sudden occurrence, their dramatic setting, association of large numbers of the injured, the social prominence of many victims, the wide publication of newspaper reports, and the growing importance of the financial claim created a lurid mental picture in the mind of the injured and indirectly affected the general public in such a way as to provide a fertile soil for nervous disturbance.90

The redefinition of railway spine, as we shall see in the following chapter, rested upon its role in wider arguments over accident insurance and compensation. It was in these forensic contests over questions of authorship, compensation and responsibility that the unconscious would achieve its historical dimension. The shift from an unconscious generated through the intensity of experience and the weight of expectation to an unconscious born out of individual history was not straightforward. Late-nineteenth-century Britain witnessed an efflorescence of interest in psychological phenomena: it was an era riven by competing visions of the psyche. The contest between these opposing visions took place on a number of sites, from the consulting room and the courtroom to the occult temple.

4  From expectation to memory It was through investigations into the supernatural that the unconscious mind was first identified with repressed or forgotten memories. In  1882, a group of scholars from Trinity College, Cambridge, set up the Society for Psychical

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Research (SPR) to investigate the startling claims being made by the spiritualist movement. From the early 1850s, small groups of bourgeois and plebeian mystics had begun to experiment with various forms of spiritual communication – first through practices such as table turning and spirit rapping and then through more complex acts of mediumship including automatic writing, materialization and trance communication. The leading members of the Society – Frederic Myers, Edmund Gurney and Henry Sidgwick – believed that these acts of mediumship contained an implicit political threat for they undermined conventional notions of authorship, personal responsibility and the public’s faith in the continuity of self-identity.91 As Gurney, the society’s secretary, argued, if the spiritualist rhetoric of mystical self-annihilation was admitted, there was ‘no manner in which our faith in the continued identity of persons concerned, or ultimately of our own, [could] be sustained’.92 The SPR responded to this political challenge by turning to the language of hypnotism in the hope of demonstrating that the sources of apparent inspiration lay within the acknowledged biography of the possessed medium. In the Society’s first major publication, Phantasms of the Living [1886], hypnotism was held up as an experimental technique which would prove the persistence of memory and self-identity beyond the boundaries of consciousness.93 It was, Myers claimed, ‘a handle which turns the mechanism of being’, allowing the threshold of consciousness to be shifted and the submerged world of the interior life to be revealed.94 The metaphors developed in Myers’s description of hypnotism were quite different from the model pioneered by James Braid. Braid had seen the hypnotic fixation of attention as a practice that would allow individuals to somatize their ideas and sense impressions. Myers and his colleagues, on the other hand, believed that the technique revealed a hidden self, replete with its own memories and desires. This model of a second self was in part inspired by idea of the ‘Doppel Ich’ feted in German romantic philosophy and was also, in part, an experimental creation.95 In their investigations into plebeian mediumship and apparent cases of spirit possession, SPR members and their continental colleagues worked hard to demonstrate the persistence of memory and desire after waking consciousness was suspended. Working with hypnotized Brighton shop boys and co-opting the speeches of itinerant trance performers, they searched religiously for any sign that would connect the entranced performance with the identity of the waking subject.96 In a collection of papers published in Mind and the SPR’s Proceedings, Gurney reported how subjects in a state of hypnotic paralysis attempted to retrieve proffered sovereigns, with fruitless results. The will was present but the flesh

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was weak.97 In a further set of experiments, Gurney hypnotized subjects and presented them with information that he would ask them to repeat upon waking. Again, this information could not be retrieved until Gurney issued a pre-agreed hypnotic command or engaged the subject in some semi-hypnotic activity such as automatic writing.98 These demonstrations suggested that hypnotic memories persisted within the individual, existing as concurrent streams of thought alongside the ordinary consciousness of our waking life. Gurney’s experiments on will and memory in the hypnotic state revealed that this field beyond the edge of consciousness was essentially personal in form. It was not simply the unconscious processes of cerebration that physiologists such as Carpenter had described but a ‘secondary’ or ‘subliminal’ self-possessing its own personality and desires.99 Just as it had been articulated in the SPR’s investigations into spiritualism, so this self-took on many of the traits and characteristics of the possessing spirit. It was capable of physical feats and mental achievements that lay far beyond the capacities of the entranced medium. Moreover, just as a spiritualist medium might channel many different spirits, so it was possible for an individual to be inhabited by many streams of consciousness, each with its own idiosyncratic attributes. Myers was to devote his career to the delineation and description of these subliminal selves. He saw himself as engaged upon a process of psychical vivisection.100 As his friend and colleague, the American psychologist, William James, wrote: What is the precise constitution of the Subliminal – such is the problem which deserves to figure in our Science hereafter as the problem of Myers; . . . But Myers has not only propounded the problem definitely, he has also invented definite methods for its solution. Post hypnotic suggestion, crystal gazing, automatic writing and trance speech, the willing game, etc., are now thanks to him, instruments of research, reagents like litmus paper or the galvanometer for revealing what would otherwise be hidden.101

The identification of the extraordinary phenomena of hypnotism with the activities of a subliminal memory rather than with the imagination marked a crucial point of transition in the psychological project. It held out the possibility that the key to episodes of spontaneous illness, paralyses or healing lay in the historical memory of the individual. It was a position that was supported by contemporary investigations on the continent. And it was, in particular, in the work of Jean-Martin Charcot at the Salpêtière in Paris, Pierre Janet at Le Havre and Ambroise Liébault and Hippolyte Bernheim at Nancy that it would receive its most detailed medical exposition.

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5  French experiments in psychological healing Charcot’s name is routinely linked to nineteenth-century discussions of hysteria, yet his impact on the development of psychological healing was fairly limited.102 His significance lay less in the therapeutic model that he developed than in his attempts to systematize the diverse paralyses, illnesses and disabilities exhibited by nineteenth-century hysterics.103 Unlike many of his British counterparts, Charcot did not believe that hysteria could be explained away as a mercenary sham.104 Rather, as he attempted to demonstrate, its origins lay in the unconscious and physical history of the individual. In  1862, Charcot was appointed Head Physician at the Salpêtrière, an unrivalled position for the study of hysteria. As he later noted, the pauper hospital with its thousands of women internees formed ‘a living pathological museum’.105 With the behaviour of patients isolated from the rich and confusing context of everyday life, and then repeated upon a massive scale, it became possible to recognize certain consistent forms of paralysis and behaviour among the Salpêtrière’s patients. Charcot attributed hysteria to the psychical effects of traumatic events on a degenerate individual. In his clinical investigations and public lectures, he sought to demonstrate how psychical traumas could divide the patient’s consciousness, obscuring memories and sensations. Photographic and experimental techniques developed by Charcot and his colleagues, such as Desiree Bourneville, provided compelling visual confirmation of these internal divisions.106 Methods such as faradization, in which a mild electric current was passed through the patient’s body, revealed a patchwork of disconnected stigmata and anaesthesias picked out in discoloured flesh and localized bleeding.107 At one level, Charcot’s experiments underlined the claims made in English psychical research, providing a dramatic demonstration of the new divisions within the hysterical psyche. Yet, he departed from his English colleagues in his insistence that these hypnotic effects were a corollary of degenerative disease rather than a universal attribute. It was through the efforts of his student and one-time follower, Pierre Janet, that this model of the psyche was universalized and connected to the framework of unconscious memory. Janet followed Charcot’s concern with the visualization of hysteria.108 Like his teacher, he had traced the pattern of anaesthesias and paralyses in his patients, treating them as a fleshy mnemonic for the psychic state. Moreover he had extended this new approach to the investigation of the patient’s sight and memory, describing the contractions and negative hallucinations which disrupted the hysteric’s vision and the systematized amnesias which prevented

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the recall of certain words or events.109 The model developed, like Charcot’s, around the idea of psychical or hysterical traumas that divided the subject’s waking consciousness from areas of the mind or the body. Janet went beyond Charcot, however, in his conceptualization of these excluded areas of memory and will. Whereas Charcot had simply written these off as passive and unconscious, Janet’s investigations into cases of hypnotic somnambulism and apparent possession led him to a position closer to that of Gurney and Myers. In his first case study of the Le Havre somnambulist, Leonie, Janet had been led to posit the existence of a telepathic rapport existing between the subject and the hypnotist. Later he discovered that Leonie’s purposive actions in a hypnotized state stemmed from ‘Leontine’, another personality created in previous entrancements by itinerant mesmerists. This personality was also conscious of all Leonie’s actions. It was the existence of this continuous but obscure memory and its realization in purposive action that pushed Janet towards a dynamic conception of the subconscious mind.110 In his first major publication, L’Automatisme Psychologique (1889), Janet developed a twofold theory of psychological automatism. Automatism, already familiar from previous studies of hysteria, was seen as the reproduction of an activity that had been adapted to a past event. Its pairing with ‘psychologique’ in the title of Janet’s best-known work points towards a consciousness accompanying these automatisms. Automatism remained distinct from voluntary action, however, since it was trapped within an adaptation to the past. The distinguishing criterion of conscious and unconscious action was its imagined temporal context. As Janet insisted: ‘a voluntary act is an act at least to some extent, new, which to adapt itself to new circumstances, reunites, synthesises, certain psychological elements not exactly grouped in that manner . . . this act is in every respect connected with the idea we have of our personality.’111 Whereas English physiologists and physicians had equated anticipatory activities with automatic routines, in Janet’s scheme it was the historical direction or past context of the activity that marked its place in the subconscious realms of the human mind. Janet drew on spatial metaphors to make sense of this process, imagining hysteria as the contraction of a spatial field of consciousness so that it covered less of the extended temporal order of the subject’s memory. A picture emerged of the present consciousness contracting to reveal other consciousnesses trapped around previous experiences and ideas. The alternate consciousness existed in a kind of narrative reverie, as Janet noted: ‘it is always the same monotonous story which the patient resumes at this point where

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she has been interrupted and unceasingly begins over again.’112 Janet found justification for this thesis in Breuer and Freud’s model of the creation of fixed ideas through trauma, in which fixed ideas became an anchor for the experiences and perceptions excluded from normal consciousness. In Janet’s schema, the submerged wreckage of fixed ideas became encrusted with ‘psychological facts’, slowly developing the kind of complexity that would turn them into alternative personalities.113 Janet’s therapeutic treatment inhabited a terrain that had been sketched out concomitantly in the English practice of psychical research.114 Therapy, for Janet as for Myers, involved a process of synthesis or, as Janet termed, it ‘presentification’. Those alternate consciousnesses that had remained rooted in the endless reverie of the past were collapsed into an awareness of the present. Janet’s model demonstrates with particular clarity the nineteenth-century transformation in the understanding of psychological medicine.115 Symptoms which had once been managed through the adjustment of one’s attitude to the future were now cured through the exploration and recovery of one’s memories of the past. True health lay in the effective integration of personal experience. As Janet explained towards the end of his career, the patient must be able to ‘associate a happening with the other events of his life, how to put it in its place in that life history which for each of us is an essential element in personality’.116 It was a model that inspired many of Janet’s contemporaries. After the death of Charcot, the new cadre which took up the leadership of French psychiatry – Joseph Dejerine, Paul Dubois and Henri Babinski – all championed a form of psychical treatment in which pathogenic memory was recovered and healed through the skill and force of the physician’s personality.117

6  The uptake of psychological healing in British medical practice The French investigations into the relationship between hypnosis and hysteria and the English development of psychical research worked together to create a new approach in which knowledge of the subconscious mind was seen as the key to health. In 1884, Edmund Gurney, Frederic Myers and his physician brother, Arthur, visited France to acquaint themselves with the new work on psychological healing. They worked hard to publicize the French experiments on their return.118 In 1890, Arthur Myers made a fairly modest attempt to introduce

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these new methods of healing to a mainstream medical audience. Writing in the Practitioner, he detailed the widespread use of post-hypnotic suggestion in European hospital treatments, complaining that the therapeutic development of hypnotism in Britain lagged far behind the achievements on the continent.119 His efforts reflected a growing, albeit cautious, endorsement of the French researches among English practitioners.120 Three years later, the Myers brothers drew upon the French experiments to develop a more radical model of psychological healing.121 They argued that the subconscious self was not simply a temporary inspiration or an artefact of hypnotic practice but existed as an ongoing presence in each of us. This subconscious harboured many of the therapeutic powers that eighteenth-century and early nineteenth-century investigators had attributed to the power of the imagination. Frederic Myers insisted that modern man could be compared ‘to a populace of hysterics’ that had ‘acquiesced in our hysteria’. Through this acquiescence, he surmised, we had surrendered certain powers over the body – powers of physical regeneration and communication – just as the hysterics investigated by Charcot and Janet has surrendered the power to retrieve a memory or control a limb.122 The recovery of this lost power over the body could only be achieved through the development of a new faith: a faith in human personality and the powers of the subliminal itself. Discussing the rise of Christian Science from 1866 and the revival of miraculous healing at Lourdes, the Myers brothers argued that the medical profession was ‘forced to recognise in these cures a true psychological problem . . . we have discovered that faith will heal; our difficulty is to find something in which to have faith. For the patient must in some way picture to himself the agency which is to effect the cure. He once pictured to himself the mesmeric effluence, and whether that effluence was there or no, the cure often came. He has now been taught to distrust mesmeric effluence and nothing been given to him in which to believe in its stead.’123 In July 1898, Myers was given the opportunity to put forward these ideas to the Psychological Section of the BMA.124 He presented his arguments for the existence of a subliminal self, developed over two decades of psychical research. Myers claimed that the subliminal possessed a ‘dynamogenic’ quality that could be marshalled through self-training and hypnotic suggestion and used to carry out physiological operations upon the body. ‘Medical science,’ he advised, ‘should recognise that a new task has opened before her; that these hypnotic artifices, empirical as they may be, do yet lie in the true path of therapeutic progress.’125 This plea for a new psychological approach to medicine met with

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a mixed reception. Myers was unlucky enough to earn the attentions of Ernest Hart, the energetic editor of the British Medical Journal, who wrote off the whole programme of psychical research as a form of mental atavism.126 Hart believed that faith in the power of the physician’s personality and the cases of so-called miraculous cure recounted by the psychical researchers amounted to a ‘new witchcraft’ which threatened to undo the bases of nineteenth-century science.127 Turning to the old rhetoric of expectation, Hart argued that hypnotic cures demonstrated the dangers of unfettered faith, rather than the disciplined actions of the patient’s subliminal history.

7  Popular literature and the new witchcraft Hart’s equation of psychological healing and superstition was underlined by the growth of Christian Science and New Thought in the United States. These popular movements arose from the mid-century engagement of American protestants with the practices of animal magnetism. The works of their leaders, Mary Baker Eddy, Phineas Quimby and Warren Felt Evans, celebrated the therapeutic potential of personal power and religious faith over the achievements of orthodox medicine.128 They described a world in which invisible forces and hidden powers could be harnessed to strengthen or undermine personal health or individual success. Shortly before her death in 1882, the founder of Christian Science, Mary Baker Eddy, warned of the influence of the ‘red dragon’ and ‘mental vampires’ who would prey on an individual, draining their vital energy and destroying their health.129 Similarly, the leading lights in New Thought, Phineas Quimby and his successor, Warren Felt Evans drew upon the old fluid metaphors of animal magnetism to argue that individuals were always confronted by a sea of competing influences which contained the power to both heal and harm.130 By the beginning of the twentieth century, these movements had achieved a tentative institutional foothold in the United Kingdom. Frank Podmore, who succeeded Gurney as secretary of the SPR, believed that 31 Christian Science Churches had been established by 1907 and 161 healers were recognized by the movement.131 Visiting American practitioners established New Thought centres in Covent Garden, Kensington and Edinburgh in the 1880s. In 1906, a Higher Thought Centre was established in Nottingham, followed in 1910 by the Isleworth New Life Centre, which quickly became the nucleus of the national movement. By 1914, related centres had been opened in Hastings, Wolverhampton and

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Edinburgh.132 The power of mental healing was popularized through the lectures of retired Indian civil servant, Thomas Troward (1847–1916), which in turn provoked a series of investigations in the Daily Express. The chair of these investigations, the engineer, Frederick Rawson, detailed his conversion to the new movement, going on to publish a series of papers and magazines on the protective power of subconscious thought.133 Although the numbers recruited to the Christian Science and New Thought movements remained limited, their power lay in the language and concepts that they made available to the lay population. The idea of life as a contest of invisible forces that could be marshalled through esoteric techniques provided the framework for a new imaginative literature that was to achieve a dominant position in the late-nineteenth-century marketplace. The best-selling novels of the closing decades of the nineteenth century – the shilling shockers of Marie Correlli and Algernon Blackwood – developed the idea of ‘psychological romance’, in which the drama of the plot unfolded within the contested domain of the protagonist’s mind. Life was depicted as a kind of psychic trial in which the vulnerable personality battled with hostile influences.134 Baker Eddy’s idea of the ‘mental vampire’ appeared in novellas by Conan Doyle and Stratford Jolly and was feted in the spiritualist literature as an explanation for neurasthenia.135 The language deployed in these novels created new domains for medical intervention by describing the psyche as a battleground for conflicting forces: forces that could be aided or undermined through outside intervention. Perhaps the most popular and dramatic exposition of this new vision of the psyche occurred in Algernon Blackwood’s John Silence stories: a series of occult tales that promoted the idea of the ‘psychic doctor’, who would use a mixture of psychological and occult methods to heal the obsessions of a haunted mind.136 Blackwood had a medical background, having sat in on the pathology lectures at Edinburgh University. He drew upon the patrician rhetoric of late-nineteenthcentury medicine in his descriptions of Silence’s disdain for the hospital project of categorizing diseases, as compared with the new focus on individual case histories.137 As Silence claimed: ‘This classification of results is uninspired work at best . . . It leads nowhere, and after a hundred years will lead nowhere. It is playing with the wrong end of a rather dangerous toy. Far better, it would be, to examine the causes, and then the results would so easily slip into place and explain themselves. For the sources are accessible, and open to all.’138 Blackwood’s stories usually degenerated into a kind of psychological duel between Silence and the pathological personality that had invaded the life of

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his patient. In his first John Silence story, ‘A Psychical Invasion’, he described the sudden anxiety that gripped a cannabis smoking humorist and gradually took control of his life and writing. Silence realizes that the drug habit has reduced the author’s psychological resistance, allowing alien forces to infect his mind. The writer complains that ‘evil, scheming thoughts came to me, visions of crime, hateful pictures of wickedness, and the kind of bad imagination that so far has been foreign, indeed impossible, to my normal nature . . . ’, a torment that only ends when Silence summons and confronts the invading spirit.139 When the first volume of John Silence stories was published in 1908, it was accompanied by a massive publicity campaign. Over 200 hoardings were set up and posters placed on horse drawn omnibuses. The stories and the publicity combined to sustain a new psychological demand. As Blackwood complained, in the months that followed first publication he was inundated with letters requesting treatment for psychic afflictions.140 There was some basis for the connection between psychotherapy and occultist practice sustained both in popular literature and in the accusations of hostile critics such as Hart. In fact, there is a striking crossover between the constituency of early medical psychology and the early occultist and hermetic movements that emerged in late Victorian London.141 The most famous of these, the Order of the Golden Dawn, was founded by three medical men, John Todhunter, W. R. Woodman and William Wynn Westcott, the Metropolitan coroner and prime mover in the revival of occultism in Britain. Westcott argued that the key to human nature lay in the hermetic teachings of the Rosicrucians and the ancient Egyptians. And although this belief may have sustained a fairly non-conclusive research programme as magical practitioners searched for and argued over the provenance and authenticity of lost esoteric texts, it also helped to sustain the idea of a many layered world of hidden human potential, health and personality that could be recovered through the scrutiny of secret signs and ciphers.142 Many of the leading champions of psychotherapeutic practice in late Victorian medicine were involved in Westcott’s Golden Dawn and its offshoots. Organized in temples in London, Bradford and Edinburgh, the members experimented with magical techniques in order to achieve higher states of consciousness and unleash hidden potentials. Charles Lloyd Tuckey, the leading champion of the hypnotic methods developed by the Nancy School and author of the first English work on ‘psychotherapeutics’, was a member of the Isis Urania Lodge.143 Robert Felkin, an Edinburgh-based physician, joined the temple of Amen Ra in 1894 before moving to Crouch End in North London. Here Felkin assumed the leadership

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of Isis Urania and, after a series of schisms, founded his own occult order, Stella Matutina Amoun.144 Despite his occult involvements, he published a detailed exposition of hypnotic techniques, defending the efficacy of the method and detailing how specific techniques of concentrating the attention could unlock the therapeutic potential of the hidden self.145 AE Waite, who managed the Horlicks Factory in West London at the same time as leading another schismatic faction within the Golden Dawn, did much to re-publicize James Braid’s early work on hypnotism, seeing it as part of a an older hermetic tradition of techniques for self-transformation.146 The occultist involvement with the development of psychotherapeutic techniques in British medical practice reminds us both of the contingency of this achievement, and of the sheer variety of forms the unconscious could take and the capacities it could acquire. Few in the mainstream medical establishment developed an understanding of the unconscious as complex as that debated in the Golden Dawn. Many denied that it was personal in form (as Gurney had insisted), seeing it as a hereditary characteristic or an ingrained habit; but the forms of treatment that the idea encouraged and the growing demands sustained by popular literature served to underline the presence and potential of the phenomenon. It provided a way of redescribing personal motivations, accidents, illnesses and relationships and each time a case was discussed, even if the intention was to dismiss psychotherapy (such as in the scandals over hypnotic crime), the idea of its presence was reinforced.147 Everyday actions became clues to a larger drama taking place beyond the boundaries of ordinary consciousness. The model of selfhood developed in occultist writing supported an abductive logic in which every gesture became a clue to a deeper, more powerful process.

8  Late Victorian psychotherapy The psychotherapy which emerged at the end of the nineteenth century described the problems of psychic disturbance in historical terms – but it was a history that could be recovered and contested through a mixture of hypnotic interventions, spoken suggestions and the force of the physician’s personality.148 At its simplest, in the work of James Woods, Edwin Ash or Hugh Crichton Miller (all of whom treated many thousands of patients between them), psychotherapy simply involved the discipline of attention. Woods at Hoxton House Asylum recorded his own successes with ‘psycho-therapeusis’, a practice in which he

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allowed his personality-free reign in making its subtle influence felt all over the patient’s body. Dealing mainly with referrals from the neurologist, David Ferrier, the Physician at Queen Square Hospital, he treated 1,129 patients for illnesses ranging from neuralgia to alcoholism and obsession.149 Similarly, in Liverpool, Alfred Betts Taplin, a general practitioner with an established reputation in psychotherapeutic work, set up a psychological clinic using directed attention to treat physical ailments.150 This form of suggestive therapeutics was taken up by Edwin Ash (later known as Hopewell-Ash) and Hugh Crichton Miller, although in their cases the practice was founded on a faith in the healing potential of the unconscious mind.151 Ash held a private surgery at Harley Street, where he combined a suggestive therapy with Christian instruction in the hope that the subliminal mind could be encouraged into the rescue and healing of the damaged body.152 Ash conceptualized his work, as Mathew Thomson has shown, in which the practitioner sought to reinforce the curative faith of the patient.153 Crichton-Miller, also a committed Christian, opened one of the first psychological clinics, Bowden House, in 1911 – an enterprise greeted with scepticism by many of his medical contemporaries, but which went on to become the forerunner of the Tavistock.154 Their efforts received popular succour from the appearance of spiritual healing movements in the Anglican and Methodist Churches (particularly the Church Medical Union and the American Emmanuel Movement) although such associations did little to endear them with the wider medical establishment.155 Early attempts to institutionalize eclectic forms of psychological healing were derided by the medical press. In 1901, when the burial reformer, Arthur Hallam and the medical clairvoyant, George Spriggs announced the inauguration of a ‘Psycho-Therapeutic’ Society, their efforts were derided by the medical press.156 At one level, the reaction was well judged, for the leaders of the new group, George Wyld, J. Stenson Hooker and Forbes Winslow, were established champions of theosophy, naturopathy and esoteric healing.157 The society, as Mathew Thomson has shown, served as a broad umbrella for a variety of heterodox medical initiatives, and its title – ‘The Society for the Study, Investigation, and Practice of Health Reform, Medical Hypnosis, Suggestive Therapeutics, Curative Human Radiations, and Drugless Healing, with due regard to Diet, Hygiene, and the observance of Natural Laws of Health’ – provided a good indication of its portmanteau status.158 Given the sheer breadth of its interests, it is not surprising that the group’s attempts to win state recognition of its medical and academic achievements were rebuffed by the Board of Trade on the grounds that

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its scope and work were insufficiently defined.159 Despite these rebuffs, there was obvious public appetite for the society’s work. By 1910, it had 212 members, was publishing a monthly journal (The Health Record) and had sufficient resources to take a lease on 34 Bloomsbury Square, which for the next 3 years operated as a free psychological clinic and library.160 By July 1912, 3,545 patients had attended the society’s clinics and over 30,625 free treatments were given.161 This success, however, brought with it severe financial strain, and by the 1914 the society had fallen into disarray. The treatments offered by the Psycho-Therapeutic Society reflected the eclectic nature of its membership and their spiritualist, Theosophical and Swedenborgian background. Their work rested upon the assumption that the mind, through personal magnetism, could achieve complete control of bodily function, down to the level of the individual cells. Their distance from the medical profession stemmed not so much from the conceptual apparatus they employed as from an overwhelming faith in the unlimited powers of the mind. In November 1906, the leading British advocates of medical hypnosis, Charles Lloyd Tuckey and James Bramwell inaugurated a Society for the Study of Suggestive Therapeutics (later the Psycho-Medical Society) on the condition that ‘the membership of the society be limited to registered medical practitioners; and second, that no such shall be eligible for membership who are connected in any way with any non-medical society which has for its object the treatment of disease by unqualified persons whether by hypnotism or otherwise’.162 Yet this society, which quickly recruited some of the leading proponents of psychotherapeutic experimentation, would itself fail to achieve any agreement as to the form and limits of psychological healing. This eclecticism was reflected in the successive editions of Lloyd Tuckey’s Treatment by Hypnotism and Suggestion, which was reprinted eight times between 1889 and 1921 and shifted uneasily between schemas of psychological analysis and suggestive command. In these psychospiritual models of healing, the unconscious achieved only the most tenuous of relationships with the individual. It was widely believed that this unconscious could extend beyond the body and that its boundaries remained vulnerable to the kind of discarnate influences described by Correlli and Blackwood. In a lecture to the London Polyclinic, Thomas Claye Shaw, a lecturer in psychological medicine at Barts now best remembered for his pioneering work in brain surgery, suggested that just as we can internalize a vision or a physical effect, so too can we externalize our thoughts: ‘. . . the strenuous tension of an idea (the antecedent to muscular action)’, would create a

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‘mental atmosphere’ that heals or poisons. Shaw believed that these unanchored influences could perhaps explain the sudden appearance of so many ‘urnings’ and ‘schwamerei’ (i.e. homosexuals) in England and Germany. He wondered whether ‘these abstract “mental atmospheres” affect the nervous system so that an insanity, or a group of symptoms may be set up without a morbid internal physical alteration?’163 Shaw returned to these questions in an address given to the Harveian Society in  1909. ‘Was there’, he asked, ‘apart from bodily tissue, something independent of it which could operate on and be affected by this body, and which could be used by the patient for his own advantage to whip up or put the brake on the dormant or the perverted will?’164 Although Shaw’s cosmology appears strange to modern observers, it was a position shared by many of his contemporaries and reflected an orthodox model of Christian dualism. Many physicians believed that mental therapeutics must involve some kind of discarnate operation in which one mind engaged with the other.165 When A. J. Brock argued ‘that is is the spiritual element in our sanatorium patient that is not being sufficiently catered for when he or she suffers from nerves’; CK Muthu, an Indian member of the Psycho-Medical Society, responded by arguing that the physician must emulate the Brahmin and marshal spiritual forces on a higher plane.166 These psychological operations took place in a universe of invisible forces: a cosmos described in the semi-spiritual cosmologies of Oliver Lodge and William Crookes, in which the unseen ether opened up the possibility of new forms of sympathetic connection.167 This vision of the universe was reflected in psychotherapeutic practice. The well-known and controversial alienist, L. S. Forbes Winslow, recorded how he had been inspired to take up a method of suggestive therapy developed by the French hypnotist, Joseph Luys.168 In this approach, the patient was not hypnotized. Instead, an entranced third party was introduced into the room and used to transmit therapeutic suggestions to the patient. As Forbes Winslow explained: ‘We have to act on the subjective mind of the operator not directly but conveyed through the hypnotized subject. The suggestions being made to the hypnotized person who for the time being is in actual contact with the patient.’169 A reporter for the Penny Illustrated Paper described how Winslow used his entranced assistant (Mr May, a gas company clerk) to ‘draw out’ the crowding thoughts, noise and pain of a woman suffering depression and tinnitus.170 In opposition to these optimistic understandings of mental healing, many physicians believed that the unconscious played a pathological role. Like Freud and Janet, they saw illness as a kind of defence that was built around a

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guilty past and could only be removed through their strenuous intervention.171 In  1906, Charles Mercier, no friend to the new psychology, recounted his treatment of a neurasthenic mission worker who seemed to have given up on life. Mercier suspected that the withdrawal was prompted by the patient’s secret homosexuality and he took an omnibus accident and an exotic holiday to Benin as corroborating evidence of a guilt-driven suicidal urge. When Mercier realized that the patient’s buttocks displayed the customary ‘epicene shape’ associated with moral perversion, it took many days of intensive questioning before impotence was revealed as the hidden cause of shame.172 That same year, James Milne Bramwell, a leading champion of hypnotherapy, recounted his treatment of a homosexual who was driven to masturbatory fantasies by the idea of myopia and presence of spectacles. The case had been passed to Bramwell by the neurologist, George Savage. Savage agreed with Bramwell that the root of such cases lay in a pathological ‘association of ideas’ and that treatment could only be accomplished through psychological means.173 As Bramwell noted: ‘It is absurd to suppose that a drug can influence such a condition, as to imagine, in Sidney Smith’s words, that stroking the dome of St. Paul’s will soothe the Dean and Chapter.’174 His own practice developed into an attempt to reconstruct patients’ ideas rationally, thus allowing them to gain control over their emotional states.175 The psychotherapies developed by Savage, Mercier and Bramwell involve a form of self-discipline in which the patient surrenders to the will of the physician and through this act of surrender achieves a new way of understanding their lives. Psychoanalysis appeared among these techniques as just one more way of narrating individual events, albeit a new technique that was undergirded by the methods of free association and dream analysis described by Eder. All these putative psychologies rested upon the beliefs that ideas could achieve agency and that the psyche existed as a kind of arena in which opposing wills – of the doctor, the patient or the repressed idea – fought for domination. As Eder explained to readers of the London Standard in 1913: when we consider the “neurotic” person it seems that he has the capacity of banishing a disagreeable complex from his conscious thoughts and apparently forgetting it,. He “represses” the complex and it fails to re-enter the ordinary consciousness by reason of a permanent resistance which Freud calls “censure”. But the forgetting is more apparent than real; although the conscious, everyday mind, knows it not, the disagreeable group of ideas, or complex, is side-tracked

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into the subconscious memory, and although repressed and censured clamours for conscious recognition – and constitutes a constant source of mental worry or irritation – a “psychic trauma” or injury.176

Although Eder may have believed that the unconscious was a relatively independent entity and that the contest was a simple engagement between doctor and patient, the sources which sustained the patient’s thought were less personal and more complex than he ever imagined.

9  Conclusion Forty-two years after his treatment by Eder, the neurotic clerk he had treated for rheumatism was once again an object of psychiatric attention. In the long decades following his prototypical psychoanalysis, his health had improved and his life had maintained a certain stability. The neck pain had indeed subsided, as Eder had predicted, although his other minor tics – his shy bladder and his embarrassment over eating in public – had remained with him for most of his life. If human character did change ‘on or around December 1910’, as Virginia Woolf declared, the change did not go so far as Eder’s patient could have hoped. As the patient explained in an interview with the psychiatrist and historian, Richard Hunter, he had liked and admired Eder and a shared interest in Fabianism had preceded their analytic relationship, yet he remained unsure if the therapy had ever been effective. His problems of incestuous attraction and his crippling shyness had only been solved for a brief time, but a more lasting solution to his troubles had been provided by the outbreak of World War I. He served in the field ambulance and while he was away, his sister married and left their childhood home. His problems, he thought, were situational and when his 72-year-old sister returned to live with him following the death of her husband, the old tensions returned. His case epitomized the problems of the unconscious and the ongoing question of whether difficulties in the present moment could be read as symptoms for deeper problems in the past. Hunter’s mother, the psychoanalyst Ida MacAlpine, saw the case in terms of the new object relations analyses that had emerged in Britain after World War II.177 She seized on the ‘clang’ similarity between the names of the desired sister, ‘Ada’, and the analyst, Eder. Although Eder had not recognized the fact in  1910, the analysis itself, MacAlpine argued, was driven by the attempted transference of the patient’s incestuous needs.178 It is difficult to judge whether MacAlpine’s interpretation is

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an improvement upon Eder’s. Yet it does serve to underline how the identification of the unconscious with the past was an unsteady achievement. The explosion of psychological language and experimentation at the end of the nineteenth century made possible myriad new ways of narrating the unconscious. As we shall see, its identification with history and memory was contingent on the changing goals and organization of contemporary medical practice.

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The Healing Power of History

1  Psychology and the fabric of things When Virginia Woolf claimed that ‘on or about December 1910, human character changed’, she was engaged in form of literary self-promotion. She was keen to distinguish the psychological sensitivity of her own artistic productions from what she saw as the coarser, more materialist approach that characterized the work of Arnold Bennett, HG Wells and John Galsworthy, the best-selling authors of the Edwardian age.1 Woolf believed that these authors failed to understand the true enigma of character and were only interested in the ‘externalities and incidentals’ of the individual.2 They were, she thought, ‘concerned not with the spirit but with the body’ and she gently mocked the method of Bennett’s Hilda Lessways (1911), which introduced the eponymous protagonist by describing her townscape and her home.3 As she explained to her audience of Cambridge undergraduates: ‘This is what I mean by saying that the Edwardian tools are the wrong ones for us to use. They have laid an enormous stress upon the fabric of things. They have given us a house in the hope that we may be able to deduce the human beings that live there.’4 It was a method of character reading unsuited to the modern age. At first sight, Woolf ’s claim to psychological modernity has strong support. Her own life was caught up with the rise of the psychoanalytic establishment in Britain.5 Suffering from recurrent melancholia, she was treated by progressive neurologists and alienists – George Henry Savage, Maurice Wright and Henry Head – who cultivated a sympathetic interest in the new dynamic psychiatries of continental Europe.6 Moreover, her family and friends were intimately involved in the establishment of psychoanalysis in the United Kingdom and many early psychoanalytic works were first published by Woolf and her husband at the Hogarth Press.7 At the same time, when her rivals addressed psychological issues, they remained wedded to Victorian approaches. Galsworthy and Wells

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explained their character’s motivations through reference to a peculiarly nineteenth-century constellation of character, race and instinct. Although Wells acknowledged the tension between the ‘front self ’ and ‘back self ’ in novels such as The New Machiavelli [1911], he believed that the solution to such tensions lay in the energetic cultivation of character.8 Likewise, in his early self-help books, How to Live on Ten Minutes a Day [1905] and Mental Efficiency [1911], Bennett explicitly allied himself with an optimistic plebeian literature which somehow suggested that the problem of psychological health could be solved through closer attention to domestic organization and personal habits.9 Yet it would be wrong to see the subjectivities that Woolf described as somehow triumphing in the modern age. As Raymond Williams remarked, ‘the issues are still very active and undecided; the issues I mean as they connect to our own active world’.10 Where Woolf maintained a nineteenth-century apprehension of the vulnerability of the subject to subtle and mysterious influences, Wells, Galsworthy and Bennett described characters driven by biology and history. The Edwardian novelists developed models of physical and mental illness that presented their aetiology in biographical terms. In their works, diseases and accidents were not depicted as gratuitous infections or chance events; rather, their appearance and development were bound up with the unspoken agendas of their characters. Their novels epitomized a new way of reading mind and illness, in which the eclecticism of the Victorian era was surrendered for a new insistence on the driving power of the past. This understanding of mind and illness in historical terms is well demon­ strated in Bennett’s work. In his novel, Riceyman Steps, published in  1923 (the year before Woolf launched her attack), he describes the descent into illness of a miserly antiquarian book dealer, Henry Earlforward, and his mildly hysterical wife, Violet Arb. Earlforward’s life and those of his household are blighted by his self-serving illness. On his one-day honeymoon to Madame Tussauds, Earlforward develops a sudden excruciating cramp when faced with the prospect of paying for dinner. This rheumatic pain returns whenever expenditure is threatened. When his maidservant is suspected of stealing a piece of cheese, Earlforward starves himself to death in a punitive attempt to demonstrate the debilitating effects of the financial anxiety she has caused him. His wife fares no better. Exhausted by the strain of keeping up appearances, she dies during an operation to remove a fibroid growth.11 Riceyman Steps is not a cheerful story but it illustrates the way that the idea of a dynamic unconscious could be used to connect physical health with unspoken personal agendas. This idea of ‘secondary gain’ was explored by many of Bennett’s

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contemporaries. Galsworthy and Wells both provided compelling portrayals of the physical concomitants of personal frustration and the goal-directed nature of individual illness.12 The theme provided a standard narrative device for many Edwardian authors. It was repeatedly utilized by May Sinclair, a slightly eccentric novelist whose own works encapsulated the drift towards a Freudian understanding of motivation. Beginning with The Helpmate, published in 1908, she detailed how the tribulations and betrayals of a honeymooning couple trigger a retreat into competitive bouts of migraine, influenza and nervous collapse which are used to negotiate the limits of sexual intimacy.13 Sinclair persisted in this psychosomatic morality long after developing an interest in psychoanalysis.14 In The Life and Death of Harriet Frean (1922), she entertained her readers with a vicious portrayal of lives blighted by sexual frustration which produced illnesses ranging from cancer to neurasthenia.15 These psychosomatic narratives, bringing together blighted expectations, frustrated desires, craven personalities and arch scheming, were rooted in a new understanding of the world; but this was not an understanding that emerged, as Woolf insisted, out of spirit of the age. Rather, it was rooted in those material concerns that she derided. The extended self that animates the popular literature of the Edwardian period was sustained by a whole complex of developments. Although it was framed in the language of the new psychology and evolutionary biology, it was undergirded by the changing organization of the medical marketplace and the emergence of new forms of social insurance and data recording. Against Woolf ’s injunction, the next part of this chapter looks closely at the ‘fabric of things’ in a way that goes much further than the method of character reading propounded by Bennett, Galsworthy and Wells. Instead of looking at the house in order to ‘deduce the character who lives there’, we will see how character was itself constructed by the material elements of modern everyday life. The interconnected views of selfhood and illness that emerge in these stories were founded, in part, on the changing organization of general practice at the beginning of the twentieth century.

2  General practice and the rise of the extended self In the opening issue of General Practitioner magazine in June 1900, the role of the family physician was defined in terms of his biographical expertise: ‘The family doctor knows his patient like a book. He is familiar with his weak points and his strong ones. He knows all the little peculiarities which make one patient

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different from all the others, and which so much influence the results of his treatment. The general practitioner who has been called to the hearth of the family through generations knows how to allow for and to utilize to his advantage those constitutional traits. Moreover he is attached to his patients, he is interested in their welfare, his sense of responsibility is increased and, unconsciously, he works harder over such cases than when he is called in casually to attend upon strangers.’16 By the twentieth century, this historical familiarity was understood as providing the basis for a new kind of psychological intimacy.17 The general practitioner, like the novelist, enjoyed a privileged perspective ‘that penetrated to the depths of human life’.18 Presiding over the births and deaths of their patients, they understood the quiet tragedies and thwarted aspirations that shaped the lives of their flocks and informed the course of their illnesses. Whereas the psychiatrist and the consultant enjoyed only fleeting and sporadic encounters with patients, the family doctor was able to trace out their histories and plot the course of their illnesses.19 Such knowledge, it became clear, was crucial if effective diagnosis was to be achieved. James Mackenzie, a reluctant cardiologist who would become a pioneer champion of general practitioner research, contended that pastoral knowledge provided the basis of modern scientific medicine.20 A long-time champion of the historical perspective that family doctoring afforded, he had himself worked as general practitioner in Burnley from 1878 to 1906 before setting up as a cardiologist in Harley Street. Mackenzie, however, was hostile to the idea of specialism, calling it ‘a curse, which misdirects every subject in which it is introduced’, and in 1919 he retired to St Andrews to found an Institute for Clinical Research.21 The Institute promoted the prognostic approach that Mackenzie had championed in his Burnley days. He believed that the presentation of an illness was rooted in disturbances of the normal reflexes and thought that careful observation and recording of related symptoms would allow practitioners to recover the natural history of disease.22 Drawing upon his observations on idiosyncratic reactions to digitalis, he argued that the effective diagnostician was one who developed the skills of an ‘intelligent shepherd’, who could trace out the minute variations in individual reaction and through that knowledge form an idea of the diagnosis and prognosis of a disease.23 As Mackenzie explained: ‘To the untrained eye the members of a flock of sheep are so like one another that it seems impossible to recognise separate individuals, yet the intelligent shepherd knows the peculiarities of each individual, though he may not be able to give a comprehensive description of the features by which he differentiates them.’24

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This idea of the general practitioner as a community and family witness would take on a new significance as the nature of illness was redefined, through the discourse of the new psychology, as a problem of the patient’s unconscious history. Psychology and general practice enjoyed a symbiotic relationship. Each derived a new significance from its association with the other. For many general practitioners, this relationship would eventually assume a crucial importance, for in the midst of many widely perceived crises in general practice over the course of the twentieth-century, psychological concepts worked to reassert the value and uniqueness of the general practitioner’s task. This symbiotic relationship, as we shall see, was not merely functionalist. Rather, many of the crises in general practice would work to create a distinctive material and intellectual framework for the practice of the new psychology. Although paeans to the family doctor may have insisted on the age-old basis of this form of personal care, the emergence of the general practitioner was predicated on a number of late-nineteenth-century developments. Between 1870 and 1914, a series of legislative initiatives bound the general practitioner ever more closely into the lives of the local community.25 General practitioners became responsible for the registration of births and deaths, the notification of infectious diseases and the administration of poor law claims.26 Through the growth of local and national insurance schemes, organized through worker’s clubs, doctors found themselves serving a named community rather than the haphazard list generated by passing trade, price and reputation. The Workmen’s Compensation Acts of 1897, 1900 and 1906 and the National Health Insurance Act of 1911 created a new culture of medical practice which allowed for the development of a psychological approach to health and illness.27 The various iterations of the Workmen’s Compensation Acts and the extension of National Health Insurance offered a scheme of sick pay and remuneration for an expanding section of the working population. By the time the National Insurance Act was put into operation in 1913, over 15 million manual workers were included within its ambit. By World War II, the scheme had been expanded to include almost 25 million workers and their dependents. As has been widely noted, the schemes changed the nature of the doctor-patient relationship, which was no longer founded on service to a patron but developed through the administration of a claim.28 Health insurance encouraged the adoption of psychological approaches, while at the same time stimulating new systems of historical surveillance. Psychological explanations of functional illness could be used to police claims for industrial compensation, while defusing any possible element of confrontation in the doctor-patient encounter. This approach

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allowed for the unconscious, rather than the claimant, to be scapegoated as the dissimulating agent in pursuit of financial reward.29 The issue of compensation neurosis that had been established in the arguments over railway spine remerged in debates about the establishment of the National Health Insurance Scheme.30

3  The forensic culture of the extended self Writing in  1912, Archibald M’Kendrick, an Edinburgh radiographer, urged medical colleagues faced with implementing the workmen’s compensation acts to draw a distinction between the conscious dissimulator and the unconscious malingerer who was the victim of his unspoken desires. As M’Kendrick noted: ‘the commonest type of the unconscious malingerer is the man who is more frightened than hurt. He craves for sympathy, and in his quest he goes from one medical man to another.’ The quest allowed the claimant to take on a new identity, constructed and sustained through his medical interviews and investigations. As M’Kendrick explained, ‘His symptoms may be founded on fact, but they are mostly imaginary. The more he thinks about them, the worse they appear and the more firmly he believes in them. Eventually he becomes like the disciple of Ananias who has told the same lie so often that he begins to believe it himself.’31 A year later, in 1913, Sir John Collie, the London County Council medical examiner, expanded on this idea of malingering as a form of unconscious selfdeception. Speaking to the Section on Forensic Medicine at the International Congress of Medicine, he argued that the establishment of the National Insurance Scheme demanded the development of ‘special precautions for the prevention of malingering’. He warned that the diagnostic powers of the general practitioner would be tested to the utmost by introspective ‘pseudo-neurasthenic’ who was ‘led by the suggestions of rascally solicitor’s touts’ and ‘genuinely distressed relatives’ into a state of hysterical illness. As Collie noted: ‘Sympathy feeds the flame and contemplated legal procedure engraves deeper and deeper on the brain cells what should be the phantom memory picture of an accident, the real physical disabilities of which have long since disappeared.’32 Again, the new system of medical investigation and compensation worked to create a new psychological identity and a new kind of illness. Collie’s position was widely upheld.33 Farquhar Buzzard, assistant physician at the National Hospital, Queen Square, argued in 1915 that the ‘only difference between pure hysteria and malingering was probably the degree to which the “wilfulness” to be blind or deaf or mute was buried in the depths or flourished

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on the surface of consciousness’. Thomas Lumsden, the deputy medical examiner for the LCC, went further, arguing that ‘hysteria may be looked upon as a sort of subconscious malingering in which the patient herself is deceived as well as, and sometimes even more than, others around her’.34 These arguments were further elaborated as the remit of the Workmen’s Compensation Acts was extended and new pension regimes were instituted during World War I.35 Government investigations into compensable conditions, such as writer’s cramp or miner’s nystagmus, led many physicians to insist that national insurance was producing new forms of unconscious malingering in the population. It created a situation in which any experience of sickness was bound up with the possibility of unearned reward.36 As William Thorburn complained in his 1914 Presidential Address to the RSM Neurological Section, insurance turned accidents into cases and through a process of constant appeal and claims transformed the ‘unfortunate victim’ into a permanent cripple who could never again return to working life.37 The processes of examination and litigation fostered by social insurance were seen as changing the psychological experience of the illness. Illness was now intimately bound up with the identity and aspirations of the insured patient. The welfare policies of the Liberal and Labour parties were thus seen as bringing about a psychological shift in the working population. Commenting on the revision of the Workmen’s Compensation act in  1927, one patrician neurologist noted how ‘this piece of legislation, when originally drafted, contemplated in the main, gross physical accidents arising in the course or out of a man’s employment, and that the increasing proportion of traumatic nervous maladies could scarcely have been foreseen, even by the keenest legal brains. But it soon became evident, after the Bill became law, that many of the simplest surgical injuries had now taken on a different course, and that something had happened whereby the average duration of disability after a simple fracture of the leg, lasting perhaps six or eight weeks in the old days, promptly rose to three or four months.’38 The persistence of these symptoms was described as an ‘unconscious affair’ brought on by the sympathy of relatives, the promises of solicitors and the victim’s repressed loathing of their employer. In these narratives, the unconscious emerged as kind of third party that could manipulate the body to advance the patient’s agenda. As a writer in BBC’s Listener magazine commented: ‘There is I admit, something rather attractive about a conception of the unconscious mind that acts almost as a sort of “villain of the piece,” or sinister power behind the tottering throne of reason that makes us ready to accept it. It offers to relieve us of a great deal of responsibility for

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some of our erratic ways – it is a very convenient scapegoat. For this reason a cynic might say that if there were not an unconscious mind it would be necessary to invent one.’39 As the popular psychologist, William Brown noted, engaging in psychotherapy was much like reading a modern thriller in which the hidden culprit – the subconscious – was pursued through clues and signs that they mistakenly left behind.40

4  Litigation, shock and the extended self Alongside the forensic use of the concept of the unconscious to interrogate insurance claims, psychological and physiological concepts could also be used to establish connections between present distress and distant compensatable events. These concepts, and the idea of physiological shock in particular, remained persistent points of contention in legal debates over the extent of liability in accident compensation. Despite the Privy Council’s initial reluctance to grant legal recognition to any concept of mental or nervous shock, a number of judges at the turn of the century sought to establish the concept’s legitimacy through reference to contemporary psycho-physiological research. They drew from the works of Erichsen, Charcot and Crile the idea that traumatic events did not simply produce pathological lesions but initiated ongoing processes of disruption in the nervous system.41 By the beginning of the twentieth century, the possibility of compensation for physical injuries caused by mental events had been established in English law.42 This recognition cut across an existing debate in insurance law over ‘proximate’ and ‘distant’ causation and the limits of legal liability. The new conception of shock would take on a constitutive role in 1909 in the case of Etherington versus Yorkshire and Lancashire Insurance Company, in which Lord Justice Williams upheld the idea that nervous shock, arising from accidents, could cause illness and death long after the original event.43 Over the following two decades, the concepts of shock, trauma and psychiatric injury were used to extend legal liability in arguments over national insurance and accident compensation, and through such arguments these concepts took on new capacities and functions.44 The unconscious provided the means to interrogate a claim without questioning the honesty or motivations of a patient. At the same time, it provided claimants with a narrative device that allowed illnesses and injuries to be connected to far distant events. The new psychology was not born from the disenchanting insights of modern life or the traumatic experience of modern warfare: rather, it was

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generated through these prosaic schemes of practical administration. Indeed, it was exactly these schemes that would allow the unconscious self to endure: as paper records of the patient’s life accumulated, fresh aspects were revealed. These aspects, sustained by the new welfare administration’s culture of documentation, would become central to the understanding of the extended self.

5  The material culture of the extended self The relationship between insurance administration and the new conception of the unconscious went beyond mere psychological rhetoric. It was also supported by the material innovations that grew up around the new national and private health insurance schemes. The operation of these schemes necessitated the informal adoption of systems of record keeping as general practitioners issued sickness certificates and negotiated claims with the friendly societies. In 1912, a special exchequer grant was initiated, paying a fee for the administration of individual patient records that were returned annually to the government. The procedure was criticized as an unnecessary piece of bureaucracy that lacked any form of clinical merit.45 It was suspended in 1917. Three years later, the newly established Ministry of Health returned to the problem of patient records. Robert Morant, the ministry’s permanent secretary, established an Interdepartmental Commission on Health Insurance Records under the chairmanship of Sir Humphrey Rolleston.46 The commission recommended the use of an A6 envelope and record slip, the ‘red card’ upon which the changing situation of the patient could be documented.47 This system remained in place until the advent of the National Health Service.48 The red cards, like the concept of the unconscious, bought together present and past events, making available new patterns of association.49 As David Armstrong has noted: ‘Before records every patient, every “contact”, was a singular event. There may have been a past “history” in the consultation and indeed the doctor might have remembered a singular past occurrence but the past and present were different domains of experience. However with the record card, which marked the temporal relationship of events, time became concatenated. Clinical problems were not simply located in a specific and immediate lesion but in a biography in which the past informed and pervaded the present.’50 Although the cards, for the most part, simply provided chronological records of successive presentations, they ensured that the patient’s complaint was now seen in terms of their biography.

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Although the new bureaucratic procedures were all too often greeted with dismay by panel doctors, the establishment of efficient systems of data management became foundational to the identity of general practice.51 The official systems of record-keeping inaugurated by National Health Insurance were supplemented by a burgeoning commercial literature, largely produced as marketing tools by the pharmaceutical companies. These diaries and appointment lists allowed physicians to track their contacts with individual patients.52 Such material developments were celebrated by the professionalizing physician: the well-organized system of records was seen as providing the individual practice with a kind of institutional memory.53 The arguments anticipated those made in social anthropology, where the adoption of new methods of inscription is held up as a crucial element in the extension of power and identity.54 Although changes in the material organization of primary care to a large extent made possible the deployment of the psychodynamic model, the limited nature of many practices severely restricted the potential for psychotherapeutic practice. The very basic premises used by many panel practitioners, the two room ‘lock up shop’ or the one room dispensary in which patients were diagnosed and prescribed across a crowded counter rendered impossible the kind of intimate inquiry imagined in psychoanalytic work. The simple fact that many doctors failed to provide a chair for patients undermined any attempt to achieve a close or confessional environment.55 Moreover, the gradual shift to a system based on capitation rather than fee for service under the National Health Insurance scheme encouraged short consultations in which the reflex prescription of a ‘bottle of medicine’ was more likely than any involved investigation of the patient’s psychological history and environment.56 Even the biographical utility of medical record cards did not go uncontested.57 The most notable, and perhaps most surprising opponent, was Sir James Mackenzie who, as we have seen, was widely regarded as a champion of general practitioner research. Mackenzie, with his belief in the longitudinal approach, had been canvassed by Morant as a possible supporter of the record card system.58 However, Mackenzie believed that the information obtained would have little value, as he reminded Morant: ‘the symptoms are subjective, they are feelings and sensations and long experience has taught me that to make records of any value of feelings and sensations is a difficult business.’59 Mackenzie thought that the confusion of patients’ symptoms and their distance from the discrete disease presentations to be found in medical textbooks and undergraduate demonstrations were rooted

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in the idiosyncrasies of the body. His own attempts to overcome idiosyncrasy through the development of electrophysiological technologies, however, would lead to a more profound demonstration that the roots of such confusion lay in the mediating presence of the unconscious mind.

6  Electrophysiology and the extended self The comparatively simple technology of the record card allowed the biographical dimension of the patient to be recovered and sustained. However, the attribution and demonstration of an unconscious mind in the sufferer was contingent upon a much broader and more complex range of inventions. Foundational to the establishment of the existence of the unconscious was the display of some kind of distance between the patient’s speech, awareness and physical actions. The techniques for this form of exhibition had first appeared in the middle decades of the nineteenth century during experimental investigations into hypnotism, spiritualism and psychical research.60 By the end of the century, they had been supplemented with new developments in electrophysiology that provided dramatic proof of the division between conscious confession and unconscious action. The co-option of electrophysiological technology as tools of psychological demonstration was in many ways a deeply creative act. The first technologies were comparatively simple devices for changing rates of pressure and electrical resistance.61 In 1860, the pioneer physiologist and photographer, Étienne-Jules Marey (1830–1904), connected a simple balance and pen to a moving strip of smoked paper to record the changing movements of a pulsating artery. Just over a decade later, Marey’s student, Angelo Mosso, constructed a plethysmograph that allowed rough estimates to be made of the blood flow through measurement of the volume of body parts. This mechanical invention was rendered significant by a deeper theoretical innovation, when Mosso attempted to correlate these physiological changes with professed states of consciousness.62 This correlation led to the idea, as William James expressed it, that the ‘entire circulatory system forms a sort of sounding board, which every change in our consciousness, however slight, may make reverberate’.63 James’s faith that a combination of bodily mechanism and physiological technology would somehow make visible the unspoken operations of the individual mind was repaid, as researchers across Western Europe searched for new forms of confessional technique.64

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It was in the midst of this continental excitement that James Mackenzie developed his ‘clinical polygraph’. Working in the early 1890s with a local watchmaker from Padiham, he connected a sphygmograph (a weighted blood pressure gauge) to a tambour and drum, creating a device which could reveal and record the movements of the jugular venous pulse.65 Mackenzie was dismissive of the device’s psychological potential, believing instead that it should be used to calibrate the tacit diagnostic skills of the general physician.66 Others, however, recognized that it could be used to distinguish between those cardiac problems rooted in physical abnormality and those that stemmed from psychological failings.67 In the hands of his followers, the technology was transformed, becoming a device against which the subject’s statements and introspections could be tested and measured. Despite Mackenzie’s scepticism, the early decades of the twentieth century witnessed an explosion of electrophysiological research. Electrocardiographic recording was refined through the combined efforts of Augustus Waller, an English physician and Willem Einthoven, who developed the string galvanometer.68 Waller carried out a series of public demonstrations at the Royal Society and University of London Physiological Laboratories to provide objective measurements of individual fearfulness and reveal the pathological consequences of imaginary fears.69 By the early twentieth century, the association between electrophysiological signs and mental states was widely accepted. In popular literature and travelling fairs, devices such as the cardiograph and the galvanometer were depicted as truth machines that would reveal the unspoken attractions and intentions of an investigative subject.70 The association was robust enough for failures of calibration – the production of signs in the absence of professed feelings – to be taken as a demonstration of unconscious feelings or desires. Thus in 1907, in a demonstration for the BMA’s Psychology Section, an American neurologist, Frederick Peterson, could use galvanometer readings to trace out the existence of unconscious complexes in a subject. Peterson had spent 10 days with Jung in Zurich testing the equipment in word association experiments. Drawing upon Jung’s vocabulary, Peterson described how whenever a stimulus ‘word strikes an emotional complex the result is sure to be registered on the galvanometer in a wave directly proportional to the degree of emotion aroused’.71 He illustrated the process through reference to an asylum attendant who presented strong reactions to the words, ‘sun’, ‘floor’ and ‘pay’, and who then confessed under interrogation that he was facing financial hardship after the stove in his apartment had broken and burnt the parquet. The technology, as the British Medical Journal

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editorialized, made possible a kind of double inquisition. It identified the ‘hidden “thought-complexes”’ described by Freud and others, while also revealing feigned and simulated psychoses.72 Just as the swing of the galvanometer could be used to reconstruct the emotional complexes of an individual, so could a failure to generate electrical signs be seen to indicate psychological disturbance. During World War I, neurologists and psychiatrists used galvanic skin recordings to test for cases of hysterical malingering.73 Working at the 4th London Territorial Hospital, Captain F. L. Golla argued that the failure to extract an electrical response that was adequate to the patient’s professed feelings could be taken as sign of their hysterical dissimulation. As Golla noted in his Croonian Lectures in 1921: ‘The mise en scene of the galvanometer room seemed to be extremely conducive to the exhibition of hysterical crises . . . One young soldier suffering from a hysterical contracture of the foot broke down during an examination; tears rolled down his cheeks, he addressed his dead brother in language savouring of a South London melodrama, he asked why he himself had not been killed in his brother’s place so that the favourite son might have been left to comfort his poor old father, and all the time while he wailed and wept the spot of light from the galvanometer mirror remained steady.’74 The movement of the instrument, rather than patient’s expression of emotion, now provided the authentic demonstration of his or her inner state. As William Brown, a leading psychological popularizer, noted, the addition of an electrophysiological armature to the psychological interrogation transformed the patient’s subjective symptoms into objective signs.75 In these investigations, the tracings of the smoked-drum kymograph and the movements of the photogalvanic lamp became an alternative form of emotional display which escaped the pretences and counterfeits of social intercourse and the conscious mind.76 This celebration of the physical correlates of the emotions as the true marks of the authentic life threw everyday interactions and behaviour under suspicion.77 As a writer in the Daily Express commented, the galvanic skin response recorder was a ‘sinister invention, and one which may send the whole social fabric – which is, as you know, built up of skilful lies – crashing into dust. The mask we all wear will be of no use when a dancing spot of light can give us utterly away.’78 In popular literature and forensic investigations, electrophysiology provided a new royal road to the unconscious. The remarkable thing about these confessional technologies is that they were seen as providing privileged access to the authentic truth of the patient’s identity. The distance between the avowed statement of the subject and the reading on

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the machine was not understood as a sign of the machine’s failings and its need for recalibration, but as indicative of the subject’s dissimulation.79 An extraordinary new regime of truth had opened up in which each new deployment of an investigative technology led to the further extension and elaboration of the patient’s unconscious life: an unconscious life formed by both individual experience and evolutionary past. The inward feelings revealed by the new technologies were increasingly seen as aspects of the individual’s animal history. The theories of instinct, developed by nineteenth-century naturalists, portrayed emotion as the re-enactment of conscious ancestral responses that had become unconscious automatic routines.80 These dumb routines, however, animated inner life and drove forward each thought and action.81 Each present moment was thus bound up with the past history of the race. The new understanding of personality made possible by theories of instinct, electro-physiological techniques, popular ideas of the unconscious and new systems of pensions administration was demonstrated most clearly during World War I. Medical investigations into wartime cases of traumatic neurasthenia and other nervous conditions involved the constant extension and renegotiation of the boundaries of selfhood. Over the course of the war, the aetiology of breakdown moved from the experience of immediate traumas (such as feeling extreme fear) or simple mechanical accidents (such as carbon monoxide poisoning and explosive commotion) and was instead attributed to distant events in the childhood of the individual and the prehistory of the race.82 At the same time, this vast proliferation of psychological narratives raised problems of consistency and coordination that would result in new attempts to institutionalize and police the incipient discipline of psychotherapy. Although World War I did not, as some have argued, institute the new understanding of selfhood, it fostered an ongoing psychological ferment, creating, in the words of one leading proponent, ‘a vast crucible in which all our preconceived views concerning human nature have been tested’.83

7  The extended self and World War I A clear example of the expanded aetiology fielded in war-time explanations is provided in the writings of John Herbert Parsons (1868–1957), an ophthalmic surgeon.84 Although psychological explanations of physical conditions such as frostbite and transient paralysis had begun to circulate among British Army

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medical officers towards the end of 1914, Parsons pressed their rhetoric much further.85 Addressing the RSM in March 1915, Parsons claimed that wartime episodes of traumatic amblyopia, a form of visual impairment with no discernable structural pathology, did not simply arise from the stress of a combat incident but were determined by the patient’s complete biography.86 As Parsons noted, ‘We are accustomed to take the past histories and present conditions of our cases. In these “wounds of consciousness” the past history involves a difficult investigation of the innate dispositions and propensities of the individual, the environment to which he has been subjected in his home life, his school life, and his further career, and last, but not least, in the special cases under consideration, the motives which led him to join the Colours.’ Such knowledge, Parsons thought, was crucial to treatment since the patient’s physical restoration was contingent upon the recovery of their personal self-esteem. Parsons’s approach was informed by the insights of the English neurologists, Henry Head and Hughlings Jackson, rather than by continental psychiatry. He saw the traumatic injury as an insult which triggered a regression to more a primitive level of function and endorsed the idea that wartime episodes of traumatic amblyopia could be seen as a form of hysteria.87 But whereas other advocates of this idea followed Janetian models and argued that the hysterical trauma originated in the repressed memory of a combat incident, Parsons went much further. He argued that the hysteria could only be understood through reference to the patient’s complete biography.88 In his attention to the evolutionary and biographical aspects of the blindness, we can see how the notion of the unconscious served to draw together the present and the past, with the trauma represented as an atavistic return to an ancestral form of consciousness. Other physicians drew upon psychology and physiology to describe nervous breakdown in terms of prolongation of strain or, in a move which reversed the nineteenth-century arguments of Holland and Carpenter, the physiological repercussions of restricting the attention.89 Some went father still. Many turned to degenerationist rhetoric, insisting that uneven patterns of breakdown could be attributed to the psychopathological role of hereditary elements in the soldier’s career, with the damage traced back onto the alcoholic indiscretions of parents or grandparents.90 By 1917, the anthropologist and psychiatrist, WHR Rivers, could argue to his colleagues at the RSM that the limitations of the straightforward shock theory needed to be overcome with a modified form of the psychoanalytic approach. Rivers would himself become a leading proponent of psychodynamic theories of

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shell shock, explaining that ‘the theory of the unconscious mind should appeal to the physician in that it provides him with a definite working scheme of the influences which he has long known to be active in the causation of mental disorders and of the bodily disorders which are traceable to mental factors. The modern conception of such disorders is they are not merely the result of some shock or strain but are the outcome of the whole life history of those who suffer, that they are the result of the totality of individual experience of the patient as well as the ancestral experience that we call heredity.’91 Rivers’s model shifted the reason for breakdown onto far distant events. Physicians drawing on his ideas were able to connect cases of shellshock with imagined episodes from childhood and adolescence. Episodes of wartime anxiety were interpreted as the recrudescence of schoolboy homosexual fantasies or neurotic rehearsals of early confrontations with violent fathers.92 Shell shock moved from being a reaction to a traumatic incident to become a form of biographical commentary: an ongoing process in which the form of the patient’s reactions was determined by tendencies accumulated over the course of his or her lifetime and the history of the race.93 The traumatized brain was likened to ‘that deep cleft in the rocks near Garavan, where for 100,000 years man dwelt, each generation merely living on top of the debris left by their predecessors’.94 The unconscious, then, made possible an expanded identity that was not limited to mere historical experience. Many physicians followed the mesmeric clairvoyants and psychical researchers of the nineteenth century in arguing that the subliminal mind extended far into the future. David Eder, who served with the Royal Army Medical Corps (RAMC) in Malta, reminded a discussion on the war neuroses in 1916 that it was wrong to see the unconscious simply as something ‘archaic and crude’, for it had a ‘creative and elaborative function’. Eder insisted that a ‘cross section (so to say) of any mind at any given moment would reveal not only the past but the germs of the future’. He described the instructive dreams of his patients which directed them towards the possibility of happiness; noting of one of his inspired charges that ‘he had only to climb his Mount Pisgah to obtain a full vision’.95 His position was endorsed by William Brown, in his role as psychologist commandant at Craiglockhart Hospital for Neurasthenic Officers. In 1919, Brown noted that his hypnotized patients displayed a clairvoyant ability, with the unconscious moving forward to embrace future events such as domestic reunions.96 There was, as the neurologist Rickman Godlee admitted, something ‘magical’ about the new cures for shell shock.97 It was an opinion shared by many of his colleagues. The psychologist’s rejection of mechanical causality and the impressive transformations wrought in the minds and bodies of the patients paralleled

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the supernatural claims of the divine healers. As one American commentator noted: ‘Miracles or their equivalents are daily wrought by men who are not prophets. Lourdes and Christian Science have their unassuming rivals.’98 The new therapy created a world, as the philosopher, JH Muirhead, commented after witnessing one episode of hypnotic treatment, ‘the like of which you would have to go back to the New Testament to parallel’.99 The magic lay in the ability of the new science to create new identities and fuse together disparate elements of a life from across time and space. Yet as we have seen over the preceding sections, this was a prosaic form of magic. The extended identities created in the treatment of shellshock were rooted in the organization and practice of new systems of national insurance and the new armature of electrophysiological investigation.

8  Psychological eclecticism Stress on the complexity of human nature, refusal of monocausal explanation and eclecticism of method were, as Mathew Thomson has shown, to become the defining features of British psychotherapy after the war ended.100 It was widely believed that Rivers’s work on the traumatic effects of fear had demonstrated the emptiness of the psychosexual explanations advanced by Freud and his followers.101 By locating the causes of unconscious conflict in a contest between different instincts rather than a sexualized id and its repressive ego, Rivers allowed for much more complex psychodynamic narratives to be developed: a complexity that could be infinitely multiplied since there was no limit on the number of instincts that might be hypothecated.102 Early twentieth-century British psychologists such as Alexander Shand, Wilfred Trotter and William McDougall supplemented the Freudian emphasis on the sexual drive with instincts of fear, repulsion, pugnacity, curiosity, self-abasement, self-assertion, tenderness, reproduction, gregariousness, acquisitiveness, constructiveness, hunger, sympathy, suggestion, play and imitation.103 During the war there was a brief attempt to make a virtue of this eclecticism. Speaking to the RSM in November 1918, McDougall announced the emergence of a new form of ‘clinical psychology’ which rejected the prescriptive frame­ works of the Freudians and the Jungians for an empirical therapy closer to that promoted by Janet: a therapy in which dissociated memories were rejoined through a mixture of analytic and suggestive techniques.104 The process, as McDougall’s pupil, William Brown suggested, could be seen as one of ‘autognosis’ in which disturbing associations between present feelings and past memories

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were confronted through discussion of the patient’s ‘wishes, longings, interests, ambitions, personal relations with others from all points of view’ in order to bring out and eliminate all possible internal contradictions.105 Despite the therapeutic eclecticism of this approach, not everyone was convinced that it marked a new departure. H. Bryan Donkin, a persistent critic of Freudian ideas, attacked Brown for his commitment to the Freudian assumption of the unconscious, saying: ‘Where would the autognosist be without the psycho-analyst sitting at his bed head? And what would become of Freudism purged of psycho-analism? The theory is the egg from which the method came.’106 Donkin’s jibes were misplaced. Although no School of Intregral Psychology was created, Brown, Rivers and McDougall successfully produced a ‘purged’ form of Freudism by emphasizing the complexity of the instincts that animated the unconscious. This multiplication of instincts vastly increased the number of psychological narratives that could be attached to an illness. Stories could be structured around themes as varied as a Nietzschean will to power, the repression of Oedipal sexuality, the denaturing effects of social organization, the unhappy consequences of posture or the interfering presence of extra-carnate or spiritual agencies.107 As Brown’s predecessor at Cragiockhart, WH Bryce noted: ‘The outcome of these theoretical variants is, for the practical man, that there is probably some truth to be got from all the sources, and in the meantime let us be prepared to gather what we can from all, for one of them is likely to be all right and none likely to be all wrong.’108 Deciding between psychological narratives was not straightforward since, as we have seen, there was no underlying substance to benchmark these claims. At worst this created a situation in which psychologists and physicians accepted, ‘rather uncritically . . . those “instincts” or activity and thought patterns which fit their needs of the moment’.109 The validity of a particular instinct and its use as a psychological explanation could not be decided through the examination of behaviour since behaviour could always be redescribed.110 Instead it was predicated upon the existence of institutions that could police the many possible histories that could be attached to the patient’s symptoms. These institutions promoted very different models of the psyche and displayed varying degrees of tolerance towards the rival theories. There were five main sites where medicopsychological models were developed and debated in Britain. These were the Medical Society for Individual Psychology, the British Psychoanalytical Society, the BMA Psychological Section, the British Psychological Society Medical Section and the Psychiatry Section of the RSM.111 Of these groups only the British Psychoanalytical Society achieved any kind of doctrinal orthodoxy.

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Indeed, the development of psychological medicine in interwar Britain very quickly became a conflict between this tradition of self-declared eclecticism and the formal claims of psychoanalysis.

9  Rival doxa: The Medical Society for Individual Psychology The eclecticism which characterized interwar British psychotherapy found its clearest expression in the work of the Medical Society for Individual Psychology, a nominally Adlerian group founded through proselytizing efforts of Dimitri Mitrinovic, a mystical Serbian émigré, pan Europeanist and founder of the New Britain movement.112 Mitrinovic had embraced Adlerian ideas in the early 1920s, seeing in their emphasis on self-advancement a practical celebration of self-transformation that acted as a refreshing rejoinder to the speculations of Freud and Jung.113 In 1927 he founded the English Section of the International Society for Individual Psychology, which developed branches devoted to Adlerian methods in the arts, education, sociology, philosophy and medicine.114 This last branch, under the leadership of Francis Graham Crookshank, became the Medical Society for Individual Psychology in 1931.115 Crookshank was not a professional psychologist. He worked as a general practitioner and sometime Medical Officer for Health in Barnes, South London, while holding paediatric posts at St Mark’s, Belgrave Children’s Hospital and Hampstead General.116 During World War I, he had served as the medical director of the Hôpital Anglais Militaire in Caen and his war-time experience endowed him with an unforgiving scepticism towards accepted ideas of language and human nature. This scepticism was clearly expressed in his best remembered but eccentric work, The Mongol in our Midst (1924), in which he argued for a polygenist model of descent: a process of competitive evolution in which the ‘mongoloid’ and ‘gorilloid’ races of the Chinese and African peoples mix unhappily with their European counterparts.117 Although Crookshank is now widely dismissed as a racist, the dismissal relies upon a misreading of his work.118 The racial categories that he deployed in his cavalier acts of classification, as Crookshank himself noted, had no basis in fact. Rather they were names used for the sake of argument and demonstration. Crookshank was committed to a theory of linguistic nominalism that was to become characteristic of British patrician medicine.119 He argued that modern medicine rested on a confusion of ‘names, notions and happenings’, adding that ‘it is a vulgar medical error, to speak, write and ultimately to think, as if these

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diseases we name, these general references we symbolize, were single things with external existences’.120 Crookshank’s nominalism, drawn from a mixture of medical and philosophical sources, provided a striking rationalization for the theoretical eclecticism that characterized interwar psychological medicine.121 Although Crookshank cited many philosophical precedents for this work, his arguments were established in debates over the nature of epidemiology. At the end of World War I, he had become involved in a bitter dispute over the bacteriological model of infection and its use in the analysis of epidemics.122 Together with William Hamer, the Medical Officer of Health for London, he had launched a sceptical critique of the fundamental concepts of bacteriology, arguing that the discipline reified a complex series of interrelated events into a single microscopic pathogen. It was, as Crookshank noted, as if a police sergeant finding that a bullet had killed a man, went out to a battlefield and finding more bullets and corpses decided that bullets were the cause of war.123 A more effective conclusion, Crookshank argued, would be to see war and illness as contingent phenomena brought into temporary existence through a chance intersection of social, political, meteorological, biological and psychological forces. This stress on the complexity of the disease won a wide audience among patrician physicians who wanted to resist the reductive diagnoses of modern scientific medicine.124 The Adlerian approach that Crookshank advocated shared many of the features that William Brown attributed to British military psychotherapy at the end of World War I. There was a repeated refusal of the Freudian insistence on the primacy of the sexual instinct and a belief that psychological illness could be interpreted as a pragmatic response to the difficulties and frustrations of an individual’s situation.125 Crookshank’s friend, Walter Langdon-Brown, the regius professor of Medicine at Cambridge, recalled the excitement of his first encounter with individual psychology, noting that: ‘a number of medical men after meeting Adler seemed to have found something entirely new and satisfying in their medical practice: not just new knowledge but a new outlook.’ Langdon Brown believed that the Adlerian method, with its commonsense solutions, was particularly well suited to British medicine. As he noted, ‘the Freudian is so occupied with the drains that he can hardly spare time to consider the physical state of the patient, while Jung is apt to retreat into the clouds of mysticism. To the practicing physician who is constantly seeing patients troubled in mind, body, or estate, either simply or simultaneously, the more realistic psychology of Adler has an increasing appeal.’126

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Part of the appeal of Adler’s approach was that it preserved the need for medical expertise, since the neurotic individual’s psychopathological response was coloured by the particular physical weaknesses of the sufferer.127 These physical weaknesses could either prompt new levels of activity as the patient strove to compensate for their individual failings or alternatively encourage and legitimize a defeatist attitude.128 As Crookshank argued, ‘physical defect (or organ inferiority) offers the excuse for organization of a “functional illness,” and is as eagerly seized upon as the peg whereon is hung the vestment we wish to discard.’129 This somatic element in the constitution of psychological illness allowed general practitioners to develop, as Adler had, a set of diagnostic short cuts which rendered unnecessary the long and drawn out work of psychological analysis. Drawing upon Adler’s theory of organ inferiority, Crookshank argued that patients manifested their psychological distress through a common somatic language or ‘organ jargon’. Physical weaknesses could thus be connected to specific character types and personal failings. This enabled him to claim that ‘the migrainous man has astigmatism and practices coitus interruptus; the vertiginous man has some middle-ear catarrh and smokes too much, as well as being in fear of falling, physically and morally; the dyspareunic woman has a misplaced uterus and a husband whom she hates; the aerophagic doctor bolts his meals, is in debt, and has a flabby abdomen; while the subject of extrasystoles and palpitation drinks too much tea, has a congenitally poor heart, and masturbates’.130 The somatic expressions provided an indirect reference to deeper physical problems (‘organ inferiorities’ such as ear wax, tight shoes or long foreskins) which the patient failed to adjust to and instead exploited to legitimize their personal failings. The Adlerian traffic between ‘organ inferiority’ and ‘organ jargon’ set up a programme of work for the general practitioner. The comparative simplicity of this approach was complicated by the linguistic nominalism of the English Adlerians. This meant organ jargon was always provisional and just about any narrative could be extracted from the presentation of a disability or a disease. Maurice Robb informed members of the Medical Society for Individual Psychology that morning sickness could be seen as a symbolic desire to be rid of the unborn child of an unloved husband and claimed that his own patients had been cured through a mixture of psychotherapy and spontaneous abortion. Moreover he argued that knee pain could be attributed to worries over childbearing, noting the analogy between the word ‘knee’ and the biblical ‘know’ and between the Latin ‘gens’ [clan] and ‘genu’ [knee].131 Most, however, settled for simpler narratives in which patients exploited their

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illnesses to compensate for their individual shortcomings. The gastric specialist, Sir Robert Hutchison, warned his colleagues against the ‘abdominal woman’ whose digestive and uterine complaints sustained her ‘incessant demand for sympathy’, making her ‘a veritable vampire sucking the vitality out of all near her’.132 Others claimed that statesmen used their illnesses as foils to escape episodes of political embarrassment, asserting, for instance, that Edward VII had developed a convenient bout of appendicitis following Lord Salisbury’s threatened resignation.133 Although the Adlerian approach was presented as an empirical or pragmatic psychology, it still rested upon a particular set of theoretical assumptions. In place of the Id and the libido, the Adlerians posited a general will to power, or life force, that was ‘inherent in every cell of our body’.134 As with the libido, this force was referenced through evolutionary psychology, with Langdon Brown arguing that it was rooted in the original impulsive energy that had left the first ‘dipnoid fish gasping for breath on the mud flats and struggling with its spiky fins to reach the land’.135 This energy did not merely drive forward the process of evolution: it provided the critical thread that held the Adlerian diagnoses together. The assumption of this drive allowed physical symptoms to be read as elements in a narrative of personal aggrandisement.

10  Institutional control of interpretation: The psychoanalytic establishment Whereas the Adlerian approach was characterized by an insistent eclecticism, the story of psychoanalysis in England was characterized by persistent attempts to achieve some sort of orthodoxy in psychological method. These attempts were authored for the most part by Ernest Jones, a controversial figure who has assumed the status of an empire builder in recent histories of psychoanalysis.136 In 1913, Jones had founded the London Psychoanalytic Circle in an attempt to build a professional culture of psychotherapy in Britain. He enjoyed only limited success. The original circle had 15 members and of those only four were medically qualified. Moreover, the membership was characterized by the same spirit of heterodoxy that Jones had wanted to suppress. His secretary, Douglas Bryan, a Leicestershire GP, was involved in experimental hypnotism; David Eder and Constance Long remained committed to Jungian ideas; David Forsyth, a wellconnected consultant at the Charing Cross Hospital whom Freud had hoped would take the leadership of psychoanalysis in Britain, refused to recognize Jones’s

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authority, while Thomas Walker Mitchell, a family doctor from Kent, remained deeply involved in psychical research and would later become the president of the SPR.137 The circle broke up after 2 years and was formally dissolved in February 1919.138 In its place, Jones formed the British Psychoanalytic Society with the support of a small number of doctors, including Henry Devine and Charles Stanford Read, who had been involved in psychotherapeutic experimentation during the war.139 The Society’s struggle for psychoanalytic orthodoxy was made possible through the collapse of a rival institution, the Medico-Psychological Clinic of Brunswick Square. In the summer of 1913, Jessie Murray, a consulting physician at the Sea Water dispensary, Euston Road, and Julia Turner, a teacher with strong medical interests, established a formal psychological clinic in Murray’s rooms at 14 Endsleigh St in Bloomsbury.140 Assisted by a £500 donation from the psychological novelist, May Sinclair the institution moved to 30 Brunswick Square where it recruited a broad team of consultants including medical practitioners, sociologists and academic psychologists.141 The team pursued an eclectic form of dynamic psychiatry that it termed ‘orthopsychics’ – a term coined by Sinclair to capture the overall aim of reshaping the patient’s personality. The clinic flourished in the atmosphere of psychological experimentation that emerged during World War I. In July 1915, a laboratory was established to provide psychotherapeutic training. In February 1917, a residential shellshock clinic was opened and came under the direction of James Glover,142 an energetic young trainee. Glover immediately embarked on a course of analysis, first in London with Murray and subsequently in Berlin with Karl Abraham, leader of the Berlin Psychoanalytic Society. It was Glover’s presence that was eventually to prove the clinic’s undoing. The experiment initiated by Julia Turner, Jessie Murray and May Sinclair in 1913 came to an end in 1922 through a mixture of illness, political intrigue and economic mismanagement.143 Although Turner and Murray had promoted an ecumenical psychotherapy that was deeply sympathetic to psychoanalysis, they soon incurred the wrath of Ernest Jones who saw the institution as a rival to his own attempts to set up a properly psychoanalytic school in Great Britain.144 In November 1920, Jones reported to members of Freud’s inner circle that the clinic had been overrun by lay members who, on the basis of a few weeks training, set out to propagate ‘wild analyses’ among the public. Jones was concerned at the threat that the group’s work posed to the incipient discipline but consoled himself with the ‘the secret hope that some day the clinic will collapse and that we may be able to convert it into a proper place like the Berlin Policlinic’.145 When Murray died from ovarian cancer in the spring of 1922, the opportunity

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presented itself. Glover, who was appointed deputy director of the clinic after Murray’s death, had returned from Berlin fully committed to the cause of psychoanalysis.146 He refused to deploy any method but full psychoanalysis on any of his patients, a restriction that the voluntary clinic was unable to support. An internecine dispute broke out between Glover and Turner as the institution spiralled into bankruptcy.147 The remaining assets of the Brunswick Square Clinic were eventually transferred to Jones’s own establishment: the newly formed London Clinic of Psychoanalysis.148 Throughout the 1920s, Jones continued his ongoing attempt to impose some form of psychoanalytic orthodoxy upon the rich psychological culture that flourished after the war. In February 1921, he sought legal counsel on the copyrighting and restriction of the term ‘psycho-analysis’ but was warned that it had already become ‘familiar to the general body of educated people, though the vast majority have never heard of Professor Frend [sic], and of those who have heard of him very few indeed have the vaguest idea of his principles’.149 A year later, when Barbara Low attempted to popularize an orthodox version of psychoanalysis, Jones complained that her efforts would only create further confusion.150 Jones blamed Low’s failure on her unresolved desires for her brother in law, David Eder, but in truth, the concept of psychoanalysis had already developed a life of its own.151 It was, as The Saturday Review commented, ‘a la mode’, functioning as a parlour entertainment in which amusing confessions could be elicited from unsuspecting family and friends.152 The analyst’s role was disregarded as autodidacts were encouraged in new forms of practical self-scrutiny that promised to improve not only knowledge and memory but will power and emotion.153 Commercial publishers such as Foulshams, Rider and Penguin enjoyed long print runs with titles that opened up the possibility of psychological interrogation. Some of these, such as William Gerhardie and Leopold Lowenstein’s Know Yourself as You Really Are (1936), became major commercial events, occupying the window displays at Selfridges and being serialized in the Daily Mail.154 In the Mail’s rival, the Daily Express, the ‘psychophysiognomist’ Jacques Penry offered a similar form of psychological enfranchisement, instructing readers on how to recover the secrets of inner character from the shape and form of the face.155 At the same time, newspapers found rich fare in the scandals associated with psychoanalysis. It was these scandals that would eventually provide Jones with the opportunity to define and defend the discipline.156 The various psychoanalytic scandals of the 1920s, particularly those associated with the sexuality of children, led to calls in the BMA for an investigation. In October 1926, the Central Ethical Committee agreed to arrange a committee of

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inquiry.157 The group included a number of leading psychotherapists – William Brown, Thomas Ross (the Superintendent of the Cassel Hospital) and Hugh Crichton Miller – although it was derided by the psychoanalytic community. James Glover likened it to the inquiry into astrophysics being led by a ‘committee consisting of some reputable professors of natural philosophy of the pre-Kelvin period, several borough surveyors – a few taxi drivers and the Editor of Ally Sloper’s Half Holiday’.158 Meeting between March 1927 and May 1929, the group came under intense lobbying from Jones for psychoanalytic representation.159 He joined the committee in July 1927 along with the Jungian, Godwin Baynes.160 Yet the end result of Jones’s lobbying was a pyrrhic victory. Although the members agreed that the label, ‘psychoanalysis’, should be restricted to those deploying Freudian methods, the final report followed the spirit of British pragmatism and withheld judgement on the adequacy and superiority of any single approach.161 As the Lancet editorialized on receipt of the report, ‘it is likely that the pattern ultimately to be woven will be made from many designs which at present seem to clash.’162 Despite the best efforts of the Freudians, eclecticism remained an enduring aspect of British psychotherapy. Despite the psychoanalysts’ trenchant efforts to proselytize for the new science, their exertions were not well met by the medical establishment. A psychoanalytic training course for general practitioners was established at the Tavistock Clinic under the eccentric direction of Eric Graham Howe, a therapist who later defected to Buddhism and Druidism.163 Talks by Jones and Forsyth to medical audiences won few converts.164 The Medico-Psychological Association maintained a sceptical attitude towards analysis, as did the newly reconstituted Psychological Medicine Section of the BMA.165 The growing dominance of psychoanalysis was not achieved through political interventions but was bound up with the popularization of psychological language: a popularization that was to change the expectations and perspectives of both doctors and patients during the years between the two World Wars.

11  A new kind of doctor: A new kind of patient Writing in the early 1920s, Woolf had derided the adoption of Freudian models in popular novels, claiming that it created an unhappy literature in which ‘all our characters have become cases’ and ‘[i]n becoming cases they have ceased to be individuals’.166 Yet to a large extent, the interwar growth of psychotherapy was predicated upon this process. It was a process that involved people imagining

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themselves and their illnesses in psychological terms and seeing their illnesses and anxieties as bound in with their instinctual sexuality. Again, it was those authors whom Woolf derided who provided the best insight into this process. In The Secret Places of the Heart, serialized in Nash’s and Pall Magazine in 1922, Wells described the growing acceptance of the new historical and sexual consciousness in the prototypical analysis of an obsessive industrialist, Sir Richmond Hardy.167 While the pioneer psychotherapist, Dr Martineau, encourages the patient to confront his past, taking him on a therapeutic odyssey from Maidenhead to Avebury, Hardy maintains an older vision of selfhood rooted in the management of nervous energy. Indeed, he is occupied as a fuel magnate and his crisis has been produced through a mixture of sexual frustration and overwork brought on by his attempt to create a planned economy for Britain’s fuel supplies. The journey in many ways represents the gradual triumph of the psychodynamic view, as the ailing industrialist recovers the story of lost loves, at the same time recovering his sense of self and energy. It is a testament, as Martineau proclaims among the megaliths of the Stonehenge, to ‘the healing power of history’.168 Faith in the healing power of history spread rapidly after World War I. In the case reports produced by those British general practitioners experimenting with forms of psychological enquiry, there is a striking simplicity and apparent effectiveness in the interpretations they produced. Patients readily concurred with the ascription of rheumatic illness to uneasiness over work, or cases of blepharospasm or amblyopia to an unwillingness to see a wronged friend or fiancé.169 These interpretations had none of the complexity that Freud and others had found in the histories of their patients. Rather, if we are to take the claims at face value, they represented a form of tacit agreement between doctor and patient in which historical knowledge replaced the old approved placebo of the ‘bottle of medicine’. It was an agreement sustained, as Wells and others noted, by the fabric of things, and it did not last. As the psychologist, JAC Brown, noted, this simple form of psychotherapy died out during World War II. Brown attributes its decline to a change in the pattern of neurosis, commenting that ‘the older type of reaction in which a relatively integrated personality was suddenly disturbed by one or more symptoms has increasingly given way to the character disorder in which the whole personality is disturbed, so that there is no clear cut border between “personality” and “symptom” with results which may well be more troubling for those surrounding him than for the patient himself. Disorders of this type naturally require an extremely prolonged, radical, and complex treatment.’170 The shift from a world in which nervous problems were cured by tonics and pills into one where they were reconstituted as problems of history, however

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simple or complex, granted a new significance to the general practitioner’s role as biographical witness. As even consultant psychiatrists recognized, by the late 1930s the family doctor played a key role in the achievement of mental health. Writing in the Medical Press and Circular in  1935, Aubrey Lewis, the deputy superintendent at the Maudsley Hospital, proposed that state-funded general practice anticipated much of the function of the new psychiatry with its holistic stress on the biography and context of the patient: ‘Along with the minute study of the derangement of systems and functions in the body which all physicians make, the psychiatrist concerns himself with how the patient lives, how he gets on in his home and his workshop, what is his energy and well being – a larger question than the well being of his component parts, though dependent on it. Many doctors are accustomed to look at their cases in this way without professing to be expert in medical psychology. Indeed psychiatric homilies may well make them feel as Maitre Jourdain felt when he discovered that he had been talking prose for forty years without knowing it.’171 His position was endorsed by a broad range of practitioners and psychiatrists.172 There were repeated calls for the psychiatric education of the general practitioner, and pedagogic series on aspects of psychiatry in general practice were organized in the Lancet and the Practitioner.173 Knowledge and practice that had formed an everyday aspect of medical treatment and administration were now presented as a particular form of expertise: one that would become a crucial component of the family physician’s clinical authority.

12  Arthur Watts and the making of the general practitioner psychiatrist With the establishment of the National Health Service in 1948, the relationship between the identity of the general practitioner and the nature of psychiatric knowledge was firmly established.174 The College of General Practitioners, founded in 1952, made the development of psychological awareness a central part of its programme.175 The new psychological perspective of the family doctor was given its clearest exposition in the work of CAH Watts, a general practitioner based in Ibstock, Leicestershire. Watts shared with many of his colleagues a certain dismay over the apparent relegation of the general practitioner under the National Health Service, but took solace from the psychiatric opportunities that the new organization of health care afforded. As Watts stated when introducing his project: ‘During the past 50 years so much of our demesne has been taken

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away from us that there is a danger that we may become finger posts directing our patient to the most appropriate specialist . . . Here in psychiatry is a new sphere of work for our attention.’176 Watts’s disciplinary claim was based in the familiar idea of the family doctor as witness to his patients’ lives: The general practitioner has certain advantages over the specialist. Living among his patients, he knows many of them before they are ill and so has a more accurate norm with which to compare his patient. He knows the background against which the patient lives his life. He knows his family and his family history often without making any inquiries. In a psychiatric interview the consultant gets as it were only a cross section of the patient’s life. The general practitioner has in addition the longitudinal section, which can only be obtained by the psychiatrist after a period of observation. The consultant has only very few diagnostic weapons which are not available too the general practitioner.177

Watts’s cases suffered from ill-defined complaints: complaints, as we shall see in the next chapter, that had only become visible through the provision of free health care.178 For example, his cases included that of a young mother whose husband thought she was ‘run down’. Although physical examinations revealed no abnormality, she confessed that she was tortured by the recurrent thought that she might throw her newborn from the window. Watts encouraged her to confront her fear by interrogating her life history. His patient had been adopted, and throughout her childhood had demonstrated a subconscious awareness of the fact in her terrified reactions to the name of her old hometown. Dream analysis revealed an unresolved grief over her brother’s death in a quarry fall and the subconscious blame she felt towards her father-in-law, his foreman. Frank discussion of the death and of her childhood anxieties removed her fears and she was able to make sense of her repeated thoughts: ‘I never realised how much my mother must have suffered until I had a son of my own: and don’t forget, my brother died by falling.’179 The abreaction that Watts achieved through his informal investigation demonstrated the importance of the biographical approach. Although his system of diagnosis was similar to Mackenzie’s, he departed from his mentor in arguing that this temporal knowledge did not simply grant a diagnostic advantage: rather, its recovery was a crucial element in the patient’s mastery of their illness. Historical insight moved from being the yardstick of disease to become the basis of its cure. Watts’s vision of the general practitioner was widely adopted. As the Lancet commented: ‘The observation of years in a mental hospital or psychiatric clinic may not reveal as much about the patients in their true environment as

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the general practitioner learns in his daily plodding.’180 The clearest statement of the general practitioner’s psychiatric clams came in  1958, when the Royal College of Psychiatrists, together with the recently formed College of General Practitioners, launched an investigation into the role of psychological medicine in general practice.181 As we shall see in the following chapter, Watts was instrumental in the commissioning of this report. Although it was written in a spirit of post-war idealism as the government mooted the potential for a project of preventative psychiatry, its rhetoric – describing the family doctor as witness to the community’s travails – remained almost identical to the professional selfdescriptions that had appeared half a century earlier. In the treatment of people with psychological illness every general practitioner starts with an advantage over the consultant because of his knowledge of his patients and the background against which they live their lives, his accessibility to their families and the continuity of his contact perhaps over generations. He is the person best fitted to manage the great majority of psychological ailments. His predecessor, the old time family physician with his common sense approach did extremely well in this field as confidante, counsellor and supporter of the families under his care. Today the general practitioner’s opportunities to know his patients and to help them psychologically are still unique especially in country practices where he is part of their environment. He lives among them and has many close ties with them. He knows their family histories and their past histories; he may be present when they are born, married or dying; he examinees them in his surgery or visits their homes when they are sick; he sees them at work and at play; and he knows how they usually behave.182

Changes in literary, medical, commercial and material culture all conspired to create a domain of historical knowledge that was seen as providing the key to the identity of the patient and the development of their illness. It was a domain to which the general practitioner was uniquely qualified to minister and, as we shall see, it was to change the form and content of family practice. Yet the idea of an unconscious that united these different roles and illnesses was always open to renegotiation and, as we investigate in the next chapter, the meaning of psychological illness is unstable. Even as the new biographical medicine was being fashioned, the unconscious symptom mutated from being a sign of the patient’s thwarted instincts to become a commentary on the state of the wider world.

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3

The Social Consciousness

1  The age of anxiety After the death of Sigmund Freud on 23 September 1939, W. H. Auden offered the psychoanalytic pioneer a guarded eulogy: if often he was wrong and, at times, absurd, to us he is no more a person now but a whole climate of opinion under whom we conduct our different lives: Like weather he can only hinder or help.1

The son of a Birmingham psychiatrist, Auden, had been an enthusiast of the new psychologies, informing readers of The Arts Today (1935) of his therapeutic adventures with Freud, Jung, Homer Lane, Gerald Heard, George Groddeck, John Layard, Maud Bodkin and others.2 Yet his own path was to lead him away from the conviction that the roots of recovery lay buried in the personal past.3 During the 1930s, a time often characterized as the ‘anxious decade’ or the ‘morbid age’, he came to see that the possibility of cure lay in an engagement with the wider social process.4 In his own career, Auden embraced an understanding of selfhood that stressed its trans-individual basis, and he came to believe that true salvation could only be achieved through the recognition and acceptance of the social basis of consciousness.5 The transformation of Freud from a selfstyled ‘conquistador’ of the unconscious into ‘a climate of opinion’ marked a similar slippage of the unconscious from its basis in history and memory to a new conception of psychological identity rooted in the wider society. In this chapter, I examine how psychiatrists, consultants and general practitioners came to share Auden’s perspective. In particular, I concentrate on his assessment of the interwar period as the ‘Age of Anxiety’. This assessment is usually read in political terms; as a poetic rendering of the nervous

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temperament of a nation caught between the destruction of World War I and the rise of continental totalitarianism. There is, however, another possible reading. The interwar period was marked by a new form of psychologized politics, in which ideas of a national mood combined with data on the psychic state of the population emerged for the first time as the basis for governmental decisions and policy formation. The transformation of political life – from a practice based on reference to moral codes or philosophical universals to one deriving from a technocratic agenda based on psychological or psychiatric expertise – is significant and deserves more detailed examination.6 This chapter pursues just one aspect of that story: the interrelationship between psychology, epidemiology and medicine. It does so by roughly following the intellectual biography of one individual, Stephen Taylor (1910–88), later Lord Taylor of Harlow. A psychiatrist, medical journalist, civil servant and critical commentator on the organization of general practice, Taylor’s life encapsulated the new logic of social psychiatry and, as such, demonstrates its massive impact on the direction of twentieth-century medicine.7 Taylor began his medical career outlining the psychopathological consequences of new forms of social organization. From this base, he went on to argue that effective political life must be benchmarked upon knowledge of the psychological state of the population. Such knowledge, Taylor believed, could only be produced once general practitioners took on the role of community psychiatrists.

2  Stephen Taylor and the case history of Mrs Everyman Writing in the Lancet in March 1938, Taylor announced the discovery of a new class of neurotic patient. He believed that the familiar figure of the working-class invalid chasing his consoling ‘bottle of medicine’ had been superseded in the outpatient clinics of London’s great teaching hospitals by a new class of wellheeled young women presenting a variety of anxiety states. These women, Taylor argued, ‘presented a definite clinical picture with a uniform background’: they were in their late 20s or early 30s, cleanly dressed but lacking any sense of zest or glamour. Their permanent waves had been abandoned and their clothes, Taylor noted, adopting the patient’s voice, were ‘never as smart as the young hussies who work in the biscuit factory’.8 Their breasts were flabby, their reflexes brisk and they regaled young housemen with a succession of spurious complaints that included trembling hands, nagging headaches, swollen stomachs, jumpiness, buzzing ears and insomnia.

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At one level, Taylor’s experience seemed to reflect what many of his contemporaries saw as the recent emergence of a new constituency of the worried well. Doctors and psychiatrists complained that the new cultures of mental hygiene and health consciousness that had emerged at the end of World War I created an expanding population of anxious patients demanding medical intervention for the most trivial complaints.9 In the early 1930s, Robert Gillespie at Guy’s and Sir Robert Hutchison at the London Hospital complained that the age had had succumbed to ‘hypochondria epidemica’. Hutchison grumbled that the modern physician was now besieged with health faddists, nudists, dress reformers, stool collectors and the anxious parents of antiseptic babies who had all developed a new disease consciousness engendered by the pharmaceutical market and the Workmen’s Compensation Acts.10 Gillespie expanded on the theme, noting the parallel between the present nervousness and the previous wave of hypochondria in the eighteenth century. He complained that even the daily press is morbidly preoccupied with health: not merely advertisements for patent medicines but the lubrications of “Harley Street doctors” fill the columns of the popular papers. The eighteenth-century hypochondriac developed a passion for simplicity and sought to emulate the noble savage in his unsophisticated ways . . . Today we are again exhorted to imitate him; but this time with the movements of our bowels, which (so we are told) should occur as with the savage, three times a day, after meals.11

And a few years later in his book on Mind in Daily Life (1933), Gillespie went on to argue that modern physiology itself was engendering mental illness by making patients aware of the somatic effects of their personal anxieties and hence adding to their reasons for worry.12 As Thomas Ross commented 2 years later: ‘The habit of inventing diseases and the cognate one of attributing to real but trivial physical abnormalities the power of producing widespread symptoms is probably one that keeps up ill health more than any other mistake which doctors make.’13 Taylor’s understanding of illness went far beyond the kind of cultural analysis that had been offered by his contemporaries. Whereas they believed that cultural developments had led to a change in the awareness of illness, Taylor argued that recent social and economic transformations had led to the appearance of a new form of emergent illness: a ‘suburban neurosis’ that afflicted the isolated young wives in the newly built dormitory estates of suburban England.14 He believed that the sudden expansion of owner occupation (over four million new houses were built between 1919 and 1938) had instigated patterns of living

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which were fraught with psychological danger.15 The massive growth in home ownership and the concomitant collapse of domestic service along with the rise of commercialized leisure had combined, he thought, to create a peculiar new mental climate: a psychopathological atmosphere that was gradually poisoning the newly enfranchised women of interwar Britain.16 It was to this rapidly changing urban landscape that Taylor attributed a new species of environmental illness. As he noted: ‘It is only when the environment fails so hopelessly that the neurosis becomes manifest,’ and he blamed the advent of contraception, the companionate marriage and the low maintenance suburban home for generating the mental squalor of the modern woman. As he observed, ‘the small labour saving house, the small family and the small friends have left the women of the suburbs relatively idle, they have nothing to look forward to, nothing to look up to and nothing to live for.’17 In line with the narrative approach developed in the new psychologies, Taylor attempted to story the symptoms of the suburban neurosis through a mixture of clinical history and character assassination. In his article, he described the life of an archetypal ‘Mrs Everyman’ whose journey from schoolroom to suburb was a litany of disappointment and limitation. The brief financial and emotional independence she enjoyed as a shorthand clerk in a Brixton business house was compromised upon her entry into the marital home. The couple’s joint savings were spent on ‘Mr Jerry-builder’s mortgage’ and hire purchase furniture, and the sexual promise of the honeymoon squandered by the shocking and disappointing efforts of her inexperienced husband. A year after the birth of her first child, she found herself condemned to a life of mind-numbing banality. As Taylor described it: ‘She had developed a routine for doing the housework quickly. She had to think a little about the shopping but the cooking she did almost blindly. The Peepshow didn’t take long to read, the wireless was always the same old stuff.’18 Faced with a grumbling husband and a fretful child, the smallest provocation was enough to precipitate a psychological collapse. In his narrative, Taylor conjectured that the arrival of a public health notice on the dangers of cancer would be enough to crystallize all her worries and fears. Imagined scenes of illness, bankruptcy and the orphaning of her child eventually developed into a series of real physical complaints. The suburban neurotic was a victim of economic insecurity, cultural limitation and social isolation. The pitiful picture Taylor developed in his imaginary case history is now all too familiar to us. The idea of the suburbs as a kind of pathological force was a staple of interwar literature and remains a standard trope among social historians today.19 Commentators from J. B. Priestley to Clough Williams-Ellis won a wide

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audience with their dismal descriptions of the ‘dull and monotonous’ rows of ‘nauseous little buildings’ that characterized suburban growth.20 There was a widespread feeling, as Guy Chapman put it, that Lloyd George’s vision of a ‘land fit for heroes’ had turned out to be an ‘Eldorado Banal’.21 The suburbanite lived out a ‘pseudo-human existence’ organized around a ‘religion of beggar my neighbour’ and a ‘science of faking and overcharging’.22 It was a world of ‘subtle swindles’, as Orwell’s character George Bowling noted in Coming Up for Air (1939), a world of ‘stockbroker tudor’ and ersatz pixie glens, in which desperate men struggled to escape the infectious mediocrity of their suburban homes and wives.23 Although many recent authors and cultural commentators have endorsed Taylor’s putative aetiology of the suburban neurosis, it is clear that the story of its emergence is much more complicated than the combination of cultural and social factors that he outlined in his Lancet paper. Alongside these acknowledged social transformations, the appearance of suburban neurosis was also contingent upon the emergence of a new conceptual framework. This framework itself drew upon a number of independent developments, including the new ways of storying illness described in the previous chapter, now combined with an environmental perspective that was emerging in the new ‘social medicine’ of Taylor’s radical contemporaries. Whereas the neurotic case histories constructed by early psychotherapists such as William Brown and W. H. R. Rivers had sought to map psychological failings onto traumatic events in the patient’s biography, Taylor insisted that they were a reflections of wider problems in the social and cultural environment. The reading of illness as an index of civilization did of course have a long history. From the English malady identified by George Cheyne and his colleagues in the eighteenth century to the neurasthenia diagnosis of the gilded age, there was widespread belief that certain forms of social organization could have a pathological effect.24 Taylor departed from these earlier models, however, in the way he imagined the origin and growth of the suburban neurosis. Whereas the English malady and neurasthenia had been conceptualized through the framework of bioenergetics, with modern society creating new demands on nervous energy, Taylor believed that contemporary developments were responsible for deforming the interior lives of his individual patients by frustrating their animal desires.25 The difference between these two approaches was underlined by the different theoretical frameworks that lay behind them. Whereas the claims for neurasthenia and the English malady had been largely anecdotal, Taylor was able to draw upon new psychological models – new forms of social experimentation and statistical technologies – in pursuit of

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his argument. As we shall see, the deployment of these theories and methods was to have a wide-ranging effect, eventually leading to a reconceptualization of illness, general practice and the nature of the general practitioner himself.

3  Suburban ethology In his analysis, Taylor argued that the patient’s ‘miserable little story’ revealed a complex and ‘deep seated aetiology’: ‘The stomach which swells represents perhaps an unconscious urge to further motherhood, the sleepless nights a longing for a full sex life.’ These frustrated animal urges had been made manifest since ‘[e]xistence in the suburbs is such that the self-preserving, race-preserving herd instincts can be neither adequately satisfied or sublimated’.26 As with the purposive stories of illness described in the previous chapter, the housewife’s symptoms can be read as failed strategies in biological advancement. This use of an inferred model of human nature to critique recent changes in social organization had become relatively commonplace by the 1930s. A number of Britain’s pioneer psychotherapists argued that the ongoing repression of instinct in modern society revealed the pathology of contemporary forms of capitalist organization. At the beginning of the twentieth century, the evolutionary psychologies of Havelock Ellis and Edward Carpenter had deployed Darwinian ideas to criticize the restrictions of bourgeois sexual relations.27 This position coloured the British appropriation of psychoanalytic ideas. Early British champions of psychoanalysis, most notably Ian Suttie, David Eder and David Forsyth, were keen to exploit the political implications of psychoanalytic ideas. They argued that true psychological health could only be achieved through a reformation of social relations. Their position was supported by the development of social psychological models in the United States and became more orthodox after Joan Riviere published the English translation of Freud’s Civilisation and its Discontents in  1930.28 The concept of instinct could of course be used as counterpoint to criticize any human institution. As D. H. Lawrence and Karen Horney noted, even the institution of psychoanalysis itself could be seen as part of the repressive apparatus of the superego.29 This use of biology to counterpoint the restrictions of contemporary society was also central to the Adlerian project. Writing in Purpose, the magazine of the English Society for Individual Psychology, in 1932, Crookshank complained of the political timidity of Ramsay MacDonald’s second minority administration. He argued that the Labour Government had failed the British people. Instead of embarking on

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a programme of socio-psychological reconstruction, it had chosen to tolerate a situation in which ‘the population at large denied of its biological, its human rights, will be controlled and shepherded, and herded through life from the moment of birth, if not before by experts of all kinds, by doctors, by publicists, by pastors, driven from welfare centre to cinema, and from football matches to hospital, fed on mass produced tinned foods, taught to read mass produced newspapers, and driven to smoke produced cigarettes throughout a dull and unfree life as controlled human atoms in a predestined dance, and not as independent human beings’.30 The language of instinct turned political difficulties into biological problems. By the end of the 1930s, patrician critics of the direction of modern civilization were making free use of psychological medicine and the framework of sex and herd instincts outlined by Wilfred Trotter to attack contemporary forms of social organization.31 In his 1936 Maudsley Lecture on ‘The Biology of Social Life’, Walter Langdon Brown complained that, ‘It is one of the drawbacks of these vast new suburbs, mere dormitories, which radiate out like huge tentacles from London, destroying the countryside as they grow, that they offer so few opportunities for communal life and a social background.’32 Two years later, a debate on the causes of the declining birth rate in the British Medical Journal evolved into a wider discussion of the nature of social pathology.33 Correspondents were united in their belief that the ‘loneliness of urban living’ and the frustration of sexual opportunity were creating a deep malaise in the body politic. As Norman McFadyean commented: ‘People who are herded into masses shrink into themselves in self defence and need altogether more space for their lives.’34 The situation demanded the surrender of the political process to medical expertise. As Arthur Brock put it: ‘The Westminsters and Whitehalls in all countries have made such a sad mess of the whole business. What about the humble general practitioner stepping in?’35 Brock’s plea did not entirely fall on the deaf ears. Over the next two decades, the general practitioner would find himself involved in the articulation of a form of biologized politics. His role however would not be in the direction of policy but in the collection of data and establishment of a surveillance medicine that recovered the psychological state of the population.

4  Surveillance medicine and psychiatric morbidity Many complained that the neurotics who cluttered Taylor’s surgery were simply an artefact of the interwar development of the outpatient clinic.36 From the beginning of the twentieth century, there was an ongoing attempt to replace the

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medicolegal institution of the asylum with some form of office psychiatry. As early as 1908, R. G. Rows, the reforming superintendent of Lancaster Asylum, and Bedford Pierce at the York Retreat, were urging the building of a system of psychiatric clinics.37 At the end of World War I, their pleas met with some response. A network of ten outpatient treatment centres for shell shock cases was established and the Maudsley Hospital, constructed by the London County Council, was granted permission to receive voluntary patients.38 Although the Ministry of Pensions’ initial experiment with outpatient clinics was fairly short-lived, with most of the network closing for financial reasons in 1922, the rhetoric of outpatient treatment took hold in mental health planning.39 It was promoted in the Annual Reports of the Board of Control and in 1926 endorsed again by the Macmillan Commission into Lunacy and Mental Disorder.40 Within the profession and among the public, a popular psychological rationale developed, in which the stigma attached to certification was seen as preventing the uptake of services.41 As the Ministry of Pensions withdrew its support, a new mixed economy of outpatient care emerged. A mixture of voluntary and local authority-funded institutions joined private and charitable psychotherapeutic clinics (described in the previous chapter), such as those at Liverpool and Brunswick Square.42 In 1917, the financier Sir Ernest Cassel funded a hospital for the treatment of ‘Functional and Nervous Disorders’ at Penshurst in Kent.43 In  1918, the Littlemore Clinic for Nervous Disorders was established at the Radcliffe Infirmary in Oxford under the direction of T. S. Good and William McDougall.44 In  1920, the Tavistock Clinic was opened, offering a mixture of training and outpatient psychiatry, followed 2  years later by the transfer of the Maudsley Hospital from military to civilian use.45 The Maudsley became the prototype for the interwar development of outpatient facilities and, after the passing of the 1930 Mental Treatment Act, for new forms of voluntary inpatient treatment.46 Moreover, despite competition from the Tavistock Clinic, the Maudsley soon emerged as the main training centre for the Diploma in Psychological Medicine, acting as a clearing house for ideas on psychiatric theory and practice.47 It was at the Maudsley that Taylor’s ideas on psychiatric health were formed.48 The building of the clinics made possible the institution of a new kind of ‘surveillance medicine’ in which the division between health and illness was blurred.49 Certainly the early statistical assessments produced by clinic workers and private physicians seemed to demonstrate a much higher rate of neurotic conditions than had previously been expected. In 1934, Maurice Cassidy claimed that 29.5 per cent of cardiac cases seen in his private practice were neuropathic.50 Four years later, Thomas Ross, reflecting on his work at the Cassel, reached a

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similar conclusion.51 However, sceptical psychiatrists tended to give much lower estimates. Bruce Pearson, working with R. D. Gillespie at the Guy’s Hospital Out Patients Department, estimated that only 16 per cent of the 1297 cases he examined over a four-year period manifested any kind of psychoneurotic element in their illness.52 Charles Shearer stated that 11.4 per cent of patients presenting at the Bellahouston Dispensary in Glasgow between October 1934 and June 1937 manifested neurotic symptoms. Shearer, however, had little time for the new psychiatric environmentalism. He claimed that all the neurotics demonstrated a ‘flagrant mental trauma’ and that ‘poverty and unemployment play a much smaller part in the causation [of neurosis] than might be supposed’.53 The high rates of reported neurosis and the sheer variety of patients presenting themselves for outpatient treatment undid the traditional understanding of mental illness. Except in a few cases, such as neurosyphilis, mental illness was no longer understood as a discrete entity capable of physical transmission but as a form of behaviour that existed along a continuum between normal adaptation and pathological failure. Taylor’s suburban neurotic was just one memorable example of the new constituency that emerged as the target for mental health intervention. British doctors drew upon Macfie Campbell’s dour assessment of the situation: The sort of material which is before us when we try to form a general conception of mental disorders . . . is a motley group. It includes respectable bankers peevish with their wives; scrupulous housewives with immaculate and uncomfortable houses; children with night terrors and all sorts of wayward reactions; earnest reformers, intellectuals and aesthetes; delicate and refined invalids evasive and tyrannical, with manifold symptoms and transitory episodes; patients delirious with fever, or reduced by a great variety of organic diseases; patients frozen with melancholy or engaging in an orgy of exuberant activity; patients living in a fantastic world with morbid visions and communications and uncanny influences in whose universe one sees no coherence or logical structure; patients keenly logical and argumentative, embittered and seeing around them a hostile world with which they refuse to compromise.54

This complication of the clinical material was rationalized using models drawn from the new psychology. Illness lost its bacteriological identification with infection and instead was understood as a defensive reaction to various forms of environmental stress.55 The leaders of British psychiatry, Edward Mapother and Aubrey Lewis at the Maudsley Hospital, Robert Dick Gillespie at Guys and D. K. Henderson at the Royal Edinburgh Infirmary embraced the psycho­ biological psychiatry proposed by Adolf Meyer at Johns Hopkins. Like the

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Adlerians, Meyer explained illness in terms of the individual reaction to psychic stress, although the pathological reactions described by Meyer were not plotted around the schemes of self-aggrandisement and evasion that characterized the work in psychoanalysis and individual psychology. Rather, they were seen in holistic terms as a reflection of the individual’s life situation.56 The combination of this reactive model of illness with the new pathological material made visible by the introduction of voluntary admission and outpatient psychiatry underlined the idea that there was no firm barrier between mental illness and mental health. Reviewing the Maudsley’s pioneer work in outpatient treatment and voluntary admission, its superintendent, Edward Mapother noted that, ‘the results of the policy adopted has been to make the clientele of the Maudsley Hospital more consonant with its dominant theoretical conception of the unity of mental disorder than that of any hospital in the world’.57 A year later, Mapother drew on his philosophical commitment to nominalism to underline the connection between new forms of psychiatric organization and psychiatric holism: The Maudsley Hospital has always stood, as it founder did, for the conception which may be termed the “continuity” of all forms of mental disorder and for the compatibility of treatment within one building of all grades of it. In speaking of the “continuity of mental disorder”, one means that this is a collective term for a medley of different anomalous reactions, and that the ratio in which these various anomalies are inter-mixed even in a single case is infinitely variable and so is the possible intensity of each anomaly . . . The vogue for such artificial simplicities as classification into neuroses and psychoses is dying out; so is belief that clinical pictures can be isolated and given a descriptive label to which one can relate with any useful constancy a general causation, treatment and course, without the balanced consideration of a multitude of individual factors.58

Mapother’s nosological scepticism was to establish the agenda for two decades of psychiatric research. Most of those who would rise to positions of prominence in British psychiatry – Aubrey Lewis, William Sargant, Desmond Curran, Carlos Paton Blacker and William Mayer Gross (among others) – worked or trained with Mapother. Even Taylor, who would abandon neuropsychiatry for medical politics, worked as an assistant medical officer with Mapother between 1935 and 1937. And each of these practitioners shared with Mapother an insistence on the continuity of mental disorder.59 Lewis, in his studies of the prognosis of melancholia and its relation to everyday depression, provided the clearest and most detailed exposition of the approach: an exposition which integrated clinical

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description with quantitative research.60 In a follow-up study of fifty-eight Maudsley patients treated for melancholia, Lewis argued for a broad conception of the illness: ‘Any person who is unhappy and ill with his unhappiness may properly be said to be in the state of depression.’61 Such studies, as Taylor insisted, undid traditional ideas of the normal and the pathological, with health emerging as simply a more effective position along a spectrum of behaviour.62 ‘At what point’ he asked, ‘does normality pass into psychopathy, and psychopathy into psychosis? I am convinced that the answer must be social and not medical, with a pragmatic criterion, and with conduct as the touchstone.’63 From this perspective, mental illness was a disorder that extended throughout the community, and as Taylor would argue, the community thus held the possibility of cure.

5  Making social pathology visible: The Peckham Experiment The conceptual apparatus established around the surveillance medicine of the 1930s relied on certain technologies to make visible the effects of social environment on individual biology and psyche. Whereas the practitioners of individual pathology could deploy serological tests to reveal the presence of an infective pathogen or use a polygraph to demonstrate a cardiac arrhythmia, the proponents of the social pathology had to develop a new and more complex set of techniques. They drew on the methods of zoological and agricultural research in their attempts to make visible the subtle forces of social interaction. In particular, they adapted two methods: the statistical analysis developed in biometrical research, and the new forms of group observation initiated by sociologists such as Patrick Geddes.64 The medical potential of this second approach was embodied in the work of the ‘Peckham Experiment’ – a pioneer attempt to extend the boundaries of primary care to cover each aspect of family life. The Peckham Experiment had started in  1926 as a form of medical club offering ‘periodic health overhauls’ to some 100 families in South East London.65 It was run by an eccentric pathologist, George Scott Williamson (1884–1953), and Innes Pearse (1889–1979), an endocrinologist working at the Royal Free Hospital. Although the club collapsed in 1929, the founders’ ambition remained undaunted. In  1935, they built the Pioneer Health Centre and over the next

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5 years almost 1,500 local families subscribed as members. This establishment marked a unique departure. Whereas rival medical centres worked towards the reduction or prevention of disease, Peckham aimed at the achievement of positive health.66 Although the medical treatment of patients was eschewed, the Centre provided a mixture of antenatal and infant welfare classes, social activities and recreational opportunities including swimming, ping pong and roller skating. This work and the guiding philosophy of the Centre has been comprehensively analysed in a series of articles by Jane Lewis and Barbara Brookes, yet it is worth pausing to recover certain aspects of the project insofar as it contributed to the conceptual development of the social psychiatry and, in particular, the concept of the suburban neurosis.67 The work of the Pioneer Centre was informed by the same model of human nature that Taylor deployed in his analysis of the suburban neurosis. Indeed, Taylor referred warmly to Pearse and Williamson’s efforts.68 They assumed the existence of a primitive potential in each human being, explaining: ‘the Pioneer Health Centre is an experiment in the field of human biology. It is an attempt to study the power or “urge” behind human living, as any physical scientist might set out to study any form of energy in the physical world. The experiment presumes the existence of such an energy or “urge” .’69 Pearse and Williamson, however, did not base their arguments on the evidence of contemporary psychopathology.70 Their approach was holistic and idiosyncratic. They insisted that the basic organism was the family, since the single individual was incapable of reproduction, and only the family could manifest instinctive urge for life.71 It was a model rooted in the emergent discipline of cell biology, and Pearse and Williamson looked to the amoeba to provide a model of healthy existence.72 Whereas the life of the modern suburban neurotic was characterized by a state of fearful withdrawal, the amoeba demonstrated a vigorous engagement with its environment. As Pearse explained: When the amoeba encounters food in the immediate environment, the whole entity flows towards the attractive morsel; it stretches out its body in the form of embracing limbs – pseudopodia, surrounds the food particle, and, dragging its whole body forward in the direction of its embrace, engulfs the prize. Whatever attracts it, the appearances, to all intents and purposes are identical – an all or nothing type of enveloping action for each and every new experience embraced.73

Pearse and Williamson believed that the operation of this amoeboid lust for life and the adverse effects of civilization would be revealed through careful observation of families who joined the Centre. After initial consultations and

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health checks, family members would be granted access to the Centre’s various social activities – the swimming pool, cafeteria, table tennis and snooker rooms – but their use of these facilities was carefully monitored.74 Ongoing surveillance of the Centre families revealed the corrupting effects of modern existence.75 On first joining, members were shown to be shy and withdrawn and exhibited none of the social and sexual striving that characterized amoeboid life. In Experiment in Living (1943), Pearse and her educational assistant, Lucy Crocker, described a fat, flabby constipated working-class couple, ‘Mr and Mrs X’, who in their 7 years of marriage had retreated into lives of suspicious disillusion. Their children – a ‘furtive’, ‘lisping’, ‘bedwetting’ four-year-old and a ‘listless’, ‘sweaty’, ‘rubberoid’ toddler – brought them little pleasure. ‘Night by night,’ Pearse and Crocker noted, ‘their long drawn out silences are cloaked in the blare of a thirty shilling loud speaker.’76 Pearse and Crocker compared this process to the amoeboid retreat from a hostile environment. Just as the protozoa shrank and dried out behind a protective cyst, the modern couple ‘encyst themselves in their houses, using them as mediaeval keeps with the drawbridges up because of their foreboding of their relative incapacity to contact any change in their self-limited environment’.77 This process of encystment occurred when the vital sources of the family’s energy – companionship, lovemaking and home-cooked food – were replaced with the dead world of commercial goods and leisure.78 It was a natural reaction of any couple who failed to find sustaining social surroundings: Out of Nature’s ample endowment, the young family builds through no fault of their own, not a rich protean body – a home that grows out from the nucleus of parenthood, but a poor hovel of sleeping and eating, breeding and clothing. For all too often the family holds no converse with the outside world; its functional scope is restricted to its own hearth and there is little to sustain and feed its members but what happens within the four walls of the house. Compelled thus by circumstance endogenously to consume its own products, the exploratory tentacles of the family are withdrawn, and, shrunken around its nucleus, there forms a hard resistant crust of suspicion and defence.79

The imposition of the metaphorical language of cell biology onto the routines of everyday suburban living turned the mundane events of family life into signs of protoplasmic decay. The Peckham Experiment, as many journalists noted, provided clear evidence as to the nature and extent of suburban neurosis.80 The unconstrained activity of the instinctive amoeba threw the stagnant conditions of modern civilization into sharp relief. It acted as a kind of benchmark for

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the rude animal health that deformed and corrupted through the constraints modern civilization. The metaphorical work of the amoeba was extended in the constructive efforts of the new epidemiology that emerged in Britain after the end of World War I. Whereas the amoeba’s movements had acted as a benchmark from which the deviations of modern life could be measured, the new epidemiology revealed, or perhaps constructed, a host of forces that governed the operation of social life. As the champions of this epidemiological approach noted, the nature of the instrument determined the nature of the evidence. ‘If you have the wrong instruments the objects of your search may well evade you. The test tube will not detect an insincerity or the microscope analyse a grief.’81

6  ‘My God Everyone’s in Hospital’: The emergence of the psychosocial In the last chapter, we saw how the rise of the nominalist medical philosophy (espoused by Crookshank and others) made possible the recognition of psychological forces and processes. The scepticism that characterized this new approach received its clearest articulation in debates over the causes and nature of the influenza pandemic of 1918–19. The pandemic, which would claim over 200,000 victims in Britain, divided the incipient discipline of epidemiology.82 The division was between a bacteriological model on the one hand and, on the other, that form of sceptical holism that we have come to associate with the work of the Medical Society for Individual Psychology. In place of the bacteriological model of infection or individual influence, these doctors tried to map illness onto a wider political and cultural environment. In their work on influenza, Crookshank and Hamer championed the Hippocratic model of ‘airs, waters and places’ as factors in the production of disease. It was a short step to provide a psychological or cultural gloss on this model. The same rhetorical gesture that reduced entities such as typhoid or influenza into mere linguistic constructions could, at the same time, enfranchise psychological forces such as anxiety or frustration, turning them into central variables in the social production of illness. This twofold gesture allowed the task of epidemiology to be reimagined. It moved from being the forensic work of detecting the origins of infective agents to inhabit a new territory of psychological government that marshalled the interactions of social, cultural and biological forces. Indeed, it was the methods of the new epidemiology that made this approach possible.

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The integration of biometrics with the new psychology was the lasting achievement of Major Greenwood (1880–1949), who held the chair in vital statistics at the London School of Tropical Hygiene and Medicine. The son of a Hackney general practitioner and an enthusiastic student of the biometrical work of Karl Pearson, Greenwood was to establish an international reputation as a propagandist for the epidemiological use of statistical methods.83 Less well known, and now almost entirely unmentioned in the secondary literature, was his commitment to psychosomatic medicine.84 Greenwood was an enthusiast of the ‘wild analysis’, practised by the erstwhile pioneer of psychosomatic medicine, George Groddeck, in which pre-emptory judgements were used to provoke patient reactions.85 At the London School, Greenwood maintained a psychological discussion group with May Smith, Millais Culpin and William Inman.86 Eschewing the forensic work of the bacteriological model, he attempted to develop a ‘descriptive epidemiology’ that could recognize the changing patterns of resistance in an individual.87 In his synthetic work on Epidemiology and Crowd Diseases (1935), he complained that: ‘We think we can understand how, perhaps, bad feeding, perhaps bodily exhaustion, any or all of the physiological errors have done so [i.e. changed resistance]. It is not so easy to think we understand, how too carefully sheltered conditions of life might work through the “soul” upon the body and precipitate a “real” attack of appendicitis.’88 The demonstration of these ‘procatartic’ relationships, Greenwood believed, would not be found in the operation of new psychological technologies such as the word association test. Rather, the shape of the relationship could be discerned in the insurance claim returns listed in the Registrar General’s Decennial Supplement.89 Greenwood’s claim was taken seriously. The notion of the unconscious, as we saw in the last chapter, was fielded as an explanation in the investigation of workmen’s compensation and was itself sustained by the material culture and practices of these investigations. The collation of statistical data on a national scale led to further development of this process: it allowed the operations and activities of the unconscious mind to be seen in terms of their relationship to wider social and political processes.90 This was a quite radical development in which the ambit of the psychiatric investigation expanded in two directions. On the one hand, the new infrastructure of medical provision allowed for estimations of the prevalence of psychological morbidity in the community to be produced. At the same time, their collation with the Registrar General allowed these figures to be connected to wider social and political changes. The clearest integration of psychosomatic ideas with models of social pathology occurred in the work of James Halliday (1898–1983), a Regional

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Medical Officer with the Scottish Department of Health.91 Halliday had worked with James Mackenzie as a junior doctor and inherited his master’s scepticism about the meaning of signs and symptoms. Drawing on Crookshank’s ideas on the artefactual nature of the infective organism as an object of epidemiological investigation, Halliday began to treat national insurance claims as psychological documents. He argued, alongside L. P. Lockhart, that the reasons provided for claims on national insurance certificates were simply ‘stereotyped descriptions of highly complicated processes . . . to which orthodox labels have been given’.92 This nominalist approach allowed him to reverse the familiar priority granted to illness in national insurance investigations. Whereas previous studies had taken illness as the cause of unemployment, Halliday understood unemployment to be the cause of the illness. This prioritization of the social over the biological allowed Halliday to read the changing rate and distribution of illness as an index of the changing mental state of the British population. In the years leading up to World War II, Halliday vastly extended his analysis. He argued that all illnesses should be seen as form of reaction in which elements of personality, environment and infection combined.93 Although he believed (following Crookshank) that these elements were abstractions, he insisted that they could be seen as productive abstractions allowing the storied nature of the illness to be recovered.94 As Halliday noted, epidemiology usually left unanswered the question of what kind of person fell ill, why they became ill when they did and why they fell ill in the particular way that they did.95 Halliday’s method loaded each sign and symptom with a possible psychological significance. Rheumatism symbolized emotional repression, while sciatica was understood as the repression of the more specific desire to kick someone; dandruff and seborrhoea were symptomatic of work anxiety and social awkwardness; colitis of cleanliness; peptic ulcer of financial obsession. The insistence on a logical key behind the individual manifestations of illness was, of course, reminiscent of the diagnostic shorthands developed by members of the Medical Society for Individual Psychology. Certainly it shares their odd denigration of the social impact of illness – with, for instance, dandruff being a product rather than a cause of social anxiety. Halliday’s analysis departed from the Freudians and Adlerians in his attention to social historical processes. He argued that the evidence furnished by National Insurance returns demonstrated the impending psychological collapse of the British population. On the one hand, there was an apparent increase in the incidence of the psychosomatic affections; on the other, the nature of these affections seemed to have been undergoing some sort of transformation since the end of World War I. Whereas old-fashioned hysteria

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with its attendant aphonias, aphasias and paralyses had declined, somatoform disorders and anxiety states had increased massively.96 Halliday attributed this psychosomatic epidemiological transition to a combination of factors. He argued that the introduction of cheap rubber supplies towards the end of the nineteenth century had led to a decline in breastfeeding as commercial teats became available. This created an orally frustrated population which was further undermined by the rising economic insecurity and crass materialism of the interwar decades.97 In this historical situation, illness, as the Adlerians had insisted, became a means to end. The sick poor, according to Halliday, looked to the state for maternal reassurance, and national insurance provided them with the sense of care that had been withheld from them in their emotionally deprived childhoods.98 This image of government as the kind of good mother imagined by John Bowlby and others in the 1930s reveals how the integration of psychological and statistical approaches had transformed the understanding of traditional psychodynamic psychiatry. The Oedipal drama of the Freudian family was replaced with a global picture in which the individual’s illnesses and repressions reflected their relationship with every level of society. Halliday’s historical approach brought home the conceptual magic of the unconscious. Once a psychological mechanism was assumed, the inefficient operation of just about any biological function could be taken as a sign of wider environmental failings and just about any aspect of the environment could be read back onto the symptom or sign. Despite the eccentricity of this manoeuvre, his position was widely supported. It would have, as we shall see, a revolutionary effect on the future organization of state and society.99

7  Doctors of society: Psychological reconstruction and World War II The new epidemiology turned the private inner states of individuals into public objects of government. In turning personal experience into statistical representation, it transformed what had been a nebulous intangible apprehension into a public object that could be transferred between medical practitioner and government departments. Moreover, the relationship between psychopathology and government policy, revealed in the work of Halliday and his colleagues, opened up the possibility of new forms of psychiatric intervention. Through the statistical procedures of the new epidemiology, the inner life of the individual became a possible target of social reconstruction. Taylor was to embrace this

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possibility. As he concluded in his article on the suburban neurosis, the effective prevention of this illness would require a complete re-engagement with the problems of urban life. Doctors would have to become the ‘social architects of the future’.100 As he concluded: ‘We have, I fear, let matters go too far in the jerry-building, ribbon-development to institute an entirely satisfactory scheme of prophylaxis. We have allowed the slum which stunts the body to be replaced by a slum which stunts the mind.’101 Taylor’s scheme of prophylaxis would involve a complete overhaul of British social relations, for it aimed to insulate the British population from the experience of anxiety. The choice of method for removing anxiety of course depended upon which psychological theory you were wedded to. For Freudians, anxiety was rooted in sexual frustration and its political relief could only be achieved through the liberation of human relations. For Adlerians, anxiety reflected a failure of social integration resulting in the sufferer’s pathological attempts at group domination. For the commonsense school of integral psychology, fear sometimes was plain fear. Taylor was attached to the therapeutic eclecticism of the Maudsley approach, and his solution to anxiety in the national population would involve the institution of new opportunities for social integration, the end of domestic overcrowding (which frustrated sexual opportunity) and the creation of a system of socialized medicine: the National Health Service. The collapse of the old distinctions between illness and health, and between medicine and politics, created a situation in which the whole population became the target for therapeutic intervention. As a character in Louis MacNeice’s 1939 play, Blacklegs exclaimed: ‘My God! Everyone’s in hospital.’102 The outbreak of war provided Taylor with the political opportunity he had long sought. The surrender of British hospitals and general practitioners to the central control of the Emergency Medical Services presented the opportunity for a planned system of socialized medicine.103 Taylor himself was drafted into the Royal Navy Voluntary Reserve, joining his Maudsley colleagues at Barrow Gurney Neuropsychiatric Station. At the same time, however, he maintained his links with the Lancet and in October 1939 he was invited by the journal’s editor, Egbert Morland, to carry out a special investigation on the organization of British health care.104 The war, Taylor thought, had created the possibility that a ‘lusty babe’ of a national health service could be born from the ‘eclamptic primagravida’ of the British medical profession.105 All that was needed was ‘fearless accoucheurs’. Throughout the war years, Taylor was to reinvent himself as a kind of fist-fighting midwife of socialized medicine who would use every tool available in the pursuit of a planned system of health care.

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In  1941, the divisions within the British medical profession over the extension of the state medical service became apparent. The BMA appointed a Medical Planning Commission made up of senior figures, including the heart surgeon Henry Souttar and the aging medical politician, Lord Dawson of Penn.106 In response, Taylor, alongside colleagues from The London and St George’s, created a rival progressive organization – Medical Planning Research – consis­ ting mainly of medical servicemen and the ‘under 45s’.107 The rival groups both published strikingly progressive reports. There was general agreement on the principle of 100 per cent free medical care and the use of health centres in the provision of primary care.108 Medical Planning Research, however, went one step further, tying the prospect of health services reform into a wider agenda of social and cultural reform. They argued that ‘mental necessities are no less important than physical necessities’ and claimed that the sickening population, like the suburban neurotic, could only be saved through the provision of adequate forms of education, occupation and recreation.109 Taylor’s political campaigning was ill matched to his psychiatric career at Barrow Gurney and he was fortunate in December 1941 to be transferred to the newly formed Ministry of Information.110 He was appointed as psychiatric advisor to the Home Intelligence division, where he worked with Tom Harrisson, the eccentric anthropologist and founder of Mass Observation.111 Together they were given the task of monitoring and managing the tide of wartime public opinion. The months leading up to the conflict had been marked by gloomy prognostications of the predicted collapse of the British population under the stress of aerial bombardment. Mixing the imagery of H. G. Wells’ The Shape of Things to Come (1933) with the psychological theories developed by W. H. R. Rivers, regional health authorities had begun planning for mass psychiatric casualties.112 The predicted epidemic never materialized.113 Instead, the population was subjected to a process of constant monitoring using a variety of methods. Informal studies drawn from Mass Observation, national polls from the British Institute of Public Opinion and assorted indices such as general practice presentation rates were collated and correlated with the progress of national events.114 As the psychoanalyst, Edward Glover, noted, the techniques ‘provided a comparatively exact instrument for the expression of democratic feeling’. ‘It was,’ he went on, ‘the first time in history a government has officially recognized the state of public opinion is as important an index of the health of the community as a full anamnesis in the case of individual illness.’115 This use of social survey techniques to measure individual and community health helped to sustain some of the new understandings of selfhood that

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emerged in wartime Britain. Many believed that the demonstration of public opinion revealed by the surveys and the experience of social solidarity could be taken as a demonstration of a deeper common identity that underlay the petty desires of modern personality.116 Popular biologists, physicians and philosophers such as Julian Huxley, John Ryle and Olaf Stapledon attempted to provide a psychological rationale for this new perspective, resurrecting ideas of telepathy and William McDougall’s notion of a group mind. Huxley claimed that the successes of the Battle of Britain and the efforts of the Ministry of Information had instilled in the British people a sense of common purpose.117 Stapledon mixed didactic philosophy with military fiction, describing the achievement of communal consciousness in an Royal Air Force (RAF) aircrew under fire over Kent.118 John Ryle thought that the war had seen ‘economic man’ superseded by ‘social man’ and urged the medical profession to come to the aid of this new awakening.119 Just as Auden had concluded in 1935, personality was not an individual possession but a social phenomenon, and health of the individual could only be achieved through the salvation of the group.120 The changing model of identity underlined the triumph of the epidemiological perspective: the subject of medicine had moved from being the individual to become the population as a whole. In his own work with the Ministry of Information, Taylor was to expand the idea of public opinion.121 Promoted to Head and later Director of Home Intelligence, he instituted surveys of the incidence of neuroses in general practice populations.122 In 1943, as part of the Wartime Social Survey, he established a National Survey of Sickness in an attempt to discover if the predicted epidemic of civilian neuroses was in fact masquerading as minor somatized disorders.123 The survey was in many ways indebted to Halliday’s project but its scope went much further. Whereas Halliday had depended on presentation of illness through insurance claims to reach his estimate, the Wartime Survey workers went into the home and asked respondents for their own health assessments.124 At one level, this new method could be seen as a kind of triumph for the psychosocial approach. Illness was no longer located in the body: rather, it was incarnated in the patient’s complaint. Voiced dissatisfaction now provided the grounds for medical intervention. The elision of the difference between illness and opinion reinforced the equation that Taylor and his colleagues had made between social medicine and political action. As Taylor noted, the Labour party agenda of social reconstruction and the public health of psychological medicine coincided on this issue: anxiety could only be dealt with through economic intervention.125 In  1944 he took his arguments to the public, in his popular book, The Battle

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for Heath. Writing in the wake of the Beveridge Report, which could now be seen as a kind of social panacea, he argued: Health like happiness appears elusive. The more we chase it, the more it does seem to slip around the corner. Yet this is not so really. It is merely that we have been looking in the wrong place. Health is not to be found in the medicine cupboard, nor yet in the pages of “Keep Fit” magazines; both breed rather hypochondriasis. The way to health – and I think to happiness too is the way we have come in this book. Examination and analysis of the problem, scientific study of each facet, logical synthesis of the results . . . The only way is the pragmatic way.126

The pragmatic way involved the provision of decent foodstuffs, the construction of new houses and homes, the guarantee of income to remove insecurity and the establishment of a system of socialized medicine to remove the anxiety of sickness and its associated costs from the British family. The pragmatic way, Taylor argued, was the way pursued by the Labour Party. He became more involved in the party’s machinery, working with Richard Crossman and Michael Young to author the party manifesto. In July 1945, his efforts were rewarded. The Labour Party won the general election with a majority of 183 and Taylor himself was elected MP for Barnet and appointed Parliamentary Private Secretary to Herbert Morrison, Lord President of the Council.

8  The National Health Service and the new psychiatry The history of the creation of the National Health Service has been told many times and told well, but the role of the psychiatric epidemiology and public opinion research tends to be overlooked.127 The initial negotiations over the shape of the NHS were shaped by social survey techniques as the BMA and the Ministry of Information and the Mass-Observation canvassed opinion on the new proposals. Moreover, the new language of public emotion and social neurosis became central to the way the debate was imagined. Aneurin Bevan, the crusading Minister for Health, became an enthusiastic exponent of the language of social organicism and the possibilities of social psychiatry. In one of his first speeches to the medical profession, given at the 104th meeting of the Royal MedicoPsychological Association, he recalled that he ‘seemed to have been living in an insane world ever since he came to adult years’. Discussing the mass unemployment that blighted his youth, he argued that: ‘Many of the maladjustments and neuroses of modern society arose directly out of such conditions. Unless in the future

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we were able to plan our social life intelligently, with a design and purpose into which the individual could adapt himself there would be more mental maladies which no clinical measures could solve.’128 Bevan returned to the theme in In Place of Fear (1952), which provided a detailed exposition of his personal philosophy. He argued that modern society could be compared to a multicellular organism in which ‘Each part is connected as though by an infinite variety of nerves with all the others so that separation is now a mutilation. It is similar to the physical organism except that it has no head and therefore no mechanism with which to receive and coordinate the vibrations.’ The social organism, deprived of rational forms of communication, turned, Bevan claimed, to the language of instinct. On occasions of threat or national emergency, ‘a moral unity informs the whole nation and the energies of the people are supercharged by the absence of inhibitions, as Wilfred Trotter has so brilliantly pointed out.’129 The social organicism that Bevan espoused, the epidemiological evidence generated in public opinion research and the models of neurosis developed in interwar psychiatry conspired together to extend the boundaries of psychological medicine. Taylor conceived of a kind of therapeutic state in which psychiatric expertize informed social reconstruction and government planning. After the wartime arguments on the shape of the NHS, his position came to be widely shared.130 Representatives from the BMA, the Royal College of Physicians and the Royal Medico-Psychological Association agreed that the task of psychological medicine was moving on to a new stage. As they noted in their 1945 Report on the Future Organisation of the Psychiatric Services: ‘Where psychiatry begins and ends has not been settled. Within the development of preventative medicine its borders will become less rather than more definite.’131 A new world of preventative mental health was envisaged in which the ‘extrinsic factors of mental infirmity’ – economic anxiety or the unhappy domestic environment – were revealed and neutralized through the efforts of nationwide system of psychiatric clinics and medical officers of mental health.132 The campaigned-for medical officer of mental health never materialized, and in their absence the family doctor moved into the frontline of psychiatric surveillance.133 In March 1949, the Mental Health Standing Advisory Committee was established under the umbrella of the Central Health Services Council.134 The committee was chaired by Aubrey Lewis and it reflected his commitment to the new psychiatric epidemiology and programmes of preventative psychiatry.135 In 1951, C. A. H. Watts joined the group and began to campaign for the development of a new kind of primary-care psychiatry.136 He argued that

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there was an unrecognized substratum of patients in the general practitioner’s caseload who manifested a variety of anxiety complaints. A four-year study of his own practice in Ibstock, Leicestershire, had revealed that 30 per cent of his list manifested some kind of psychological distress, with 200 new cases appearing every year. From his own small sample, Watts estimated that this would lead to 1.2 million new cases of mental illness appearing annually in the national population.137 Watts’s assessment was questioned by many of his fellow practitioners but his insistence on the distribution of minor forms of mental illness throughout the patient list was widely accepted. Earlier studies conducted at the inception of NHS had varied enormously in their assessment of the extent of psychiatric morbidity, with estimates running from 6.5 per cent to 50 per cent.138 In a series of pioneering studies carried out under the auspices of the College of General Practitioners, John Fry estimated that 10 per cent of his Beckenham patients manifested forms of neuroses.139 J. D. Paullett, working on one of the new dormitory estates outside London, appeared to confirm Taylor’s worst fears when he found that 70 per cent of his practice population presented psychiatric symptoms over a five-year period.140 Anthony Ryle, at the Caversham practice in Kentish Town – a fairly deprived area of North London – came to much a lower estimate of 5–10 per cent in 1960.141 This figure was confirmed in the work of W. J. N. Kessel.142 The data produced in the general practice surveys of psychiatric morbidity had a number of effects. It led in part to a new psychologized conception of primary care.143 It also led to a transformation in the aetiological models used to explain the appearance of psychiatric illness. The early interventions in psychiatric epidemiology, such as those of Greenwood or Halliday, had largely relied on the individualistic models of psychoanalysis and psychodynamic psychiatry. The episodes of childhood repression or deprivation which might blight an individual’s life were simply repeated on a massive scale. In the new epidemiological studies published after the war, changes in psychiatric presentation were more broadly related to the presence of ‘stress’, a catch-all term that had been fielded in the psychobiology of Adolf Meyer but which now took on a new significance. The work of Hans Selye, in particular, on the relationship between the adrenal medulla, the alarm reaction and physiological exhaustion offered general practitioners a new language for connecting the patient’s illness to their environment.144 Encouraged by leading members of the College of General Practitioners, including Desmond O’Neill and Heneage Oglivie (the editor of the Practitioner magazine), physicians turned away from

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the suggestion that psychoneurotic symptoms might reveal some problem of the individual’s hidden past to a new understanding of minor morbidity as a kind of running commentary on the difficulties of the patient’s situation.145 This model changed the nature and meaning of the patient’s neurosis. Whereas psychosomatic illness or psychoneurotic symptoms had previously been seen as a reflection of a buried fault or biographical trauma, they could now be understood as a complaint about the impossibility of the patient’s circumstances. Symptoms were thus transformed into a demand – not for psychotherapeutic explanation or understanding – but for social or political intervention.146 Both aetiology and epidemiology had moved in the direction that Taylor and the early advocates of social medicine had prescribed. Since the patient’s body incarnated a demand for political action, the doctor’s mission moved from the repair of physical function to the reconstruction of the environment. As F. A. E. Crew, the new professor of social medicine at the University of Edinburgh, announced in 1949: ‘today in this country the interests of medicine are becoming focussed on the disharmonies which exist between the biological nature of man on the one hand and, on the other, the social structures and institutions, the political and other creeds which man has invented. Medicine is rapidly becoming a social science and as such is regarded as one of the most potent instruments that a modern society can use in its enterprises in social engineering.’147 Despite Crew’s confident prediction that the medical profession would become ‘architects of a new world fit for homo biologicus to live in’, it was not until 1950, when Taylor’s parliamentary career was cut short by the general election, that he would be able to engage upon this programme of sociobiological reconstruction. After leaving parliament, Taylor was given an opportunity to become directly involved with the creation of a new kind of urban environment: an environment that would be capable of satisfying the animal appetites and emotional emptiness of its inhabitants. This urban utopia was Harlow.

9  Harlow: A socio-psychiatric experiment Harlow was one of fifteen new towns created by the New Towns Act of 1946, although construction did not begin until 1949.148 Its master planning was under the control of the modernist architect, Sir Frederick Gibberd. Taylor acted as one of Gibberd’s commissioners on the board of the Harlow Development Corporation.149 The design embodied the new social hygiene necessary to combat the possibility of suburban neurosis. An Arts Trust was established to

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counter the ‘emotional poverty’ of the residents, bringing in a resident sting quartet and sculptures by Henry Moore and Barbara Hepworth (a corporate raffle prize from the Festival of Britain).150 Social isolation was offset by the creation of ‘neighbourhood units’ of between 3,000 and 5,000 people, which encouraged community interaction and the satisfaction of the population’s latent herd instinct.151 And although many believed that the openness of the new houses’ interior and exterior design stifled sexual opportunity (especially the bedroom picture windows), the rapid birth rate in the young population gave the lie to this complaint.152 The concept of the suburban neurosis that Taylor had first described in his psychological manifesto of 1938 was central to the design of Harlow, yet the new town would ultimately prove to be the concept’s undoing. In 1959, with the support of the Mental Health Research Fund, Taylor began a series of surveys into the psychiatric condition of Harlow’s population.153 He worked with Sidney Chave (1914–85), a postgraduate student who had taken part in the large-scale London School of Hygiene and Tropical Medicine (LSHTM) investigation into rates of illness on an LCC estate in Hertfordshire.154 The Harlow study was set up as a comparator to these earlier investigations. Its aim, as Chave noted, was to see whether ‘the social planning embodied in the new town could lessen the prevalence of neurosis when compared with a typical housing estate where such planning is largely absent’.155 The approach was comprehensive. Surveys were made of the rates of admission to local mental hospitals, of referrals to psychiatric outpatient clinics and of psychological consultations with general practitioners. Market research was undertaken into the inhabitants’ satisfaction with the urban environment and a field investigation was made into self-reported psychiatric symptoms.156 The results, as Taylor and Chave admitted, were surprising.157 Although there was a lower rate of major psychiatric referrals, the rates of primary-care consultation for minor neuroses were roughly equivalent to the rates found in the LSHTM survey, and these again were almost 30 per cent higher that the national averages established by the General Register Office in  1957.158 Furthermore, psychiatric interviews testing for symptoms of nerves, depression, undue irritability and sleeplessness revealed that the incidence of reported complaints was similar to that of the figures produced in Chave’s earlier study of Tottenham – the borough from which most of Harlow’s population had emigrated.159 The distribution of these symptoms did not correlate with the image of the anxious young housewife produced in Taylor’s original work and cultivated in Young and Wilmott’s surveys of East London.160 It was the 45–54-year-old woman who was at greatest risk – and the children that had once been blamed for confining

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the mother to the house were now feted as ‘social catalysts’ bringing about community integration.161 As Chave and Taylor realized, their survey effectively undermined both the psychological claims of new town design and the idea of suburban neurosis from which it had been conceived. They concluded that ‘sub-clinical neurosis is not a product of immediate environment’. Their new claim was that it was a disease entity ‘with its roots deep in the physical or emotional background of the individual’.162 The problem, as Chave later noted, was not one of urban design but of individual recalcitrance: Our search for symptoms has thus enabled us to identify a group of people who displayed the signs of individual and social malaise more than the others. Was this due to the new town? Is this the “suburban neurosis”? The “new town blues” of which we have heard? We think not, we believe that these, the symptoms and the discontents, are all the marks of underlying emotional disturbance; that these are the people who carry their neurosis with them wherever they go and project their inner disharmony upon their environment. But our evidence suggests that such people are to be found everywhere and in about the same proportion if we look for them systematically.163

In their reassessment of the suburban neurosis and the psychological limitations of the planned environment, Taylor and Chave transformed the focus of their analysis.164 Their identification of a stable sector of the population who consistently projected ‘their inner disharmony onto the environment’ directed attention away from the role of environmental influences, focusing instead on the need to refine and calibrate the instruments of epidemiological analysis. If neurosis remained a constant value across the population, then reported variations in its incidence became suggestive of the limitations of the investigative instruments rather than the cultural or the psychological limitations of the built environment. The findings encouraged a new reflexive deployment of the techniques of the survey: a deployment that would lead eventually to a reconceptualization of the life and work of the general practitioner.

10  The reflexive logic of the psychiatric survey Taylor had become aware of the limitations of general practitioner research, and indeed general practice itself, some years before he undertook he psychiatric survey of Harlow. The creation of the NHS had led to widespread and ongoing

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discussion about the nature and direction of primary care in the United Kingdom. The grudging decision of general practitioners to join the NHS in 1948 had in many ways been forced by the flight of patients from private practice. Driven by economic pressure, many practitioners believed that their old freedoms were being sacrificed in favour of new career as salaried servants of the state. In the midst of this disillusionment, the Nuffield Foundation decided to commission a survey on the state of general practice in the United Kingdom.165 The report, produced by a young New Zealand doctor, Joseph Collings, quickly achieved a kind of infamy.166 Collings surveyed 55 practices (16 industrial, 17 suburban and 22 rural), although the selection criteria, as he himself admitted, were simply informal advice and intuition. He started from a belief that the general practitioner had achieved the kind of political authority that Taylor and his colleagues could only dream about, arguing that: ‘In a world of ever increasing management, the powers of even the most senior manager are petty compared with the powers of the doctor to influence the physical, psychological and economic destiny of other people . . . but unlike the manager who exercises his control over whole groups of society, the doctor exercises his is in a microcosm and in relation to individuals; and for this and other reasons he is largely free from the limitations which democratic principles set on the acquisition of power.’167 He regaled his readers with stories of an urban practice where the two practitioners blindly dished out ‘bottles of medicine’ and ‘sick notes’ and the rural practice where the respected family doctor proudly led him on domiciliary visit to present a gangrenous leg that he had been treating for the last year through bandages and bed rest. Although physicians were divided in their reading of the report, and the informal methods used to select the evidential material could be easily criticized, Collings’s approach confirmed that idea that general practitioners could be studied as a population using the same kind of methods that had been deployed to explore the civilian population during World War II. In 1951, the BMA responded to the questions raised by the Collings report by establishing a General Practice Review Committee. Stephen Hadfield, an assistant secretary at the BMA, was commissioned to carry out a field enquiry into the state of general practice. Hadfield’s report resisted the informalism and judgementalism that had characterized the Collings survey, producing in its place a reassuring document that stressed the integration of the general practitioner into the life of the community. Most doctors, he claimed, worked in practices with lists of less than two thousand people, enjoyed friendly relations with most of their patients and benefitted from the solid supports of their wives in the surgery

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and at home.168 Subsequent commentators have tended to regard the report as a missed opportunity.169 In  1951, the Nuffield Provincial Hospitals Trust approached Taylor with a view to undertaking a more thorough analysis of general practice along the lines of the Collings Report. Again the selection of practices under examination was based on informal recommendations rather than on any formal procedure and the overall portrait was a qualitative impression of the forms of best practice. Between February 1951 and September 1952, Taylor undertook interviews and observations with 94 model practitioners, paying particular attention to the technological infrastructure (e.g. the office design or record management systems) that undergirded the physician’s work. Drawing on his own experience in planning the health centre at Harlow, Taylor offered a minute analysis of the correct kind of organization of general practice from the layout of the building through to the appropriate filing systems for record cards. As with the social reconstruction of the new towns, the reorganization of a practice was seen as making possible the reorganization of the physician’s personality. R. J. H. Pinsent, an enthusiast for Taylor’s ergonomic approach, noted: ‘The mind of the doctor will function best if he is at work in congenial surroundings’ and this in turn would affect his practice population.170 As Taylor made clear, the right attitude on behalf of the doctor would encourage the right attitude in the patient. He had little time for those who tried to befriend or surreptitiously control their patients, instead holding up as a model a kind of efficient reserve which reduced the opportunity for psychological interaction. He is brusque and gruff and wastes no word on the lead swinger. Every complaint is investigated with complete efficiency and one has seldom seen patients dealt with more conscientiously or thoroughly. After having dealt shortly but efficiently with a string of miserable moaners, his face will light up as a sick child enters the consulting room, and there will be no tears or difficulty over examination. He has a fairly high degree of contempt for the human race, but the highest standards of conduct in dealing with them. He is respected by his patients rather than popular with them.171

The general practitioner endorsed by Taylor was very different from the psychologically engaged practitioner imagined by Watts and others and his caseload similarly lost the large psychological component that had been identified by many post-war general practitioners. As Taylor noted: ‘It was a surprise to find during the survey how comparatively seldom the good general practitioner diagnoses neurotic illness. Loose statements that between a quarter

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and a third of all presenting illness is neurotic has found no support among the GPs visited or among those who have published analyses of their work.’172 The large estimates put forward for the extent of the psychoneuroses were attributed by Taylor to those ‘psychotherapeutically inclined doctors’ who, confronted by the patient’s natural anxiety over their illness, proceeds to ‘hunt for causes of hidden mental tension and of course there are few normal people in whom such causes cannot be unearthed’.173 In the post-war analysis offered by Taylor and his contemporaries, the source of psychoneurosis began to shift from the ‘anxiety prone patient’ to the ‘psychotherapeutically inclined physician’. Indeed, the post-war general practitioner seemed to acquire many of the characteristics that had once been associated with the interwar suburban neurotic. The long standing failure of the government to establish health centres and the unwillingness of many doctors to engage in group practice created a socially isolated practitioner, whose cultural aspirations were limited to the commercial flyers and advertisements that arrived from the pharmaceutical companies each day. As R. P. Handfield Jones noted, the pursuit of sole practice was a royal road to premature senility.174 And as John Hunt, the indefatigable secretary of the College of General Practitioners warned, good diagnosis was being undermined by the simple reliance of the harried practitioner on the ‘blotting paper reference library’ – free pamphlets and booklets that ‘reaches us at our breakfast tables six mornings a week’.175 The general practitioner, as Taylor insisted, could only be rescued through the adoption of the military insights of operational research.176 His personality would have to reformed and extended through the adoption of new material practices of record keeping and appointment systems.177 The organization of the doctor’s working practice became an object of intensive investigation.178 The tools of epidemiological investigation which had been designed to reveal the relationship between psychological illness and the wider environment were transformed in these post-war analyses into something much more intimate: a kind of microscope which revealed the personal presupposition or practical failings of the individual general practitioner. This created, or perhaps more correctly, helped to reinvigorate a culture in which the doctor’s personality became the central aspect of psychological healing. As we shall see in the next chapter, the psychological project of primary care would move from the restoration of the patient’s identity to the perfection of the physician’s.179

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1  Medicine and the art of living Writing in the Lancet in February 1958, Max Clyne, a Leipzig born general practitioner working in Southall, West London, recounted his treatment of a case of abdominal pain in a 5-year-old girl.1 Clyne’s article was unusual, not so much for its focus on an individual case history (although this approach was beginning to wane by the 1950s) but for the part that his own personality and emotions played in the narrative reconstruction.2 Standard clinical histories tended to efface the presence of the doctor: value judgements were withheld and the approach that elicited specific signs and symptoms was only rarely mentioned.3 Clyne’s article, however, developed into a kind of expository self-analysis in which each of the patient’s symptoms triggered new insights into aspects of his own personality and fragments of his once forgotten past. The practice of medicine was transformed into an ‘art of living’ in which the encounter with the patient led to development of the physician’s personality. Clyne had been called on a Sunday morning and, as he admitted, had been loathe to leave his home. Although the parents claimed that the child was in severe pain and vomiting, Clyne advised the application of a hot water bottle and decided ‘to shave, dress and breakfast before visiting the girl so that I could combine my visit to her with my other visits, without having to go home again’.4 He saw the patient about 1 hour after the initial call. The air of candid confession that surrounds Clyne’s reconstruction of his initial response increases as the case history unfolds. He recognized that his encounter with the sick child came loaded with a weight of parental expectation as well as his own anxieties. A previous consultation over the same girl’s suspected tonsillitis had established the dominant position of her mother, as Clyne acceded to her requests for referral. This encounter, Clyne argued, did not simply establish the context of future interactions, but defined the nature of what he called ‘the patient group’.5

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Parents, child and physician ‘were all’, he thought, ‘in varying measures, affected by the central illness. The peripheral members of the patient-group showed mixed somatic and emotional reactions, commonly anxiety or guilt, or fear of having a similar disease.’6 Clyne’s analysis was thus dependent upon a kind of emotional epidemiology which redefined the boundaries of individual and of the doctor-patient relationship. There was no simple equivalence between the identity of the individual, their desires or their illness; rather, each was conflicted and contested and each made possible and in turn sustained by a wider network of personal relationships.7 The situation was perhaps even more complicated than this. As Clyne’s meditation makes clear, these constitutive relationships themselves helped to create and sustain the emotions. Illness and identity were not confined to the present moment: they stretched back deep into the historical experience of the members of the patient group. Clyne recognized that his immediate advice to the anxious parents (the application of a hot water bottle to the feverish child) had been given without much reflection. It did not, he surmised, ‘arise out of conscious logical reasoning; it must have been derived from unconscious sources, determined by the personal experiences and attitudes of the doctor’.8 In an act of imaginative introspection, Clyne suggested that his initial reaction to the parents’ request had been driven by ‘three major emotions’: anxiety, hostility and guilt which corresponded in turn to his concern for the child; his hesitation over immediate attendance and his ambivalence over his chosen course of action. There was no rational basis for these emotions given the immediate knowledge of the illness. Instead, Clyne deduced ‘that the anxiety, hostility and guilt already existed within the doctor, and were waiting only for a particular confluence of events to stir them up’.9 Clyne’s analysis was very different from the psychological models of medicine developed by the Adlerians, the Freudians or the psychosomatic school.10 The illness in this case did not simply map onto emotional events in the patient’s life. Instead, it triggered a kind of emotional awakening in the doctor, and these awoken emotions came to play a role in determining the course of the illness in the patient. The mixture of guilt, hostility and anxiety experienced by Clyne evoked a memory of the episodes of abdominal pain that he himself had experienced as a child. His parents had attributed the pains to ‘wind’, but Clyne, terrified by the pain and fear of death, saw them as a form of divine retribution for his childish sexual fantasies and his avoidance of scripture lessons. His understanding of the child and his identification with her pain was thus mediated by his own

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childhood fears; indeed, his idea of the child could not be separated from that pain and that in turn undermined the basis of his professional practice. As Clyne explained: ‘Projection of our past and present emotion on to the image of the patient will influence treatment decisions, and gross distortions of the patientimage may lead to technical errors.’11 A snap decision, made in a matter of seconds, collapsed the histories of Clyne’s childhood, his professional relationship with the family and the illnesses of the child into a single complex action.12 In part, this was a demonstration of the magic of the unconscious, which, as we saw in Chapter 2, could be used to disrupt conventional models of chronology and causality. The confusion of the child’s pain and the physician’s anxiety also raised another, deeper problem which had bedevilled the project of psychologized medicine from its first inception. This is the problem of ‘influence’, a loaded concept that was deployed routinely in discussions of psychotherapy and doctor-patient relationships to explain all manner of psychological operations, from placebo effects to hysterical paralyses. Yet the word was rarely reflected upon by those who used it. Its meaning was unstable and its mechanism was imagined in different ways and according to different agendas.13 Like the unconscious, ‘influence’ collapsed together changing physiological ideas, political ideals and problems of professional identity. It was the lynchpin of the new psychologized medicine, yet in the end, the concept’s ambiguity would threaten the very fabric of that project. The shifting meaning of influence, as we shall see over the course of this chapter, allowed the nature of illness, selfhood and treatment to be reimagined.

2  Imagining influence The roots of influence lay in those mesmeric practices discussed in the first chapter of this book, but the concept remained central to political and psychotherapeutic language long after the astrological and magnetic armanterium of mesmerism had been abandoned. In place of the nervous fluids and astral forces that Mesmer had hypothesized, influence was imagined as a form of unconscious connection or communication that guided the health and behaviour of the suggestible patient. The mechanism of this connection remained opaque but this only added to the utility of the idea.14 As the American psychologist, James Mark Baldwin, noted at the end of the nineteenth century: ‘This term is useful from its very generality and vagueness; it applies to physical

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forces, mental elements, moral and social factors of change.’15 Just at the concept of the unconscious provides us with a mechanism for connecting individual behaviour to distant causes, so the concept of influence makes possible new descriptions of personal action and intention. Through the idea of influence, the authorship of individual activities or events is shifted onto other, more powerful actors. By the beginning of the twentieth century, this language and the rhetorical transformations associated with it were well established. The idea of ‘psychological suggestion’, in which an influence was imprinted and enacted, attracted a wide literature.16 It was used to explain all manner of relationships, from the therapeutic to the political.17 Mob protests, political order, mysterious illnesses and miraculous cures were all attributed to the process of suggestion, and through this attribution surrendered to the authority of psychological expertise. Given the inherent slipperiness in the idea of influence, its political utility and its rhetorical power, it is unsurprising that the concept has earned the opprobrium of many commentators on the history of the human sciences. Historians as diverse as Georges Canguilhem, Quentin Skinner and Roger Cooter have questioned the explanatory force of the concept.18 For Skinner, looking for clear criteria that would govern the use of the term in intellectual history, the ascription of influence must be contingent upon the fulfilment of a set of necessary conditions. Influence can only be ascribed, he argues, if the subject under discussion is: (1) known to have received the crucial information from the claimed source, (2) known to have been isolated from any alternative source of the same or similar information while (3) also being incapable of reaching the same conclusion or pursuing the same course of action independently.19 With their emphasis on conscious insight and rational reconstruction, it is difficult to see how Skinner’s criteria could be meaningfully used in the kind of situation described by Max Clyne. Indeed, the whole idea of subconscious or unconscious influences would be ruled out as explanations if we were to employ this prescriptive historiography. As a working method, it has much to recommend it, but it has little relationship to the uses of influence in everyday speech or interactions. From a quite a different perspective, Roger Cooter has also criticized the ideological work of influence as an explanatory category, arguing that this ‘soaky sponge model of the transmission of ideas . . . upholds the cheap fiction of individuality’.20 In its description of certain actors ‘absorbing the thought of others’, it ignores the determinative role of economic and political context, which, Cooter believes, can alone explain the reasons why people adopt particular beliefs at given historical moments. While many might want to contest Cooter’s

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political philosophy, it has the advantage of reminding us of the ideological values inherent in different theoretical models. The ways in which influence and its operation were imagined were not simply pragmatic ad hoc attempts to concretize an opaque and nebulous process; rather, they provided maps of power, discretion and agency which worked to sustain a particular conception of political and social relations.21 There were at least three different models implicit within medicopsychological uses of the concept of influence. The first, in part arising from the language of mesmerism, depicted influence as a kind of infective process. The signs or impressions given off by a dominant character somehow took control of the minds of his or her audience, generating new physical or mental patterns. This, as we shall see, encouraged the idea of a kind of medical ‘svengalism’ in which a masterful physician seized control of the patient’s suggestible body and mind, either filling it with illness or healing its pains at whim.22 The second model presented influence in environmental terms: the cultural atmosphere or historical circumstances of an individual’s existence were seen as shaping the course of their being. This miasmatic model of influence was sketched out in the writings of Victorian intellectuals such as Thomas Carlyle and Herbert Spencer, who stressed the formative effects of milieu on the individual.23 This second conception of influence was formalized in the epidemiological models discussed in the previous chapter and for that reason will only be touched on in passing in the discussions that follow. The third model, however, was of much more direct concern to the identities of doctors and patients in the twentieth century. This model drew on Christian ideas of the exemplary force of personality developed in nineteenth-century theological glosses on the Epistle to Galatians.24 Here, the personality was not seen as somehow surreptitiously intruding into the subconscious life of the patient. Rather, the physician’s character was depicted as a kind of moral template around which the patient reformed their sickened self. This idealized model of personality persisted well into the twentieth century but was much affected by the technical ideas developed in the new discipline of psychoanalysis. As we saw in Clyne’s critical reflections on his own practice, the simple idea of personality as a moral template became complicated by the description of processes such as projection and counter projection or transference and counter transference. These processes lent a new ethical dimension to the practice of primary-care psychiatry: the idea of personal influence, in any of its forms, demonstrated that the patient’s triumph over illness could only be achieved through the physician’s mastery over himself.

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3  The infectious personality of the physician As we have seen, the idea of an unwitting or unconscious form of communication had been developed in the Victorian investigations into spiritualism and psychical research. The extraordinary performances of clairvoyants and mind readers were understood by early psychologists as little more than a heightened form of expectant attention: a subliminal form of observation which detected the minutest changes in demeanour or behaviour and then somaticized a response.25 The hubris associated with the psychological denouement of these supernatural performances and entertainments received probably its most notorious demonstration in 1907, when the striking abilities of Clever Hans, a mathematical wonder horse, were explained. It is worth pausing to consider the case of Clever Hans, for his story has been cited many times in attempts to make sense of the magic of suggestive therapeutics. Clever Hans had been trained by his German owner, Mr William von Osten, to perform incredible feats of mental arithmetic. Mathematical puzzles offered by the audience would be solved and the results announced through the banging of his hooves. His abilities and their pedagogic potential soon attracted the attention of the Berlin Board of Education. On their instruction, he was subjected to two investigations by a twelve-member commission, headed by the experimental psychologist, Carl Stumpf.26 These initial investigations failed to provide any adequate explanation for Clever Hans’s mathematical insights, bar his equine genius. However, a second investigation by Stumpf ’s student, Oskar Pfüngst, revealed that the animal seemed to be responding to minute visual cues unintentionally generated by his audience and in particular by von Osten. When the horse was blinkered and the questioner placed out of sight, Hans lost his mathematical insights. As Pfngst demonstrated, what had seemed to be an example of animal genius or possible telepathy was little more than a trained display generated by the unspoken expectations of his owner.27 The dumbshow displayed by Clever Hans and his owner was seen by many as a model of the unreflective medical encounter. It was an act freighted with signs and implicit instructions that took place in a situation of heightened suggestibility. This belief and the idea of subliminal influence provided rival physicians with a new rhetoric for redescribing the therapeutic achievements of their colleagues. Dramatic cures or exemplary illnesses were attributed to the accidental suggestions of unwitting physicians. The form of this critique resurrected the arguments put forward by Haygarth and Falconer at the end of the eighteenth century, but the implied mechanism was now quite different.28 In

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place of the active imagination described by the Georgian physicians, a form of subliminal communication was imagined taking place beneath the threshold of consciousness.29 This new model had its origins in nineteenth-century France, where the psychiatrists associated with the Nancy School, Hippolyte Bernheim and J. A. Liébault, had countered the work of Jean-Martin Charcot at the Salpêtrière.30 Liébault and Bernheim claimed that the stereotyped behaviour exhibited by Charcot’s hysterics was little more than a trained performance produced through the suggestible patient’s unwitting surrender to the expectations of his or her physicians.31 Charcot, through a simple piece of rhetoric, moved from being the master nosologist of hysteria to a master puppeteer whose patients’ illnesses were simply theatrical performances fielded to confirm his theories. As Freud astutely noted, if Bernheim was right, then ‘all the observations made at the Salpêtrière are worthless; indeed, they become errors in observation. The hypnosis of hysterical patients would have no characteristics of its own; but every physician would be free to produce any symptomatology that he liked in the patients he hypnotised.’32 The rhetoric that transformed Charcot’s reputation also transformed the understanding of hysteria as a disease. Hysteria was redefined as ‘pithiatism’: a morbid phenomenon produced and cured through suggestion.33 The criticisms developed by the Nancy School were publicized in Britain by Joseph Babinski and Arthur Hurst, whose ideas received widespread coverage during World War I. Babinski was a former pupil of Charcot’s who later rejected his teachings; Hurst, a remarkable British gastroenterologist who, in  1907, had studied in Paris with Babinski and Joseph Dejerine.34 In their investigations into apparent cases of shell shock, Hurst and Babinski had both shown that the hysterical anaesthesias that Charcot had so assiduously mapped in his Salpêtrière demonstrations were in fact artefacts dictated by the investigating physician’s own manner of examination.35 Thus Babinski saw the doctor as one possible source of pathological influence and psychogenic infection. In the official British military medical manual on hysteria, he argued that: Doctors themselves do not sufficiently realise the good or bad effects which their statements, comments, examinations and gestures may have upon the minds of their patients, whom suffering, privations and moral or physical commotions have made very responsive to suggestion, doctors, we say, sometimes unconsciously exercise a hetero-suggestion which is all the more powerful as their profession gives them authority.36

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This idea of the pathogenic presence of the doctor was widely adopted by members of the Royal Army Medical Corps.37 An ill chosen phrase or the wrong intonation could undo the patient’s chances of recovery. Thomas Arthur Ross, the Medical Director of the Cassel Hospital, recorded how the excitement engendered by the visit of a voguish London physician caused an epidemic of apparent epileptic attacks in the shell-shocked servicemen he was treating.38 Likewise the pioneer medical psychologist, Millais Culpin noted how his own use of electrical equipment in the investigation of limb injuries was likely to produce an anaesthesia or paralysis, even if the recording apparatus was turned off.39 These arguments were incorporated into a growing British critique of the emergent discipline of psychoanalysis. In his Croonian Lectures of 1919, Frederick Golla, pathologist at the Central Pathological Laboratory at the Maudsley Hospital, argued that the psychological associations produced by the analytic subject were not the product of any endogenous neurosis but reflected the unspoken agendas of their psychotherapeutic interrogators. The analyst’s intense focus on the patient’s performance meant that the subtle flicker of his eyes, or the changing inflection of his voice, could elicit evidence of a classic sexual neurosis just as easily as a mathematical solution could be produced in Clever Hans.40 For Golla, the evidence produced in the psychoanalytic encounter held the same implication as the early telepathic experiments conducted by the SPR. The initial excitement over the apparent acts of thought-transference was revealed in these investigations as nothing more than the mind-readers’ ‘interpretation of signs, consciously or unconsciously imparted by the touches, looks or gestures of those present’.41 This misplaced excitement over the accidental products of slipshod investigations was, Golla believed, the distinguishing feature of psychoanalytic research.42 The concept of suggestion undermined models of illness, clinical practice and the fundamental idea of the patient’s autonomy. Thus it was hardly surprising that many early commentators on shell shock presented suggestibility as a pathological phenomenon.43 It was seen as a reversion to a primitive form of communication – the herd instinct – which sustained the same sort of mindless group coordination experienced by the Melanesians and the South Sea Islanders that Rivers and colleagues has studied at the end of the nineteenth century.44 But by the 1920s, with the rise of mass culture, a more resigned view took hold. Suggestion began to be seen as a ubiquitous presence which insinuated itself into every encounter and each aspect of social life.45 Writing in The Lancet

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in 1920, Robert Armstrong Jones, the ex-superintendent of Claybury Asylum, attributed most of the recent changes in clothing fashion, arts, food, crime and medical technique to the power of suggestion.46 This conviction that suggestion was a ubiquitous presence had a number of effects on medical practice. First, it encouraged a new scrutiny of the doctor-patient relationship for evidence of possible psychological traffic. Second, it led to the importation of basic techniques developed in early twentieth-century practices of positive thinking.47 For many doctors, the practice of positive thinking was little more than common sense. G. E. S. Ward recalled how during World War I he had made naval officers write out ‘there is nothing the matter with my heart’ and place the note in a prominent position in their cabin.48 Hayden Brown, who championed a form of adapted suggestion that he termed ‘neuroinduction’, argued that the process simply involved the encouragement of the highest centres of nervous activity. This could be achieved by the practice of a kind of progressive relaxation so that the patient’s mind lost its distractions and focused on the physician’s instructions.49 Alfred Betts Taplin at the Liverpool Psychotherapeutic Clinic endorsed a similar method.50 Clifford Allen, a proponent of modified psychoanalysis, encouraged his psychotic patients to mentally rehearse an account of their conflicting desires before falling asleep, claiming that this would produce cathartic dreams.51 There was little agreement over the physical scope of suggestion. Brown and Hopewell Ash claimed that it could be deployed in the removal of cancerous growths; others reported more success in removing warts and many simply believed that suggestion should be deployed as a form of additive therapy.52 In interwar medical literature, suggestion was depicted as a very shallow form of psychotherapy. Although its actual mechanism remained opaque, the subject was presented in common sense terms.53 Many practitioners drew upon the definition put forward by William McDougall, the dominant force in respectable popular psychology, who insisted that suggestion was simply ‘a process of communication resulting in the acceptance with conviction of the communicated proposition in the absence of logically adequate grounds for its acceptance’.54 The most determined advocate of this model was William Brown, who succeeded McDougall as the Wilde Reader in Mental Philosophy at Oxford.55 Brown developed a model of therapy as a contest between the pathogenic ‘autosuggestions’ of the neurotic patient and the rational ‘heterosuggestions’ of the physician.56 This model of a kind of inner contest enjoyed a wide uptake in popular psychology. Plays, novels and self-help guides gave detailed portrayals

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of the seductive power of the physician’s personality and the transformative effect it could have on both individuals and communities.57 The popularity of the suggestive methods lay in part in the fact that they maintained some semblance of the professional relationship between doctor and patient. However, the rational basis of this relationship was open to negotiation. Suggestion stood on a continuum between persuasion – in which the patient rationally acceded to the logic of the physician – and hypnosis, in which an irrational appeal was made to the unconscious mind.58 The therapeutic process, from this perspective, was transformed into an episode of psychological domination. Thus hypnotic treatments in which the client surrendered conscious control of his or her faculties were largely marginalized within the profession.59 The practice remained faintly scandalous, being associated in the popular mind with showmanship, fakirism and the promise of sexual opportunism.60 Yet the conscious and rational bases of suggestive methods raised their own problems. As many physicians noted, if efficacy moved from the use of the drug to the manner in which the doctor deployed it, then it became difficult to separate medical practice from mere everyday talk. Moreover, if mere talk enjoyed this therapeutic or pathogenic potential, then each aspect of the doctor-patient interaction became freighted with a new medical significance. The magic of influence could not be contained. As the veteran investigator, Thomas Walker Mitchell, commented in 1927, ‘Hypnotism was declared to be an unclean thing and suggestion without hypnotism was felt to be too like the waving of a magic wand to be respectable.’61 The disciplinary implications of the new suggestive methods were brought home by the Coué craze of the early 1920s. Émile Coué’s simple method of auto­ suggestion through positive incantations (‘Everyday in every way I get better and better’) did much to popularize a primitive model of psychosomatic medicine among the reading public, but this model made only limited inroads into the profession.62 His two visits to England in 1922 met with a lukewarm response in the medical press.63 The Lancet complained that Coué replaced the complex medical work of diagnosis and treatment with a blanket of sympathy: ‘In the ready acceptance of suggestion as an explanation of cause and cure we see the workings of comforting words in the place of knowledge. Suggestion is commonly regarded as a source of energy – a tank of fairy petrol to be tapped by incantation . . . The process is so common that it influences a great part of our beliefs and opinions, and by the generality of its occurrence it become valueless for particular pathological explanation. “What explains everything,” the Lancet complained, “explains nothing.” ’64

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4  The infectious physician as a basis for ethics Despite this editorial assertion of the vapidity of suggestion, the idea of its presence, as previously noted, complicated each aspect of the therapeutic relationship and clinical practice.65 The Bethlem psychiatrist, Charles Stanford Read, warned general practitioners in 1934: ‘Consciously or unconsciously the physician is constantly employing it [suggestion] in connexion with his patients, and not infrequently this influence is neglected or misused. The expression of the doctor’s face, the tone of his voice, the conviction of his assurances, and this expression of opinion on his patient’s symptoms are all potent suggestive influences working for good or for ill.’66 The preoccupations of the physician threatened every aspect of clinical research and public health. Lecturing students at St Thomas’s Maurice Cassidy jokingly explained that if the nation’s vitality was to be preserved, then the medical profession would have to be abolished, since despite its useful work on ruptures, fractures, malaria and syphilis, the net effect of medical research had been to increase the anxiety and suffering of the population as they repeatedly measured their blood pressure and palpated their torsos for signs of a dropped stomach.67 In response to these problems, doctors developed a number of practical and conceptual strategies. At a prosaic level, there was a new emphasis on managing the information available to the suggestible patient. Harry Banister, a Cambridge psychologist and consultant to the Papworth TB colony, urged doctors to develop the skills of poker players so that they wouldn’t broadcast unwitting hints.68 Likewise medical educators, such as Ralph Noble, warned of the pernicious effects of overheard conversations on ward rounds and the Lancet reported on the suicides of curious patients who had surreptitiously examined their medical records.69 In the advice given by Banister and Noble, we can see how the emergence of new psychological objects created the terrain for a new conceptualization of professional ethics. The phenomena created and materialized in psychological, neurophysiological and psychiatric research – anxiety, stress, influence and the unconscious – provided new benchmarks against which moral decisions and individual behaviour could be judged. The changing pulse rate recorded by the electrocardiograph demonstrated the tension created in patients by a boorish practitioner’s interview technique. The emergence and disappearance of a delta rhythm recorded on the EEG revealed the possible flicker of attraction in the patient.70 The search for physiological correlates of emotional

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and intellectual change provided a rich range of markers through which the physician could assess not only their patient’s inner state but the unspoken effects of their own personal style on those they treated. Moreover the new psychosomatic models of illness promoted by Selye, Alexander, Dunbar and others provided a conceptual framework which linked these emotional and physiological changes to the emergence of chronic physical illnesses.71 An ethic which had been grounded in a humanist system of universal values was now surrendered to a new morality based on the evidence produced through biochemical, psychological and electrophysiological technology. Examples of this new ethic could be found throughout the interwar period. In 1931, Walter Langdon Brown argued that the physical consequences of fear and the pathological effects on the body of the over-stimulation of ephedrine or adrenalin meant that the irrational demands of the patient’s physiology would have to override the doctor’s ethical commitment to truth and honesty.72 A year later, Hugh Crichton Miller, the honorary medical director of the Tavistock Institute, warned that the modern physician would have to turn to the ancient duplicities of the savage witch doctor if he was to save the patient from the damage of an ungoverned parasympathetic nervous system. The old magical techniques of ‘fictitious explanation, fantastic activity and reassurance’ were needed to control the sufferer’s ‘epinephrine output’ which threatened oesophageal constriction, valvular irregularities and tissue inflammation.73 The space between doctor and patient was further complicated by the invention of new psychological concepts. Newly coined words such as ‘empathy’, ‘transference’ and ‘projection’ (in its psychological sense) transformed what had been a professional interaction into an encounter that was heavy with emotional possibility.74 The doctor and patient were not involved in a simple analysis of each other’s behaviour; rather, their responses were overlaid with elements of memory and fantasy.75 In the interwar years, this was mainly seen as the patient’s problem. The little that general practitioners did borrow from Freud was an awareness of the sexual agendas that might underlie both the development and treatment of a patient’s illness. More psychoanalytically inclined practitioners went slightly further, arguing that the patient’s attachment to the doctor could undermine the possibility of cure.76 Henry Yellowlees, the Superintendent at the York Retreat who maintained a sympathetic interest in Freudian theory, complained of the ‘psychosexual dependence’ which developed in patients who surrendered themselves to the physician’s suggestive influence.77 At the same time, Thomas Ross argued that

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these patients were likely to use their illnesses as part of a strategy to maintain the doctor’s interest. Ross wrote: A more serious thing which may prevent the disappearance of symptoms, is that the patient leans too much on the doctor. This leaning may be only the natural leaning of the weak on the strong, or it may be due to pleasure in being in his society which may amount to being in love with him.78

As William Jago, psychoanalyst and physician at the London Neurological Clinic, warned family doctors: ‘Transference is a good servant in psychotherapy but a bad master in general practice, and to overlook the possibility of its existence may spell disaster to the medical man.’79 Male or female patients might use the doctor to satisfy long-held sexual fantasies of exposure, and the care regime provoked by imagined symptoms utilized to recreate the patterns of domestic submission they enjoyed in their childhood home. The rhetoric placed awkward patient behaviour firmly within the realms of the irrational. By the 1930s, such ideas were common currency. The Anglo-Welsh nature mystic, Margiad Evans, in her remarkable cystitis memoir, The Wooden Doctor (1933), relates in great detail how the course of her illness was bound up with the attraction she felt towards her general practitioner.80 She connects the onset of her infection to the initial affinity she feels towards him and eventually recognizes that the doctor’s many attempts to treat the disease have been thwarted by her desire for him. The cystitis forces him into activities which would normally be the province of a particularly brutal lover but, as Evans recognizes, the practitioner refuses to offer the one thing that could remove her suffering – his personal commitment to her. The novel ends with no hope of a cure in sight.81

5  Insulating the physician If the patient’s illness was a reflection of the physician’s individual style and personality, the results were not always pleasing. As the Broadstairs doctor, Martin Raven, suggested in 1932, the therapeutic process could be likened to an artistic endeavour in which one projected one’s identity onto the patient’s illness: ‘If one considers the medium – whether poetry, music, architecture, painting – through which the artists work in order to project their minds into the minds of others, it will be found that it always has something which we can “pattern” . . . In so far as we deal with [patients] scientifically we treat them as objects of rational

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diagnosis and/or rational or empirical treatment but when we get beyond the relatively simple sphere of management we automatically fall back on our art. It is then upon the way in which we behave to them, not so much upon how they react, that the restoration of their physiological and psychological pattern depends; the patient’s personality becomes our canvas. The pattern which we leave there will correspond to some extent to the pattern existing in our minds.’ However, as Raven noted, in the absence of cure, the finished work might be a sad indictment not just of the physician’s artistic or clinical skill but of his own pathogenic identity.82 The distaste that many doctors felt when confronted with the effects of their personal influence on the bodies of their patients is apparent in the shifting models of persuasion and cure which developed throughout the interwar period. At one level there was a general fear of anything approximating to a direct personal relationship between doctor and patient. Modernists such as Henry Brackenbury, the vice chairman of the BMA, might insist that the new holistic emphasis of medicine had revealed that ‘the relationship between doctor and patient is not merely between two persons but two personalities’.83 However, more cynical commentators, including Hugh Crichton-Miller, director of the Tavistock Institute, noted that few doctors would attribute a cure directly to the effect of their personality on that of a patient, although many were happy to subject the patient to their will under the disguise of placebos or pills.84 Many psychologically minded doctors seem to have agreed with W. H. R. Rivers that the goal of therapy was to undo any level of intimacy in the doctor-patient relationship and instead induce in the patient a new level of independence and self-reliance.85 Speaking at the RSM in  1923, Mary Bell argued that whereas the older generation of doctors had sought to impress upon the patient the authority of their individual personality, modern doctors encouraged independence by seeking to create a division between the patient and themselves.86 This attempt to erect some kind of emotional quarantine between doctor and patient was facilitated by the adoption of new model of influence – a model which attributed the doctor’s therapeutic achievements to his or her moral integrity.

6  The exemplary physician This process of insulating the physician from the patient was reinforced by the adoption of alternative understandings of the curative influence. Against the

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scientific idea of cure as a form of direct intervention, many of the Adlerian writers of the 1930s sought to return to the theological model of the physician who influences through the power of his or her model character.87 Late Victorian writers such as the Metropolitan Police Surgeon and sometime demonologist, Arthur Taylor Schofield, had claimed that the moral example of the physician had an immediate reformatory effect on the patient’s life.88 As Christ had banished demons through the force of his personality, so too did the example of the modern physician encourage nervous or neurasthenic patients in their recovery of health and identity.89 As Schofield wrote, ‘the moment the eye of the patient meets the eye of the physician, psychological action influencing the course of the disease at once takes place through the course of the patient’s mind’.90 This idea of the moral power of physician’s personality was developed in the work of Maurice de Fleury, whom Schofield greatly admired. De Fleury forecast a time when the medical profession and the personalities of its members would be transformed through a process of moral growth. As de Fleury noted: ‘a day will come when there shall arise an upright and intelligent physician, strong enough to defy ridicule, and authorized by a noble life and the merit of his labours to lay a claim to the superior dignity of a moralist’, and such a ‘sound medical moralist might be able to double the amount of voluntary energy and moral strength in us all’.91 Schofield’s idea was rooted in the language of quality and incommunicable knowledge that Christopher Lawrence has identified with the practice of patrician medicine in the nineteenth and twentieth centuries.92 Certainly Schofield drew his Christian model from the writings of John Russell Reynolds, the president of the BMA and the Royal College of Physicians, who argued that the doctor’s personality stood in direct imitation of the healing example of Christ.93 Others employed more prosaic models, seeing the physician’s identity as reflection of various chosen ancestors from Hippocrates to Jenner.94 In his Harveian Oration, Sir Dyce Duckworth, personal physician to the Prince of Wales, claimed that the fellows of the Royal College of Physicians, were knit together in the image of Harvey and held up the form of his character to influence and restore the sick lives of their patients.95 The most energetic advocacy of this moral understanding of the physician’s personality occurred in the writings of Harry Campbell, who worked as editor of the Medical Press and Circular from 1918 to 1933.96 In his standard work, On Treatment, which went through many editions between 1907 and 1930, he outlined the physical and mental qualities demanded of the effective physician.97 The exemplary practitioner needed to demonstrate a hale demeanour and physical vigour which would act as tonic inspiration on the patient’s debilitated

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state.98 Campbell was more prescriptive in his assertion of the mental qualifi­ cations needed: ‘he must be business like; he must have a knowledge of men and things; he must be authoritative, so that he may enforce his orders; he must impress his patients with his ability, so that his words shall carry conviction; he must be able to inspire hope where hope is failing; and he must be tactful; he must have a kindly personal manner that makes a patient feel his case is of special interest, not a mere item in the day’s work; he must moreover, know how to create some sort of interest, and even enthusiasms in the patient for the treatment prescribed: it is no small gain when we have made our patient work with us in the in the cure of his complaint. Last but not least, he must be duly endowed with sympathy and geniality.’99 By the 1920s and 1930s, this emphasis on the moral status of the physician’s personality had become a standard trope in medical school celebrations – receiving particular attention in the works of the English Adlerians. In  1925, George Robertson, the President of Royal College of Physicians of Edinburgh and an enthusiastic convert to Freudianism, reminded graduating students, that: ‘the most valuable asset of the physician is personality. Its influence in sickness is mental healing and it is of greatest value when trained and directed . . . You all have within you a psychic influence more powerful to relieve and more helpful in sickness than all the drugs in the British pharmacopoeia.’100 Two years later, F. G. Crookshank, in his small book on Diagnosis and Spiritual Healing, argued that the individual’s innate capacity for repair could only be released if the sick were to encounter the ‘objective personality of a physician . . . a personality marked by an ethical or moral superiority’.101 This personality was effective, not because of its magnetic power as the Victorians had thought, but because of its ability to inspire a therapeutic emotional response in the patient. Crookshank’s position was shared by many of the Adlerians, such as C. M. Bevan Brown and Langdon-Brown, as well as some of the more eclectic Freudians like MacDonald Laddell, Ian Suttie, Henry Yellowlees and Eric Graham Howe.102 Eric Graham Howe was probably the foremost propagandist for this position. An aristocratic theosophist and Honorary Physician at the Tavistock, he had set up one of the first postgraduate psychotherapy courses for general practitioners.103 In his lectures he repeatedly raised the problem of the physician’s personal sense of inferiority and the dangerous effects of the various defence mechanisms which might be used to disguise these feelings of inadequacy during the process of treatment.104 Examples of this (according to Howe) included the doctor acting as if he or she were omniscient or the prescription of panaceas which might do more harm than good. The doctor’s emotional state inspired a corresponding

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response in the patient. The magnetic influence which passed between mesmerist and entranced subject had been replaced by a new traffic in emotional signs and physical reactions. The idea of the doctor healing through personal example was, of course, rooted in the Gospels of Luke and Mark, but in the interwar period, a new secular understanding of the process became well established in popular theatre and fiction. One West End hit of the time was Granville Barker’s translation of Jules Romains’ play, ‘Dr Knock’, depicting how the arrival of new doctor inspires new levels of physical awareness and health consciousness among the population of a French village. This consciousness transforms the lives of his patients and eventually leads to the breakdown of the doctor’s sense of self.105 Sidney Daukes, a librarian at the Wellcome Institute, explored the same theme throughout the 1930s. Writing under the pseudonym, ‘Sidney Fairway’, he described the suggestive potential and crises of faith suffered by errant charismatic doctors.106 A more sophisticated version of the theme was presented in Private Worlds, published in  1934. The author, Phyllis Bottome (an enthusiastic champion of Adler’s work), explored the effect of staff relationships on the patients of a modern English mental hospital.107 In contrast to previous examples of mad literature that concentrated on the eccentricities of individual lunatics, Bottome focused on the minor complexes and frustrating anxieties of a small number of doctors and their families as they struggled to overcome habitual defences and achieve fulfilling relationships. In her novel, the patients can only begin to recover once the doctors have themselves achieved personal happiness. Bottome’s work won a wide readership: it was the seventh most popular work of fiction published in 1934 and a year later was released as an Oscar-winning film.108 Bottome’s novel pointed to a wider transformation brought about by the change in models of influence. It turned the work of suggestive therapeutics from a kind of psychical engagement with the expectations of the patient into a new moral project in which the physician perfects his own character to ensure its efficacy as a curative agent.109 This moral project overlapped with earlier work on the pathogenic potential of the physician’s personality to create a situation in which the doctor-patient relationship and the patient’s illness are both imbued with a new significance. The course of the patient’s illness under treatment no longer simply reflected his or her own psychological history: it also provided a surreptitious assessment of the personality of the family practitioner. In the changing models of emotion and influence deployed in British general practice, we can thus trace the emergence of deeper and more complex understandings of power and subjectivity in the doctor-patient relationship.110

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In early British psychotherapeutic and anti-psychoanalytic writings, the idea of suggestion was used to police the physician’s behaviour: it highlighted the danger of methods of interview and diagnosis which might generate artefactual forms of psychological and psychosomatic distress. By the time of World War II, the emphasis had changed. The resurrection of Christian notions of a personal exemplar meant that threats of illness or the promise of cure seemed to arise not so much from the physician’s behaviour as from the structure of his personality.111 As had been the case with the development of general practitioner epidemiology, the limitations of therapy revealed the need for the physician to achieve selfmastery. This project of moral reformation was attempted in several ways. As we saw in the last chapter, many general practitioners believed that it could be achieved through an ergonomic intervention in which the reorganization of office life would lead to the reorganization of the doctor’s personality. The Freudians, in contrast, believed that transformation could be achieved through sustained acts of introspective self-analysis; and it was in the work of the Hungarian psychoanalyst, Michael Balint, and his followers that this idea of a general practitioner psychotherapy would receive its clearest exposition.

7  The personality of the doctor Although many interwar commentators believed that the shape of the doctor’s personality could be traced in the illnesses of their patients, its actual content, for the most part, remained beyond the realm of scientific research.112 However, the outbreak of World War II and the rise of the welfare state saw a renewed attempt to resolve the personal characteristics of the physician into a quantifiable object. In 1942, the War Office introduced a system of formal psychometric testing to its Officer Selection Boards (WOSBs).113 These represented a considerable advance on the techniques developed by the by the Medical Research Council (MRC)sponsored Industrial Health Research Board and the independent National Institute for Industrial Psychology during the interwar years. Whereas the industrial psychologists had concentrated on the measurement of speed, fatigue and dexterity, the WOSBs attempted to isolate fairly nebulous characteristics in the candidate: neuroticism, leadership qualities and ability to maintain personal relationships under stress. In the wake of the Goodenough and the Royal College of Physicians reports on medical education, there was wide excitement over the possibility of importing these techniques into the procedure for student selection.114 The Medical Research Council funded a pilot study at their Applied Psychology Unit in Cambridge

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to investigate the most effective tools for quantifying the potentialities of the undergraduate personality.115 The Mill Hill Inventory for neuroticism, designed by H. J. Eysenck, was considered at Aberdeen and St Mary’s Hospital, London.116 Similarly, at Oxford, R. W. Parnell’s attempts at a mass health screening of the student population revealed that minor anxiety disorders occurred in  13 per cent of the students.117 The efforts of the psychometricians were met with scepticism by many medical commentators. It was seen as another attempt to turn the autonomous practitioner into an efficient cog in the bureaucratic machine of the welfare state. Conservative physicians turned in response to the old patrician language of incommunicable knowledge. Speaking to the new entry of medical students at Sheffield University in 1948, four months after the institution of the NHS, Lord Horder warned them not to sacrifice their human qualities to the education system: ‘Industry can never be a substitute for sensitivity. When you begin the study of medicine, many of you possess the power of fine appreciation and delicate discrimination. Don’t try to “douse” it. Don’t be ashamed of it. It is of tremendous service if transmuted through the personality of a good doctor.’118 At the same time, the writer of the ‘In England Now’ column in the Lancet confessed his despair over the possibility of psychological testing, arguing that such methods could never capture the gift of empathy that was integral to the practitioner’s whole outlook and identity: ‘the one gift a G. P. must have or acquire is of being able to put himself in the patient’s place – see with his eyes the sordid hopeless scene, hear with her ears the cry of the unborn, feel the longing behind the placid face, be in the factory where it happened, sense the closing walls of circumstance, glimpse the coloured toy that is the end of all desire, know the slow winding sheet of toxaemia, the hope that flickers in old age and death, and the fear that has no feared thing. In short sym-pathy with a hyphen, a subject not in the curriculum.’119 Despite their avowed opposition, the psychometric approach and the patrician rhetoric shared a common faith in the significance and centrality of the physician’s personality. And this belief in the therapeutic importance of the general practitioner’s personality would have wider political ramifications. Just as psychological arguments had been used to justify political decisions in the midst of post-war reconstruction, so too did doctors turn to the language of psychology to underwrite the case for a more generous system of financial support.120 The creation of the NHS had in many ways undermined the personal prestige of the family practitioner. Although GPs maintained their status as independent contractors within the system, the formalization of the divide between hospital

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and primary care had left the practitioner as a gate keeper and supplicant to the specialized services offered by the hospital consultant.121 The demoralization engendered by this division has been widely commented upon.122 The sense of distress was reinforced by the findings of the Collings Report (discussed in the previous chapter), which described the disastrous condition of English primary care, and was later epitomized in the well-rehearsed jibe by Lord Moran that a general practitioner was nothing more than a would-be consultant that had fallen off the lower rungs of the ladder.123 The language used to contest this situation was for the most part psychological. Instead of referring to professional rights or honour, general practitioners problematized the developments through reference to individual morale and personal prestige. In 1950, the BMA established a committee under the direction of Sir Henry Cohen (later Lord Cohen of Birkenhead) to examine the status and training of general practitioners in the United Kingdom.124 Cohen concluded that the status and prestige of the general practitioner should be equivalent to that of a hospital consultant and emphasized that the expertise of the general practitioner lay in their achievement of a full personality. As the report noted: An enumeration of the desirable personal qualities of the ideal general practitioner reveals that only a superman could possess them all. He should have inexhaustible tact, wisdom, patience, discretion, and that “impeturbability” which Osler placed in the forefront of the qualities of a physician or surgeon. He needs to be gentle yet firm in speech and action, and his manner must inspire confidence and trust. He should have a kindly, humane approach to his patient and, however pressed he may be for time, each patient should be made to feel that his illness is of real concern to the doctor. The general practitioner needs a deeply imaginative sympathy which enables him to understand his patients’ fears, anxieties, pain and discomfort.125

The general practitioner was thus encouraged to embark upon a project of therapeutic self-fashioning, in which the perfection of his inner life led to the physical and mental redemption of his patients. Although the project was ambitious, the methods used to achieve it remained prosaic. The members of the Cohen committee recommended literature as a tool for self-cultivation and urged the practitioner to acquaint himself with the wisdom of the Western canon: As a man of culture with an interest in the general trends of national life, he should read some of the more important books dealing with contemporary affairs and with work in other professions. And he will no doubt wish to indulge in a little of the ephemeral literature of the day. But, and this is most important of all, the

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general practitioner must retain his acquaintance with those imaginative and creative works of permanent value, “the best that has been thought and known,” which represent the highest reaches of the human mind and “contain a potency of life.” Communion with the great poets and dramatists and philosophers can bring, as can no other medium, consolation and mental refreshment after a day’s toil and confirm the practitioner’s faith in the human spirit. It contributes towards the maturing of that cultivated intellect which, Cardinal Newman says, “brings with it a power and grace to every work and occupation it undertakes.”126

The identification of general practice with a form of ethical self-cultivation was supported by Theodore Fox, the editor of the Lancet. In his Croonian Lectures on ‘professional freedom’, he argued that the profession could only be saved from being reduced to the level of mere medical technicians through engagement in a kind of state-funded bildungsroman: Never, I believe was there more need that the doctor should be a cultivated person, respected for his own sake and for his knowledge of men and things, whose way of life gives him leisure and balance and a chance to reflect. Even if little can be done about it today, let us note that professional freedom should include freedom from overwork and financial anxiety on the one hand – and from too many household duties on the other. If I may coin another Arab motto, “Wisdom is born in the bath but dies in the sink.” There is a real danger that our rulers will foolishly think in terms of medical technicians, not of physicians – of quantity, not of quality.127

In many ways the arguments put forward by Cohen, Fox, Horder and others were extremely successful.128 In March 1952, Mr Justice Danckwerts concluded his investigation into the remuneration of general practitioners. He recommended that if the family physician was to maintain his status among the professionals, the central funding pool would have to be increased by roughly a quarter, to £51million. The government acceded to his recommendations, but used the award to encourage changes in practice organization. Loans were offered to modernize surgeries, list sizes reduced (to a maximum of 3,500) and recruitment increased, with over 800 doctors entering general practice in the following year. At the same time, the public image of the practitioner seems to have been re-evaluated in turn. Stephen Hadfield, engaged on a survey of general practice very similar to that undertaken by Collings 3 years before, found that 9 out of 10 patients regarded their doctor as a family friend.129 The family doctor was no mere dispenser of state services. He or she was a trusted confidante, a friend who pursued the best interests of the patients and followed them through their personal trials and tribulations.130

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8  The project of therapeutic friendship Changing models in politics and therapeutics thus conspired to create a new emphasis on the interior life of the general practitioner and the erotics of the doctor-patient relationship. And for many, the erotics or psychological dynamics of this relationship could not simply be rescued, as Taylor and Pinsent had suggested, by moving the surgery furniture or displaying a stuffed trout in the waiting room.131 Many doctors, especially those returning from work in the forces, searched for a way of deploying the insights associated with psychotherapeutic work in their own practices. In part, this demand for psychological training was stimulated by the new findings on the extent of neuroses in general practice populations and arguments over incorporation of humanist insights into medical education.132 As Clyne recorded, he had first approached the Tavistock for postgraduate training in psychiatry, and the nature of the course offered in general practitioner psychotherapy came as something of a surprise.133 The Tavistock course was established in 1950 by Michael Balint, a Hungarianborn psychoanalyst, and Enid Edmonds, a family welfare worker in training with John Rickman.134 Balint and Edmonds married in 1953 and their combined intellectual and social pedigrees established much of the agenda that would come to characterize the Tavistock training. Balint had trained in the 1920s with Hans Sachs, who promoted analytic approaches in psychosomatic medicine, and Sandor Ferenczi, Freud’s radical protégé who did much to highlight the issue of counter-transference within the analytic community.135 Edmonds was involved in the Family Welfare Association and turned to the Tavistock in an attempt to introduce a more psychoanalytic sensibility into British social work. The course they devised drew upon the example of the Family Discussion Bureau that Edmonds had developed to train social workers in family counselling. The organization of the course borrowed from the supervision analyses that Ferenczi had developed in Budapest and the forms of group therapy perfected by S. H. Foulkes and Joshua Bierer at Northfield.136 Balint appealed for trainees in the Lancet. Fourteen practitioners attended the initial course.137 At a primary level, the problems facing Balint’s group were the same questions of suggestion and influence that had bedevilled psychiatric, psychoanalytic and general practice throughout the twentieth century. The group was concerned with limiting the implication of the physician in the patient’s symptoms. The original psychoanalytic approach had encouraged the analyst to aim for a kind of machinic neutrality, in which the open talk of the subject’s free association was

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matched by the open listening of the analyst’s mind. Freud urged the therapist ‘to bend his own unconscious like a receptive organ toward the emerging unconscious of the patient, be as the receiver of a telephone to the disc. As the receiver transmutes the electric vibrations induced by the sound waves back again into sound waves, so is the physician’s unconscious able to reconstruct the patient’s unconsciousness.’138 This ethical project of honing the techniques of empathy and perception, which Freud encouraged among his fellow analysts, was complicated by the process of counter-transference. In his early writings, Freud had recognized that the analyst’s interpretation was always limited: ‘no psychoanalyst’, he insisted in 1910, ‘goes further than his own complexes and internal resistances permit’. For this reason, he advocated a process of ongoing self-scrutiny, in which the analyst assessed his or her own inadequacies and limitations.139 Balint followed his mentor, Ferenczi, in his belief that the process of transference and counter-transference could not be contained.140 This idea had assumed a central position in post-war discussions in British psychoanalysis, and was not a pessimistic conclusion. Rather, it opened up the possibility of a new technical project in which this persistent influence could be incorporated into the therapeutic armoury of the physician.141 Balint famously developed this notion in his conceptualization of the doctor as a form of drug but, as he made clear, in the absence of informed psychoanalytic insight, the use of this pharmaceutical would remain empirical: its operation remained mysterious and it could only be judged on its results.142 As Balint noted: ‘no guidance whatever is contained in any textbook as to the dosage in which the doctor should prescribe himself; in what form, how frequently, what his curative and his maintenance doses should be and so on. Still more disquieting is the lack of any literature on the possible hazards of this kind medication, on the various allergic conditions met in individual patients which ought to be watched carefully, or on the undesirable side effects of the drug. Despite the long established use of personal influence in healing, the paucity of information on the process compared unfavourably with the wealth of information on recently introduced drugs of the current pharmacopoeia.’143 Balint located the specificity of the ‘drug doctor’ in what he called ‘an apostolic function’. This is a process in which the doctor attempts to win the patient over to the doctor’s understanding, and through that contest organizes the patient’s symptoms into a fixed pattern that will determine the trajectory of his or her illness.144 This ‘apostolic zeal’ or overpowering influence arises in part

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as a defence mechanism, allowing the general practitioner to avoid the pains of self-examination.145 Similarly, the therapeutic use of reassurance by the doctor is seen as another form of defence, in which the general practitioner avoids the humiliation of having to acknowledge his ignorance or impotence. In the account of the doctor-patient encounter developed by Balint and his trainees, diagnosis and treatment are reduced to a kind of game in which doctor and patient negotiate the symptoms and the course of the illness, each player being handicapped by various psychological inadequacies.146 The physical illness, which in the early models of psychosomatic medicine had been presented as a medium through which various unconscious agendas or fantasies were acted out, was now subsumed into a single psychological condition – the child’s loss of love during infancy – that Balint termed the ‘basic fault’.147 Although many historians interpret the post-war British psychoanalytic interest in childhood affection in terms of the wartime experiences of evacuation and separation, Balint proposed the basic fault as a universal mechanism that drove the presentation of illness.148 The doctor-patient encounter was not so much the complex expression of some hidden wish but the fulfilment of a basic need for attachment, and the provision of the training groups in turn served the individual practitioner in his or her own insecurities and anxieties. Thomas Osborne has argued that Balint’s training seminars were part of wider Tavistock agenda to ‘mobilise psychoanalysis’ and place it at the heart of post-war reconstruction. In this aim, the scheme was only partially successful.149 Balint’s initial recruits included many of the most significant individuals in academic general practice and by 1962, five courses were in operation at the Tavistock, three at the Cassel and eleven others were being run on a fairly informal basis by general practitioners in Ipswich, Canterbury, Sheffield, Leeds, Plymouth, Maidstone, Birmingham and London. Although based on the Tavistock model, none of the provincial groups followed a Balintian line and many elected not to read his work.150 Other practitioners mocked these efforts, refusing to problematize their professional activities through any psychological schema.151 Balint claimed that ‘every doctor willy nilly creates a unique atmosphere by his individual ways of “practising” medicine and then tries to convert his patients to accept it’.152 He argues that the effects of influence can no longer be avoided. As he says: ‘Whatever he does he cannot fail to influence his patient, and these influences will add up in the long run.’153 With regard to competing models of influence, Balint’s globalizing rhetoric fused two approaches – the atmospheric

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infection and exemplary cure. These were originally deployed to insulate the physician from the patient and the illness but Balint’s conjunction transformed them. The miasmic influence of the doctor’s personality was now seen to engulf the patient, and the patient’s body and behaviour became symptomatic of the physician’s inadequacies and anxieties. These changing models of influence reveal how the relationship between psychology and general practice was similarly transformed. It moved from being a project engaged with the management of the suggestible patient to become something akin to an older moral discipline, in which the doctor perfects his personality in order to maintain his status as a therapeutic instrument.154 As Balint made clear, ‘the physician must learn to use himself as skilfully as the surgeon uses his knife, the physician his stethoscope or the radiologist, his lamps.’155 This change appears to have been generated through the specific problems of medical science and primary care. The development of new concepts that problematized the behaviour of the patient – the unconscious, suggestion, anxiety and transference – would in the end infect every aspect of the doctor’s work. Each call ignored and each prescription written could be read in terms of a psychoanalytic drama of resistance and appeal for love.156 What had been pictured in the 1930s as a kind of discrete bacteriological transfer of unwitting signs between doctor and patient became, by the 1950s, a miasma of unspoken, infectious emotions. The language of influence and the unconscious which emerged in the twentieth century problematizes every aspect of the relationship between doctor and patient, from their life histories to their current behaviour. The magical aspect of psychology was that it made everything relevant and everything open to intervention.

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Placebo and the Problem of Truth

In September 1953, a debate broke out in the Lancet over the nature and significance of the placebo effect. The debate was highly unusual. Although placebos and bread pills often featured in informal discussions on medical practice, they only rarely became the objects of clinical investigation.1 In the late 1930s, American investigators had carried out a small number of scientific trials which attempted to assess the extent of the placebo effect, but these works on the power of the placebo were largely ignored across the Atlantic.2 And although the discussion coincided with the first controlled clinical trials in Britain, with Linford Rees in Cardiff and Joel and Charmian Elkes in Birmingham using placebos to test the efficacy of chlorpromazine, this public debate on the placebo’s potential was provoked by another source.3 It arose from those attempts to objectify the informal aspects of the doctor-patient encounter that I outlined the previous two chapters.4 Indeed, it was a social survey into the nature of family doctoring that formally revealed the extent of the placebo’s work in post-war British medicine. In 1952, in the midst of concerns over the spiralling cost of the health service, Derrick Dunlop, Chair of Therapeutics at Edinburgh University, and two colleagues analysed 17,301 prescriptions issued at selected practices across the United Kingdom. They estimated that roughly one third of the drugs prescribed lacked any specific therapeutic effect. They were, Dunlop thought, mere ‘bottles of medicine’ deployed to placate the patient. The majority of these non-specific drugs prescribed by family physicians were hypnotics (low-dose barbiturates and bromides) and tonics (home preparations) that made up 23 per cent of all prescriptions.5 The findings confirmed the general estimate that around half of all doctor-patient contacts were simple ritualized encounters in which a ‘bottle of medicine’ was demanded by the patient and supplied in part to relieve the doctor.6 It was, as R. E. Hope Simpson announced to the College of General Practitioners, ‘the most potent and most economical psychotherapy’ and there

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was little sense in ‘weaning the patient’ from their ‘fanciful attachment’ to this placebo in favour of a new dependence on syringes, X-rays or physiotherapy.7 This ‘bottle of medicine’, as Collings had remarked in his field survey of family medicine, was the ‘sine qua non’ of British general practice.8 For Michael Balint and his colleagues at the Tavistock training seminars, the high rates of reported placebo prescription revealed the psychological foundations of clinical work. Throughout The Doctor, His Patient and the Illness, Balint had made frequent references to the role of the ‘bottle of medicine’ and noted that its use was an ongoing point of reference (and a source of embarrassment) for his trainees.9 The prescription of a bottle of medicine did not simply reflect the psychological needs and suggestibility of the anxious patient; it also acted as an effective method of closing consultations for the overworked and emotionally exhausted family doctor. As Balint noted, a frequent joke made during the training seminars was that such action was ‘reassuring but to whom?’10 When the Lancet discussion of the nature of the placebo began in 1953, Clyne decided to share this joke with its readers. ‘The doctor,’ he explained, ‘only too often has to prescribe a placebo, because he needs it for his own reassurance. And this is the true function of the placebo. It does not serve the patient but the doctor’s need, whatever the excuse may be with which it is prescribed.’11 Clyne disputed the pharmacological description of the placebo as an ‘inert’ substance, arguing that it was psychologically active and that such psychological activity was characteristic of just about every element of clinical practice. He argued that ‘many forms of treatment which are considered scientific in themselves, such as electro-shock, insulin shock, or antibiotics, may well be given as placebos, as much as the reassuring pat on the shoulder and red tonic’.12 Clyne was not alone in his extension of the idea of the placebo or psychological function to include what seemed to be the most material examples of medical practice.13 Many psychoanalysts had interpreted the new physical methods in the treatment of mental illness, such as electro-convulsive therapy, as theatrical techniques for staging therapeutic transference or generating episodes of infantile regression.14 And as the Balints themselves made clear, there was no situation, even in the double-blind trial, where therapeutic effects could somehow be isolated from psychological influences.15 The one place, they believed, that was somehow insulated from the uncontrolled and disruptive effects of unconscious processes was in the psychotherapeutic encounter itself. It was, the Balints thought, impossible to give a placebo in psychotherapy. As they explained: ‘Psychotherapy is either a proper and honest attempt, and is recognised as such

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by the patient and doctor, or is nonsensical, when again both of them must be aware of this fact . . . whereas it is easy to persuade a patient to “swallow” a pill, whatever its contents, it is impossible to make him “swallow” a piece of understanding or an interpretation which is does not make sense to him.’16 The Balints’ description of their psychoanalytic work binds together the ethical and the ontological. The scientific aspects of their therapeutic practice were predicated upon the assumption that beneath the illnesses and treatments negotiated in the doctor-patient relationship lay a foundation of unconscious history and fantasy that structured the therapeutic encounter: an encounter that would, if managed correctly, reveal and transform these forces. The practices and commentaries produced by the members of the Tavistock were thus grounded in the emerging psychological framework described in the opening chapters of this book. And in many ways they represented the triumph of that framework; for they demonstrated that those material categories which had been used to organize everyday medical practice – the backache or the bronchial asthma – were mere epiphenomena beneath which a more fundamental psychological truth lay waiting to be discovered.17 Illness became a kind of ‘artistic creation’, a ‘sick role’ which the patient retreated into with the doctor’s agreement when the problems of life became overwhelming.18 And treatment was revealed as a symbolic process in which the materials of therapy, consultations and pharmaceuticals were exploited so that the patient might abandon his or her regressive fantasies.19

1  A different theatre and a different truth Balint’s work won an influential audience among the some of the leading figures in British primary care, yet his moral enterprise with its commitment to historical or psychological authenticity bears only a tangential relationship to the therapeutic practices that have developed within the modern discipline of psychiatry and current practice in primary care. Alongside the confessional methods developed by the early psychotherapists, there had always been an insistence that cures were achieved through faith rather than through historical insight. The medical successes of Haygarth and Falconer, which inaugurated the new therapeutics, had been based, as the authors admitted, on a subtle piece of duplicity.20 Their methods were replicated by many of their contemporaries. Phillippe Pinel, who was held up by many as the founder of ‘moral therapy’

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and modern psychiatry, recounted the various subterfuges he had used to trick patients out of their delusions.21 This use of suggestive methods would endure. In the twentieth century, British psychiatrists developed techniques which pastiched psychoanalytic ideas of abreaction. They argued that the dramatic experience of apparent confession possessed a therapeutic value: a value which was entirely independent of, and indeed many times absent from, the psychotherapeutic recovery of repressed facts. It was a viewpoint forged around the specific military demands of World War II. The most vocal proponent of this ironic view of psychotherapeutic confession was William Sargant, a psychiatrist at the Maudsley and St Thomas’s Hospital.22 Before the war, Sargant had been a fierce critic of drug treatments for psychological disorders in general practice. Writing with Francis Pilkington (a fellow Maudsley worker) in the Practitioner, he complained that ‘drugs are so often given to a [“nervous”] patient without any attempt at an adequate physical or mental examination. The practitioner is too busy or it may be that he is not interested in psychological disorders; but the busiest physician would hesitate to prescribe for a severe physical illness without first examining the patient, and the same caution should be exercised in dealing with even the mildest forms of mental disorder. Many psychiatric patients, however, are quickly dismissed from the consulting room with a bottle of medicine and well worn platitude’. A truly adequate treatment, Sargant and Pilkington wrote, would be a psychological medicine directed towards the whole person.23 This commitment to holism was to break down during the early years of World War II when Sargant moved to Sutton EMS hospital. Working with psychiatric casualties evacuated from France after Dunkirk and the D-Day landings, he engaged in a form of modified psychotherapy, using chemical treatments such as ether, pentothal and insulin shock to achieve rapid abreactions.24 These chemical interventions had been developed within a familiar psychotherapeutic framework. The pioneers of the new technique, Stephen Horsley in Dorchester and Harold Palmer working with the Eighth Army in North Africa, believed that the drugs helped break down conscious resistances or ‘loosen psychic tension’, allowing the cathartic presentation of repressed material.25 Sargant shared this belief and in his initial reports celebrated the interrogatory potential of the barbiturate drugs.26 Like Horsley, he believed that the evidential value of the abreacted material would have to be tested against some criterion of forensic truth. Thus he warned his colleagues that patients in narcoanalysis could tell ‘plausible and circumstantial stories which are no less the product of dream

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fabrication. Truth and fantasy will have to be sifted when the patient is in a state of clear consciousness, events seen in a reasonable perspective, and shorn of exaggerated affect, integrated with the rest of the patient’s experiences. A cautious and sceptical attitude on the part of the doctor will save him from swallowing all of his patient’s hokum, hunting Snarks and exploring nightmare’s nests.’27 Despite this injunction, Sargant was to embrace the Snark. In his own practice, he celebrated the power of patient and therapist fantasy over the curative value of truth. In his attempts to bring about psychological relief through an emotional abreaction, Sargant realized that the patient’s recovery of traumatic events bore little relation to their prospects of cure. As Sargant and Slater noted in Physical Methods of Treatment in 1948: ‘The great benefit that is often felt by the patient after a fortuitous abreaction like this has usually been interpreted by Freudians and others as due to the release of the emotion tied down to the traumatic incident itself and subsequently repressed. But we have made observations which suggest that physiological mechanisms may also play a large part. The abreaction need not be centred around a real experience; a fantasy may be exploited just as well.’28 Although Alison Winter has drawn attention to the relationship between the American deployment of chemical abreaction and the technological model of flashback sequences in cinema films, the British work was less sophisticated.29 It imagined the process as more akin to a one-sided telephone call or ‘wireless commentary’ in which the therapist guided through exhilarating or terrifying narratives the experience which the patient lived out in a state of chemical excitement.30 Such models left the authorship of the fantasy and the abreaction wide open. After the war, Sargant reminisced that in his Sutton practice: . . . we did not always find it essential in abreaction, to make the patient recall the precise incident which precipitated the breakdown. It would often be enough to create in him a state of excitement analogous to that which had caused his neurotic condition, and keep it up until he collapsed; he would then start to improve. Thus imagination would have to be used in inventing artificial situations, or distorting actual events, especially where the patients, while remembering the real experience which had caused the neurosis, or reliving it under drugs had not reached the transmarginal phase of collapse necessary for disrupting the new morbid behaviour pattern. The arousing of crude excitement might often be of far greater curative virtue than the reliving of any particular forgotten or remembered experience.”31

It was a kind of narcotic drama therapy that prioritized excitement over truth. Sargant’s separation of catharsis and abreaction marked the apotheosis of the

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patrician critique of psychoanalytic thinking that emerged in Britain during the interwar years.32 Like Stephen Taylor and Aubrey Lewis, Sargant had received his psychiatric education at the Maudsley, adopting the pragmatic psychiatry espoused by Edward Mapother. This psychiatry took a different path to the forensic pursuit of the patient’s inner history that had animated the psychoanalytic project. The Maudsley workers agreed with the psychotherapeutic suspicion of the patient’s speech and used a variety of electro-physiological technologies such as the galvanic skin response and the EEG to demonstrate the emptiness of the subject’s statements, yet they refused the consolation of believing such statements obscured an authentic truth that somehow remained hidden in the patient’s unconscious mind.33 This parting of the ways between Maudsley psychiatry and forensic psychotherapy was in part mediated by the different investigative technologies the two traditions employed. Whereas the psychotherapists attempted to retrieve truth through the close analysis of speech, associations, dreams and gestures, the Maudsley group focused their search on the physiological correlates of mental states.34 These detection technologies, as we saw in Chapter 2, were initially deployed in studies of malingering and fatigue, yet soon came to represent the emptiness and failure of the patient’s interior life. The lack of an anticipated electrophysiological signal demonstrated the lack of deep emotion.35 The many illnesses and crises that confronted doctors in their day-to-day work were not the product of deep psychic wounds or historical trauma but indications of the shifting chemical tides in the patient’s body. They were, simply, affective currents that could be changed through the addition of corrective benzedrines or bromides.36 In adopting this position, the Maudsley workers maintained a line of sceptical argument that had been in place since the work of the Crookshank and his nominalist contemporaries in the 1930s.37 Sargant’s mentor, Edward Mapother, was convinced that the psychoanalytic equation of cure and truth led to a conflation of words and references.38 In his presidential address before the Psychiatric Section of the RSM in  1930, Mapother dismissed the ‘tenderminded’ sciences such as psychoanalysis, arguing that they were predicated upon a form of ‘animist conceptualism’ which confused rhetorical explanations (such as the unconscious) with actual existing entities. In contradistinction to this, he followed Crookshank and the English Adlerians in advocating a speculative nominalist psychiatry which would be ‘tough minded’ in its ‘retention of [an] awareness that words are just symbols designed to express observed sequences of phenomena (“whether subjective or objective”)’.39

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This pessimistic model of knowledge, and indeed the language of ‘tough and tender minded’ which informed the Maudsley approach, was drawn from William James. In The Will to Believe (1897), James argued that quest for truth was a matter of energy and attitude rather than of ontology.40 It was a philosophy in which truth was not discovered through the investigation of memory but through the exercise of the will. Indeed, in its attention to the role of force, it much resembled the agonistic understanding of truth and power that animates late-twentieth-century philosophy. From this perspective, as the late Michel Foucault noted, ‘one’s point of reference should not be to the great model of language (langue) and signs, but to that of war and battle. The history which bears and determines us has the form of a war rather than that of a language: relations of power, not relations of meaning.’41

2  Irony and rival systems of truth Between the work of Balint and Sargant, one can see the emergence of rival systems of truth. Balint’s group at the Tavistock argued that physical illness was the outward manifestation of a deeper process taking place at an unconscious level. In contrast to this, Sargant and his co-workers insisted that the deep self was a fiction and that personality was merely a superficial phenomenon that could be remade through technical intervention. Although these models were in conflict, neither was extinguished in the decades that followed. Instead, each was sustained by separate cultural, social and economic developments. On the one hand, certain commentators argued that life in the modern West has fostered a culture of narcissism in which selfhood assumes a central role; on the other, there arose a new emphasis on the fragility of individual autonomy and the ephemeral nature of identity.42 Although there is an obvious tension between these two positions, their combined effect was to cultivate an ironic attitude in which different ideas of the psyche were adopted and related treatments encouraged on the basis of their therapeutic efficacy rather than any scientific or metaphysical commitment. The self no longer demanded particular interventions: rather, its shape and organization were reimagined around those interventions. It could be seen as a compounded elaborate history or as a neurochemical complex depending upon the treatment regime in place. The variety of treatment encouraged a kind of psychological agnosticism: an agnosticism that deepened as new tranquilizers and antidepressants trailed in Britain’s mental hospitals began to be deployed in general practice.

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The tranquillizer era in general practice was ushered in by Meprobamate, a propanediol derivative, first synthesized in 1950. Following a small number of psychiatric trials in 1955, it was marketed as ‘Miltown’: a ‘penicillin for the blues’. Alongside its commercial rival, Soma, it quickly took over a large part of the market share among the bromides and barbiturate hypnotics (such as Veronal) that had formed a staple treatment for nerves in primary care. Lacking the barbiturates’ toxicity and extreme sedative effects, the new tranquillizers were seen as creating a demand for pharmaceutical treatment among those troubled with psychological problems.43 In  1960, the first benzodiazepines, Valium (diazepam) and Librium (chlordiazepoxide), were introduced ‘into a market’, as Peter Tyrer noted, ‘in which the demand was immense and in which there were few competitors’.44 These minor tranquilizers were joined in 1965 by Mogadon (another benzodiazepine) and Mandrax (a non-barbiturate combination), developed for the hypnotics market. The new tranquilizers were joined in turn by a new wave of antidepressants. Just as the proprietary tranquilizers took over the niche of the bromides and barbiturates, so too did the new antidepressants colonize the space occupied by the tonics. The tonics included a broad range of stimulants, from herbal extracts such as St John’s Wort to proprietary antihistamine and amphetamines (such as Dexedrine) and amphetamine compounds – most notably Drinamyl (dexamyl, United States), a combination of dexaphetamine and an amylo­ barbitone (a barbiturate which worked to potentiate the stimulant effect). These amphetamine derivatives were joined in the 1960s by the monoamine oxidase inhibitors and the tricylic antidepressants: drugs which were held up as the ‘second generation of anti-depressants’.45 The appearance of this new generation of minor tranquilizers and antidepressants, as many noted, did little to change the nature of general practice.46 Rather they continued a long tradition of sedative prescription that dated back to the end of the nineteenth century.47 What provoked comment, however, was their impact on prescribing costs in the NHS. This had been an issue since the service’s first inception. In its first two years, the NHS drug bill had risen by one third.48 At first this was understood in terms of growing consumer consciousness but by the early 1960s such demands were being read in psychological terms as reflecting underlying levels of neurosis.49 This new understanding was largely sustained by the rising use of this new generation of psychotropics. By the early 1960s, concerns were being raised in parliament over the use of Miltown. Answering a written question in November 1962, the

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health minister, Enoch Powell, noted that roughly 870,000 prescriptions for the drug had been issued in the past year.50 Rising prescription costs were generated as new proprietary drugs began to take over the niche occupied by older (and far cheaper) barbiturates such as Veronal. Between 1965 and 1970, the number of prescriptions for barbiturate hypnotics fell by 24 per cent from 17.2 to 13.1 million, although proprietary barbiturate combinations (Soneryl, Tuinal, Nembutal and Sonalgin) still maintained a large segment of the psychotropic market. By the end of the 1960s, the use of meprabomate itself was beginning to undergo a rapid decline but rates of psychotropic prescription continued to rise. Between 1965 and 1970, the consumption of tranquilizers in Britain rose from 10.8 million prescriptions a year to 17.2 million while prescriptions for non-barbiturate hypnotics increased 145 per cent from 2.9 million prescriptions per annum to 7.1 million.51 At the same time, a new generation of tricylic antidepressants, amitrypyline (marketed as Trypitzol) and imipramine (marketed as Tofranil), encouraged antidepressant prescription, with a rise of 2.9 million prescriptions between 1965 and 1970 despite the concomitant decline in the use of the monoamine oxidase inhibitors. The benzodiazepines did not simply take up the niche occupied by the old hypnotics: they created a new market underlining the cultural acceptability of pharmaceutical solutions to everyday problems. The idea that ‘mother’s little helper’ could take a tablet form became a stock-in-trade image of the post-war housewife, as Andrea Tone, Elianne Riska and Ali Haggett have shown.52 The success of the minor tranquilizers was astounding. As Dunlop noted in 1970, the sheer number of minor tranquilizers prescribed in primary care was large enough to ensure that one night of sleep out of every ten in the United Kingdom was hypnotically induced.53 The problems that people brought to general practice for treatment with the new drugs remained the same non-specific complaints that had prompted Balint’s enquiry into the prescription of the ‘bottle of medicine’. Indeed the whole transaction seemed to continue the old ritual. Many psychiatrists complained that the new drugs were prescribed in doses that were too small to be effective; others argued that the efficacy of the drugs could not be distinguished from that of the placebo.54 Critical commentators insisted that the benzodiazepines, rather than embodying any pharmacological advance, simply sustained a new kind of therapeutic relationship. Sociological studies of general practice in the late 1960s had shown that although the number of attendances remained constant, doctors saw fewer individual patients.55 The high number of consultations was sustained by a small number of patients seeking repeat prescriptions. The psychotropics,

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it was argued, were not being prescribed to help individuals through an episode of extreme mental distress but instead had become a constant resource for those feeling overwhelmed by the problems of living. As Balint noted in a number of studies he carried out with the pharmacologist, Dick Joyce, psychotropics made up over half of repeat prescriptions of longer than two-year duration.56 They had been assimilated into the everyday lives of their patients. Their function, as Joyce argued, was largely symbolic. They served, as practitioners had long recognized, as a ‘tangible reminder of the doctor’s presence and advice’.57 As Clyne had predicted, the prescription of minor tranquilizers was understood as a social act that served the psychological needs of both doctor and patients.58 The new consensus that emerged between doctors and patients was based on very different grounds to the psychotherapeutic understanding that had emerged in the years leading up to World War II. It was not that doctors and patients embraced a materialist or neurochemical model of mind. Most patients related their treatment needs to the problems of living and the most typical profile among patients on long-term psychotropic prescriptions remained those suffering from isolation and bereavement.59 Likewise progressive physicians, particularly those involved in the Royal College of General Practitioners discussion, insisted that such chemical treatments should be seen as purely ‘symptomatic’ with the true source of psychological distress existing in the unconfessed histories and social difficulties of their patients. Many admitted their deepening sense of unease over rising rates of psychotropic prescription. Peter Parish, a medical sociologist from Swansea, who undertook a detailed survey of psychotropic prescriptions for the Royal College of General Practitioners, worried that ‘the increasing prescribing of CNS [central nervous system] depressing drugs suggests that general practitioners are blanketing their patients’ emotional reactions to an excessive degree and they must ask themselves whether it is right to produce a pharmacological leucotomy on contemporary society’. Reporting his findings at a meeting of the Royal College of General Practitioners in  1971, Parish argued that doctors were using these drugs ‘in order to accomplish the regulation of personal and interpersonal processes’. As he noted: ‘the increasing prescribing of CNS [central nervous system] depressing drugs suggests that general practitioners are blanketing their patients’ emotional reactions to an excessive degree and they must ask themselves whether it is right to produce a pharmacological leucotomy on contemporary society’. He quoted the findings of the American social psychologist, Henry Lennard, and his claim that, ‘When a physician prescribes a drug for the control or solution or both of

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the problems of living, he does more than merely relieve the discomfort caused by the problem. He simultaneously communicates a model for an acceptable and useful way of dealing with personal and interpersonal problems.’60 A few years later, this position was endorsed by the Manchester psychiatrist, William Trethowan. Surveying the rising costs of tranquilizer prescription, he complained that ‘psychotropic drugs are being increasingly prescribed to try and modify personal and interpersonal processes. One of the dangers inherent in this is: the more the habit of prescribing pills for personal problems grows among doctors, the more likely it is that their patients may come increasingly to demand this kind of solution to their difficulties.’61 The new consensus that emerged between doctors and patients was based on very different grounds to the psychotherapeutic understanding that had emerged in the years leading up to World War II. It was not that doctors and patients embraced a materialist or neurochemical model of mind. Most patients related their treatment needs to the problems of living and the most typical profile among patients on long-term psychotropic prescriptions remained those suffering from isolation and bereavement.62 Likewise progressive general practitioners insisted that such chemical treatments should be seen as purely ‘symptomatic’ with the true source of psychological distress existing in the unconfessed histories and social difficulties of their patients. Yet the prescription of tranquilizers and antidepressants continued unabated.63 In practical terms, there emerged a shared sense that these deep difficulties no longer mattered. They became peripheral to the business of living, as the psychiatric alchemy of Valium and Librium made all such questions irrelevant. The symptomatic understanding of psychological distress was also reflected in the emergence of new diagnostic methods and therapeutic techniques. From the early 1960s onwards, there was turn away from the hermeneutic inquiries that had animated early psychotherapeutic concerns and towards a more structured approach that enumerated the symptoms and social relationships of the sufferer. The adoption of formal research instruments such as the psychiatric questionnaire was driven, in part, by a growing awareness of the interview’s inadequacy: an inadequacy revealed by the discrepancies in individual prescribing styles described in the last chapter.64 The work of Michael Shepherd and his colleagues at the General Practice Research Unit of the Institute of Psychiatry underlined the need for instruments that could be used to calibrate primary-care assessments of mental disorder. By the end of the 1960s, standard questionnaires and symptom inventories – such as the Cornell Medical Index,

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the Beck Depression Inventory, the Maudsley Personality Inventory and Max Hamilton’s tests for anxiety and depression – were beginning to be used by general practitioners. Although the uptake of these instruments was extremely patchy, it received encouragement through the ‘yellow literature’ of the drug companies as they sought to expand their markets by revealing the host of minor neuroses that lay beneath the ‘subclinical iceberg’ of patient complaints.65 In 1961, Merck distributed 50,000 copies of Recognising the Depressed Patient by Frank Ayd, the US apostle of psychopharmocology.66 In 1968, May and Baker marketed its new tricyclic antidepressant, Surmontil (trimipramine), by distributing Beck and Hamilton rating scales to general practitioners in its free guides to depressive illness.67 Implicit within these rating scales was a particular conception of the shape and structure of personality. It was no longer seen as a deep and mysterious entity that only revealed in itself in fleeting hints and traces during the consultation. Rather, it was conglomeration of variables that could be mapped and measured through questionnaires and symptom sign inventories. The tests, as Maarten Derksen has argued, worked to separate the quantifiable personality from the unruly phantom aspects of selfhood that were constrained through rigorous administrative procedures.68 What was striking about these methods was not so much their disciplinary function – since attempts to drill and regulate human response have been in place throughout the modern era – but their establishment of a new grounds of psychological truth. Whereas the dynamic psychologies described in Chapter 2 located the truth of individuality in the hidden recesses of an obscured history, the tests, like the psychotropic drugs, rendered this history irrelevant. The truth of individual identity was now located in the external marks of test scores and overt behaviour and, as such, demanded new forms of therapeutic intervention. The development of these new investigative instruments and the concomitant rejection of depth psychotherapy were strongly associated with the pragmatic approach developed by the Maudsley Hospital. After WWII, a research programme in clinical psychology was developed under the direction of Hans Eysenck and Monte Shapiro. Rejecting, as Sargant had done, the historical assumptions that undergirded mainstream psychotherapeutic techniques, they sought to make such interventions quantifiable. In a 1952 paper that would become something of a manifesto for this approach, Hans Eysenck argued that rates of recovery achieved through psychotherapy were no better than rates of spontaneous remission among those suffering from a broad spectrum of

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minor mental disorders.69 His figure for spontaneous recovery (66 per cent), drawn from the American insurance industry and state hospital records, was probably too high, since both sets of institutions had an economic interest in divesting themselves of patients. However, although analysts sought to contest these figures, Eysenck was successful in changing the bases of psychotherapeutic evidence from insights to outcomes.70 In place of the detailed forensic investigations carried out by Balint and his followers, Eysenck and Shapiro’s students advocated new forms of behavioural training. Beginning in the mid-1950s with the use of conditioning techniques to cure a case of adult bedwetting, the new approach was energized by the research of the South African psychiatrist, Joseph Wolpe, into the therapeutic use of reciprocal inhibition. Wolpe argued that neurotic disorders could be seen as maladaptive conditioned responses that might be extinguished through continued exposure to original stimulus in a pleasant and reassuring environment. Wolpe was lionized by Eysenck and Maudsley students took up the new approach.71 In  1960, Hugh Freeman, then a Bethlem registrar, and David Kendrick, a trainee clinical psychologist, described the rapid extinction of cat phobia in a Lewisham housewife through a process of systematic desensitization.72 The case attracted widespread press interest, and although the authors recognized that the therapeutic process could be redescribed in terms of suggestion or transference, the rapid success of the cure underlined the efficacy of symptomatic treatment. It no longer mattered if the unconscious source of a condition was discovered: symptoms responded, in Arnold Lazarus’s phrase, to a ‘broad spectrum behavior therapy’.73 Such treatments, as Eysenck himself insisted, ‘break decisively with psychoanalytic thought of any description’. As he went on to explain: Freudian theory regards neurotic symptoms as adaptive mechanisms which are evidence of repression; they are “the visible upshot of unconscious causes.” Learning theory does not postulate any such “unconscious causes,” but regards neurotic symptoms as simple learned habits; there is no neurosis underlying the symptom, but merely the symptom itself. Get rid of the symptom and you have eliminated the neurosis. The notion of purely symptomatic treatment is so alien to psychoanalysis that it may be the crucial part of the theory here proposed.74

Although general practitioners only made limited use of the new therapies, they provided a rationale for the growing involvement of local authorityfunded clinical psychologists in primary-care teams, and a new language for

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redescribing the mechanics of the consultation.75 As noted by Kevin Browne, a North London General Practitioner who had worked with Balint groups and behaviour therapy clinics, the bag of sweets in the General Practitioner’s drawer could be seen as a technology for encouraging reciprocal inhibition, and a ‘warm consulting room, a warm personality and a comfortable chair’ might be enough to extinguish anxiety as the patient confronted fears in conversation with the doctor.76 Less partisan psychiatrists than Eysenck argued that behavioural treatments worked well with traditional forms of psychotherapeutic counselling and that different psychological treatment regimes were effective for different patients.77 The eclecticism that developed in primary-care psychology after the 1970s gives the lie to the idea that psy-sciences somehow subsumed the role of religion. Rather, by the end of the twentieth century both religion and psychology became subject to the same attitude of ironic pragmatism.78 The power of prayers said and pills taken seemed to be determined by the subject’s belief. Yet, at the same time, pastoral and pharmaceutical techniques both acted as vehicles for new systems of value, one inculcating acceptance of neurobiological descriptions, in which depressive illness or anxiety disorders may be read in terms of serotonin deficit, the other, renewing faith in the power of historical interrogation to overturn repressed feelings or ingrained patterns of behaviour. The language of the unconscious and the language of sceptical psychiatry allowed different objects to be materialized and dissolved. Physical illness could be seen as a mask for unconscious desires or the psychotherapeutic abreaction of some hidden truth, or written off as a mere fiction. Both approaches were fecund enough to populate the world with new concepts and objects: the unconscious, the anxiety disorder and the Oedipus complex are three examples of many. At the same time, both approaches were instrumental enough to hold out the promise that these objects might be open to renegotiation. The search for authenticity could be replaced by symptomatic treatment; pharmaceutical innovation could be redescribed as a suggestive cure. In the decades that followed, there arose a new cosmetic psychiatry in which the goals of medicine would shift from the recovery of a self that had been lost to the creation of a new self, made possible – or at least imaginable – through the rise of the new pharmacotherapies.79 The process of making and undoing objects is not, of course, restricted to the sciences of medicine or psychology; historical narratives, and narratives in the history of science and medicine in particular, engage in a similar process

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of creating and deconstructing the familiar categories we live by.80 What the history of psychiatry in general practice demonstrates is that such processes are powerful – and the horizons of possibility that are drawn and redrawn in the languages of psychiatry and psychology transform the presentation and experience of our bodies, our personalities and our illnesses. Yet it would be wrong to conclude from social constructionist accounts like this one that the worlds of biology and medicine can be treated with an unrelenting scepticism. As the arguments of psychiatrists like William Sargant and doctors like Max Clyne demonstrated, the mere fact of belief is transformative. Shared between patient and doctor, it was capable of creating new illnesses, new kinds of patients and a new vision of society. It made its own truth.

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Notes Preface 1 P. Conrad, ‘Wellness as virtue: morality and the pursuit of health’, Culture, Medicine and Psychiatry 18 (1994): 385–401. 2 For medical commentaries on the rise of this rhetoric, see: N. W. Goodman, ‘The Observer’s Barefoot Doctor: explanations for the credulous’, British Journal of General Practice 51 (2001): 952–3; Edzard Ernst, ‘Barefoot and empty brain? What are we to make of journalistic alternative nonsense’, British Journal of General Practice 51 (2001): 1026–7. 3 Harriet B Braiker, Lethal Lovers: How to Protect Yourself from Relationships that Make you Sick. New York: Pocket Books, 1992; M. Scott Peck, The Road Less Travelled: A New Psychology of Love, Traditional Values and Spiritual Growth. London: Arrow New Age, 2006; Louise L. Hay, You can Heal your Life. London: Hay Books, 2004; Darian Leader and David Corfield, Why do People Get Ill? Reflections on the Mind Body Connection. London: Hamish Hamilton, 2007. Nick Read, Sick and Tired: Healing the Illnesses that Doctors Cannot Cure. London: Phoenix, 2005, pp. 120f. 4 On cervical cancer, see: H. L. Lombard and E. Potter, ‘Epidemiological aspects of cancer of the cervix’, Cancer 3 (1950): 950–9. On leukemia, see: L. L. LeShan and R. E. Worthington, ‘Some recurrent life history patterns observed in patients with malignant disease’, Journal of Nervous and Mental Disorders 124 (1956): 460–65. For overviews of the literature, D. Maddison and A. Viola, ‘The health of widows in the year following bereavement’, Journal of Psychosomatic Research 12 (1968): 297–306. For overviews of the literature, see: Brian Totman, Social Causes of Illness. London: Souvenier Press, 1987, chs. 5 and 6; Leader and Corfield, Why do People get Ill?, chs. 11 and 12; S. v. Kasl, ‘Stress and health’, Annual Review of Public Health 5 (1964): 319–41. 5 Peter Worsley, Knowledges: What Different Peoples make of the World. London: Profile Books, 1997, pp. 206–65; Cecil G. Helman, ‘Feed a cold, starve a fever: folk models of infection in an English suburban community and their relation to medical treatment’, Culture, Medicine and Psychiatry 2 (1978): 107–37. Idem. Culture, Medicine and Illness: A Guide for Health Professionals. Bristol: John

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Notes Wright, 1990; G. G. Harris, ‘Mechanism and morality in patients’ views of illness and injury. Medical Anthropology Quarterly 3.1 ns (1993): 3–21. Rita Charon. ‘Doctor Patient/Reader-Writer: Learning to Find the Text’, Soundings 72 (1989): 137–52; Rita Charon, ‘Narrative Medicine: A Model for Empathy, Reflection, Profession, and Trust’, JAMA 286(15) (2001): 1897–1902; A. W. Frank, ‘Reclaiming an Orphan Genre: The First Person Narrative of Illness’, Literature and Medicine 13.1 (1994): 1–21. Arthur Frank, The Wounded Story-teller: Body, Illness and Ethics. Chicago: Chicago University Press, 1995; Arthur Frank, ‘Illness as moral occasion: Restoring agency to ill people’, Health 1 (1997): 131–48; Anne Hudson Jones, ‘Literature and Medicine: Narrative Ethics’, Lancet 349 (1997): 1243–6; Anne Hudson Jones, ‘Narrative based medicine: narrative in medical ethics’, British Medical Journal 318 (23 January 1999), 255; Laurence J. Kirmayer, ‘Broken narratives: clinical encounters and the poetics of illness experience’, in Cheryl Mattingly and Linda Garro (eds) Narrative and the Cultural Construction of Illness and Healing. Berkeley: University of California Press, 2000, pp. 153–80. For commentaries on this new approach, see: Anne Oakley, ‘Telling stories: auto/ biography and the sociology of health and illness’, Sociology of Health and Illness 15.3 (1993): 414–18; Roland Littlewood, ‘Why narrative? Why now?’, Anthropology and Medicine 10.2 (2003): 255–61; Mike Bury, ‘Illness narratives: Fact or Fiction’, Sociology of Health and Illness 23.3 (2001): 263–85. Elaine Showalter, The Female Malady: Women, Madness and English Culture, 1830–1980. London: Virago, 1987; Caroll Smith Rosenberg, Disorderly Conduct: Visions of Gender in North America. New York: Alfred A. Knopf, 1985; Karl Figlio, ‘Chlorosis and chronic disease in nineteenth-century Britain: the social constitution of somatic illness in a capitalist society’, International Journal of the Health Services 8 (1978), 589–617. For similar approaches, see: Eric Leed, ‘Fateful memories: Industrialized war and traumatic neuroses’, Journal of Contemporary History, 35 (2000): 85–100. Ioan M. Lewis, Ecstatic Religion. London: Penguin, 1971. For developments of this approach, see A. Ong, ‘The production of possession: spirits and the multinational corporation in Malaysia’, American Ethnologist 15.1 [Medical Anthropology] (February 1988), pp. 28–42; H. Faberga and B. D. Miller, ‘Towards a more comprehensive medical anthropology: the case of adolescent psychopathology’, Medical Anthropology Quarterly 9.4 (1995): 431–61. http://www.hopeallianz.com/ResourceCenter/feelings_defined.html. Accessed 8 December 2004. For an overview, see: Roger Luckhurst, ‘Traumaculture’, New Formations 50 (2003): 28–47; Michael R. Trimble, Post-traumatic Neuroses: from Railway Spine to Whiplash, Chichester: John Wiley, 1981; Allan Young, ‘Our Traumatic Neurosis and Its Brain’, Science in Context 14 (4) (2001): 661–83; Allan Young,

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‘History, Hystery and Psychiatric Styles of Reasoning’, in Margaret Lock, Allan Young and Alberto Cambrosio (eds) Living and Working with the New Medical Technologies: Intersections of Inquiry. Cambridge: Cambridge University Press, 2001. Freud, ‘Fragment of an Analysis of a Case of Hysteria’, Standard Edition 7, pp. 77–8. Although some historians question the use of literary texts as historical evidence, (e.g. James Smith Allen, ‘History and the Novel: Mentalité in Modern Popular Fiction’, History and Theory, 22 (1983): 233–52) their value in discussions of psychological developments cannot be underestimated. Psychological knowledge, unlike chemical or physical knowledge, lacks any fixed point of reference in the world. It is, as we shall see, purely ‘performative’, and our descriptions and redescriptions of psychological concepts, such as ‘instinct’ or ‘character’, change their very nature. It is as much in literature, film and popular culture as in clinical research or laboratory investigation that these redescriptions are made. On Halliday (1898–1983), see: BMJ 287 (3 September 1983): 697. For an overview of this programme, see: J. L. Halliday, ‘Psychosomatic Medicine and the Medical Officer’, Bulletin of the Scottish Department of Health 4.4 (1947): 9–12. Glagow University Archives MSS Gen 1669/252. P. Pignarre, Comment La Depression est devenue une Epidemie. Paris: Decouverte, 2002; M. Borch- Jacobsen, ‘Psychotropicana’, London Review of Books (11 July 2002): 18–19. On the origins of this phrase, see, Peter Kramer, ‘The New You’, Psychiatric Times (March 1990): 45–6; Idem. Listening to Prozac. London: Penguin Books, 1994. For commentary see, Lauren Slater, Prozac Diary. London: Penguin Books, 2000. See, [Office of National Statistics], Living in Britain: The 2002 General Household Survey, London: HMSO. 2004, pp. 87, 90–1; S. Wessley and K. Ismail, ‘Medically unexplained symptoms and syndromes’, Clinical Medicine 2.6 (2002): 501–4. For an overview, see: C. Burton, ‘Beyond somaticisation: a review of the understanding and treatment of medically unexplained physical symptoms’, British J. General Practice 53 (2003): 231–9. C. Nimnuan, M. Hotopf, and S. Wessely, ‘Medically unexplained symptoms, How often and why are they missed?’, Quarterly Journal of Medicine 93 (2000): 21–8; Sidford, ‘General Practitioners’ workload in primary care led NHS: practices consultation rates have increased by three quarters in the past 25 years’, BMJ 315 (1997): 546–7. D. P. Goldberg and K. Bridges, ‘Somatic presentation of illness in primary care settings’, Journal of Psychosomatic Research 32 (1988), 137–44.

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19 Carl Elliott, Better than Well: American Medicine meets the American Dream. New York: W. W. Norton and Co., 2003, pp. 44–50; J. P. Hewitt, M. R. Fraser and L. B. Berger, ‘Is it me or is it Prozac: Antidepressants and the construction of self ’ in D. Fee (ed.) Pathology and the Postmodern. London: Sage, 2000, pp. 163–85. For a survey of popular attitudes, see: David Karp. Is it Me or My Meds? Living with Antidepressants. Cambridge MA: Harvard University Press, 2006. 20 On medicine as theatre, see: Brat Wenegerat, Theatre of Disorder: Patients, Doctors and the Construction of Illness. New York: Oxford University Press, 2001; E. Goffman, Asylums Essays on the Social Situation of the Insane and other Inmates [1961]. Harmondsworth: Pelican, 1975. For theatrical models of identity, see: Arnold Ludwig, Ho do we know who we are? A Biography of the Self. Oxford: Oxford University Press, 1997; William Miller, Faking It. Cambridge: Cambridge University Press, 2003; E. Goffman, The Presentation of the Self in Everyday Life, [1959]. London: Penguin, 1987. 21 On social and economic dislocation and selfhood, see: G. Simmel, ‘The metropolis and mental life’ [1903], in N. Donald Levine (ed.) On Individuality and Social Forms. Chicago: Chicago: University Press, 1971, 324–39; A. Giddens, Modernity and Self Identity. Cambridge: Polity, 1990; Ian Burkitt, Bodies of Thought: Embodiment, Identity and Modernity. London: Sage Publications, 1999, ch. 7; Peter Berger, Brigid Berger and Hannisfred Keller, The Homeless Mind: Modern­ isation and Consciousness. Harmondsworth: Penguin, 1974. On new media technologies and selfhood, see: A. R. Stone. ‘Will the real body please stand up? Boundary stories about virtual cultures’, in M. Benedikt (ed.) Cyberspace: Frist Steps. Cambridge, MA: MIT Press, 1999; P. Virilio, The Aesthetics of Disappearance. New York: Semiotext(e), 1991; Kenneth Gergen, The Saturated Self: Dilemmas of Identity in Contemporary Life. New York: Basic Book, 1991; Sherry Turkle, Life on the screen: Identity in the age of the internet. New York: Simon & Schuster, 1995.

Chapter 1 1 For an excellent account of Eder’s life and its significance, see: Mathew Thomson, ‘“The Solution to his Own Enigma”: Connecting the Life of Montague David Eder, (1865–1936): Socialist, Psychoanalyst, Zionist and Modern Saint’, Medical History 55 (2011): 61–84. This supersedes the more hagiographic collection edited by J. B. Hobman, David Eder: Memoirs of a Modern Pioneer. London: Victor Gollancz, 1945. 2 David M. Eder, ‘A Case of Obsession and Hysteria treated by Freud’s PsychoAnalytic Method’, BMJ (30 September 1911): 750–2. On the growth of the clerical

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classes in late Victorian London and their lifestyles, see: Peter Bailey, ‘White Collars, Grey Lives? The Lower Middle Class Revisited’, Journal of British Studies 38 (1999): 273–90. William Osler, Principles and Practice of Medicine, 7th edn. London: D. Appleton, 1909, p. 396; Frederick Taylor, The Practice of Medicine, 9th edn. London: J. & A. Churchill, 1911, pp. 431–2. On the word association tests, see: C. G. Jung, ‘The Association Method’, American Journal of Psychology 31 (1910): 219–69, rev. C. G. Jung, Analytical Psychology, trans. Constance Long. London: Bailliere, Tindall & Cox, 1917, ch. 2. Eder translated Jung’s experimental reports in 1918, Studies in Word Association Experiments in the Diagnosis of Psychopathological Conditions. London: Heinemann. On free association, see Freud, The Interpretation of Dreams [1900]. London: Penguin Press, 2001. Eder translated the dreams volume in 1914, see: On Dreams. London: William Heinemann. R. A. Hunter and I. Macalpine, ‘Follow Up Study of a Case Treated in 1910 by “the Freud Psychoanalytic Method” ’, British Journal of Medical Psychology 26 (1953): 64. Woolf, ‘Mr. Bennett and Mrs. Brown’, in The Captain’s Death Bed. London: Hogarth Press, 1950, p. 91. Paul Ricoeur, ‘The Question of Proof in Freud’s Psychoanalytical Writings’, Hermeneutics and the Human Sciences, trans. John B. Thompson. Cambridge: Cambridge University Press, 1983. Peter Stansky, On or about December 1910: Early Bloomsbury and the Intimate World. Cambridge, MA: Harvard University Press, 1997; Mark S. Micale, ‘The Psychiatric Body’, in Roger Cooter and John Pickstone (eds) Medicine in the Twentieth Century. Amsterdam: Harwood Academic Publishers, 2000, pp. 323–46; Daniel Pick, ‘The Id comes to Bloomsbury’, The Guardian, 26–7: R. D. Hinshelwood, ‘Psychoanalysis in Britain: Points of Cultural Access, 1893–1918’, International Journal of Psychoanalysis 76 (1995): 139; Idem., ‘Psychodynamic psychiatry before World War I’, in G. Berrios and H. Freeman (eds) 150 Years of British Psychiatry, vol. 1. London: Gaskell, 1991, pp. 197–205; Malcolm Pines, ‘The development of the psychodynamic movement’, in G. Berrios and H. Freeman (eds) 150 Years of British Psychiatry, vol. 1. London: Gaskell, pp. 206–31; Idem., ‘A history of psychodynamic psychiatry in Britain’, in J. Holmes (ed.) A Textbook History of Psychotherapy in Private Practice. Edinburgh: Churchill Livingstone, 1991. Virginia Woolf, ‘Mr. Bennett and Mrs. Brown’, in The Captain’s Death Bed. London: Hogarth Press, 1950, p. 91. Mathew Thomson, Psychological Subjects: Identity, Culture and Health in Twentieth-Century Britain. Oxford: Oxford University Press, 2006, p. 174.

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11 S. Freud, ‘Letter from Sigmund Freud to C. G. Jung, 12 October 1911 [273F]’, in William McGuire (ed.) The Freud/Jung Letters: The Correspondence Between Sigmund Freud and C. G. Jung. London: Routledge/Hogarth, 1994, pp. 447–8; Edward Glover, ‘Eder as Psychoanalyst’, in J. B. Hobman (ed.) David Eder: Memoirs of a Modern Pioneer. London: Victor Gollancz, 1945; Janet Oppenheim, Shattered Nerves. Oxford: Oxford University Press, 1991, pp. 304–5; Paul Ferris, Dr Freud: A Life. London: Sinclair Stevenson, 1997, p. 300; Martin Stone, ‘Shellshock and the Psychologists’, in William Bynum, Roy Porter and Michael Shepherd (eds) The Anatomy of Madness: Essays in the History of Psychiatry, vol. 2. London: Tavistock Publications, 1985, p. 243; Samuel Hynes, The Edwardian Turn of Mind. Princeton: Princeton University Press, 1968, p. 164; Jonathan Rose, The Edwardian Temperament, 1895–1919. Athens: Ohio University Press, 1986, p. 180; Gay, Freud, pp. 183–7; Ernest Jones, The Life and Work of Sigmund Freud [abridged edition]. Harmondsworth: Penguin Books, 1964, p. 365; Jones did not always hold this position, possibly because he was stung by Freud’s assertion (in his preface to the Hobman volume) that Eder had been the first to practice psychoanalysis in England. For the his more contextual accounts, see: Jones, ‘Reminiscent Notes on the Early History of Psycho-analysis in the EnglishSpeaking Countries’, International Journal of the Psycho-analysis 26 (1945): 8–10; Ernest Jones, ‘The Early History of Psycho-analysis’, Journal of Mental Science 100 (1954): 198–210. 12 Oppenheim, Shattered Nerves, p. 305. 13 Freud, ‘Screen memories’, in James Strachey et al. (eds) The Complete Standard Edition of the Works of Sigmund Freud London: Hogarth Press, III, 1899, pp. 301–22; Psychopathology of Everyday Life [1901], ch. IV. 14 For examples of the extensive coverage of Freud before 1911, see: ‘Professor Freud and Hysteria’, BMJ (11 January 1908): 103–4; ‘Freud’s Theory of Hysteria and other Psychoneuroses’, Lancet (21 May 1910): 1424–25; J. Mitchell Clarke, ‘Review of Breuer and Freud, Studien uber Hysterie’, Brain 19 (1896): 401–14; T. Claye Shaw, ‘The Clinical Aspects of Emotion and Action’, Lancet (11 February 1911): 353–5. The most prominent advocate was Bernard Hart, assistant medical officer at Long Grove, London County Council Asylum, see his: ‘A Philosophy of Psychiatry’, Journal of Mental Science 54 (1908): 473–90; ‘The Psychology of Freud and his School’, Journal of Mental Science 56 (1910): 431–52.; ‘The Conception of the Subconscious’, Journal of the Abnormal Psychology 4 (1910): 351–71; ‘Freud’s Concept of Hysteria’, Brain 33 (1911): 339–86. On Hart (1879–1966), see: Munks 6, pp. 226–7; BMJ 1 (1966): 806; Lancet 1 (1966): 720. His contribution tends to have been written out of the psychoanalytic account because of his difficulties with Ernest Jones, see: Paul Roazen, Oedipus in Britain: Edward Glover and the Struggle over Klein, New York: Other Press, 2000, p. 42.

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15 ‘The British Association’, The Times (8 September 1898), p. 5a on 6a; [William Crookes], ‘British Association: President’s Address’, BMJ (10 September 1898): 733. 16 Henry Devine, ‘The Significance of Some Confusional States’, BMJ 2 (1911): 747–8. See also: ‘The Biological Significance of Delusions’, Proc. RSM VII (Sect. Psychiatry] (1914): 194–8. On Devine (1879–1940) see Munks Roll. 17 Its reception does not merit a mention in the Freud/Jones correspondence although Freud knew that Eder was due to present the paper to the BMA, see Paskausas, The Complete Correspondence of Sigmund Freud and Ernest Jones, 1908–1939. Cambridge, MA: Harvard Bellknap, 1995, p. 112. 18 William Graham, ‘Psychotherapy’, BMJ (19 August 1911): 396–7. Mapother claims that psychotherapeutic techniques being used by Bernard Hart at Long Grove; Graham Soutar ‘the same kind of treatment had been pursued under various names for a long term’. See also [Medico], ‘Psycho-analysis’, BMJ (19 August 1911): 416 on a case of hysterical pregnancy; Hugh Wingfield, ‘Four Cases Illustrative of Certain Points in Psycho-analysis’, BMJ (5 August 1911): 256–7 hypnotic treatments and catharses of hysterical paralyses. Eder, ‘Freud’s Method of Psychoanalysis’, BMJ (14 October 1911): 959 provided a literature list for the many who have written asking for defences, includes Hart’s essay in JMS. Constance Long, ‘Psychotherapy’, BMJ (2 December 1911): 1476. 19 Psychology like medicine should be seen as portmanteau term which covers a range of divergent practices, see: Roger Cooter, ‘Framing’, in Frank Huisman and John Harley Warner (eds) Locating Medical History: The Stories and Their Meanings. Baltimore: The Johns Hopkins University Press, 2004, pp. 309–14; Nikolas Rose, ‘Medicine, history and the present’, in C. Jones and R. Porter (eds) Reassessing Foucault: Power, Medicine and the Body. London: Routledge, 1997, pp. 48–72; John Pickstone, Ways of Knowing: A New History of Science, Technology and Medicine. Manchester: Manchester University Press, 2000, pp. 6–7. 20 Lancelot Law Whyte, The Unconscious before Freud. London: Social Science Paperbacks, 1992; Henri Ellenberger, The Discovery of the Unconscious, [1970]. London: Fontana Press, 1994; Adam Crabtree, From Mesmer to Freud: Magnetic Sleep and the Roots of Psychological Healing. New Haven: Yale University Press, 1993; Stanley W. Jackson, Care of the Psyche: A History of Psychological Healing. New Haven: Yale University Press, 1999. For an overview of the historiography, see the bibliographic essay of M. Micale in Idem. (ed.) Beyond the Unconscious: Essays of Henri F. Ellenberger. Princeton, NJ: Princeton University press, 1993. 21 For a useful if slightly gnomic introduction into how the unconscious can be reconstituted through different language and practices, see: G. Deleuze and F. Guattari, ‘1914: One or several wolves’, in A Thousand Plateaus: Capitalism and Schizophrenia. London: Athlone, 1988, pp. 26–37.

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22 This model has persisted in the work of certain psychotherapists and placebo researchers, see: Jerome D. Frank, Lester H. Gliedman, Stanley D. Imber, Anthony R. Stone and Earl H. Nash, ‘Patients’ Expectancies and Relearning as Factors Determining Improvement in Psychotherapy’, American Journal of Psychiatry 115 (1959): 961–8; A. K. Shapiro and L. A. Morris, ‘The placebo effect in medical and psychological therapies’, in Sol Garfield and Allen E. Bergin (eds) Handbook of Psychotherapy and Behavior Change: An Empirical analysis. New York: John Wiley and Sons, 1978, pp. 369–410; A. K. Shapiro and E. Shapiro, The Powerful Placebo: From Ancient Priest to Modern Physician. Baltimore: Johns Hopkins University Press, 1997. Nicholas Humphrey, ‘Great Expectations: The Evolutionary Psychology of Faith Healing and the Placebo Effect’, in Nicholas Humphrey (ed.) The Mind made Flesh: Essays from the Frontier of Evolution and Psychology. Oxford: Oxford University Press, 2002, pp. 255–85. 23 Sigmund Freud, ‘Introductory lectures on psychoanalysis’, [1917] in S.E. XVI: 284–5; ‘A difficulty in the path of psychoanalysis’, [1917] in S.E. XVII: 139–43. 24 Barry Barnes, ‘Social Life as Bootstrapped Induction’, Sociology 17 (1983): 524–45. Ian Hacking, ‘The Looping Effects of Human Kinds,’ in Dan Sperber, David Premack and Ann J. Premack (eds) Causal Cognition: A Multidisciplinary Approach. Oxford: Clarendon Press, 1994, pp. 351–94; Ian Hacking, ‘WorldMaking by Kind-Making: Child Abuse for Example’, in Mary Douglas and David Hull (eds) How Classification Works: Nelson Goodman among the Social Sciences. Edinburgh: Edinburgh University Press, 1992, pp. 180–238; Kurt Danziger, Naming the Mind: How Psychology found its Language. London: Sage Publications, 1997. 25 Kurt Danziger, ‘Natural kinds, human kinds and historicity’, in W. Maiers, B. Bayer, B. Duarte Esgalhado, R. Jorna and E. Schraube (eds) Challenges to Theoretical Psychology. North York, ON: Captus, 1999; Kurt Danziger, ‘When history, theory and philosophy meet. The biography of psychological objects’, in D. B. Hill and M. J. Kral (eds) About Psychology: Essays at the Crossroads of History, Theory and Philosophy. Albany: State University of New York Press, 2003; Roger Smith, ‘The History of Psychological Categories’, Studies in the History and Philosophy of the Biological and Biomedical Sciences 36 (2005): 55–94. 26 It is a curious fact that we have little difficulty in accepting the idea that selfhood might be a social construction and there is a large academic industry devoted to the analysis of this idea. However, the unconscious or subconscious mind seems to have largely escaped this kind of interrogation. 27 Steven Shapin, ‘History of science and its sociological reconstructions’, History of Science 20 (1982): 157–211. Steven Shapin, ‘Here, There and Everywhere: Sociology of Scientific Knowledge’, Annual Review of Sociology 21 (1995): 289–321; Jan Golinski, ‘The theory of practice and the practice of theory: sociological

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approaches in the history of science’, Isis 81 (1990): 492–505; Jan Golinski, Making Natural Knowledge: Constructivism and the History of Science. Cambridge: Cambridge University Press, 1999. Karl Popper, The Logic of Scientific Discovery [1959]. London: Hutchinson, 1987, pp. 93–111. There is a massive philosophical and sociological literature on the resolution of experimental disputes and the problem of replication. For a simple introduction, see: Harry Collins and Trevor Pinch, The Golem: What Everyone should know about Science. Cambridge: Cambridge University Press, 1997. Problem of extending symmetry to interests, see: Steven Woolgar, ‘Interests and Explanation in the Social Study of Science’, Social Studies of Science 11 (1981): 365–94; Andy Pickering, ‘The Mangle of Practice: Agency and Emergence in the Sociology of Science’, American Journal of Sociology 99, 3 (1993): 559–89. Ian Hacking, ‘The Self-Vindication of the Laboratory Sciences’, in Andrew Pickering (ed.) Science as Practice and Culture. Chicago: University of Chicago Press, 1992, pp. 29–64. D. C. Gooding, ‘Experiment as an Instrument of Innovation: Experience and Embodied Thought’, in M. Benyon et al. (eds) Cognitive Technology: Instruments of Mind. Heidelberg: Springer, 2001, pp. 130–40. Timothy Lenoir, ‘Practice, Reason, Context: The Dialogue between Theory and Experiment’, Science in Context 2 (1988): 3–22 repr. Instituting Science: The Cultural Production of Scientific Disciplines. Stanford, CA: Stanford University Press, 1997, pp. 22–44. Joseph Rouse, Engaging Science: How to Understand Its Practices Philosophically. Ithaca and London: Cornell University Press, 1996, p. 137. Gerd Gigerenzer, ‘Discovery in Cognitive Psychology: New Tools Inspire New Theories’, Science in Context 5 (1992): 329–50. Andy Pickering, ‘The Mangle of Practice: Agency and Emergence in the Sociology of Science’, American Journal of Sociology 99, 3 (1993): 559–89. Peter Galison, ‘Reflections on Image and Logic: A Material Culture of Microphysics’, Perspectives on Science 7, 2 (1999): 255–84; Hans-Jorg Rheinberger, Towards a History of Epistemic Things: Synthesizing Proteins in a Test tube. Stanford: Stanford University Press, 1997. Shigehisa Kuriyama, The Expressiveness of the Body and the Divergence of Greek and Chinese Medicine. New York: Zone Books, 1999. The idea of emergence taken from Bergson, and developed in Andy Pickering, ‘The Mangle of Practice’, see also, his, ‘Science as Alchemy’, in Joan Scott, Deborah Keates and Clifford Geertz (eds) Schools of Thought: Twenty-five Years of Interpretive Social Science. Princeton: Princeton University Press, 2001, pp. 194–206.

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40 For the examples of the impact of technology on the conceptualisation and practice of remembering, see: Jack Goody, The Domestication of the Savage Mind. Cambridge: Cambridge University Press, 1977; Paul Connerton, How Societies Remember. Cambridge: Cambridge University Press, 1989; D. Leary (ed.) Metaphors in the History of Psychology. Cambridge: Cambridge University Press, 1990; Graham Richards, Putting Psychology in its Place: An Introduction from a Critical Historical Perspective. London: Routledge, 1996; Andy Pickering, ‘Science as Alchemy’, in Joan Scott, Deborah Keates and Clifford Geertz (eds) Schools of Thought: Twenty-five Years of Interpretive Social Science. Princeton: Princeton University Press, 2001, pp. 194–206. 41 Roger Smith, ‘Does Reflexivity Separate the Human Sciences from the Natural Sciences?’, History of the Human Sciences 18, 4 (2005): 1–25. 42 Roger Smith, ‘The History of Psychological Categories’, Studies in the History and Philosophy of the Biological and Biomedical Sciences 36 (2005): 55–94. 43 qv. OED, Raymond Williams, Keywords: A Vocabulary of Culture and Society. London: Fontana/Croom Helm, 1981; Shamdasani, ‘Keywords: Unconscious’, Lancet (4 June 2005): 1921. 44 Jonathan Miller, ‘Going Unconscious’, in Robert B. Silvers (ed.) Hidden Histories of Science. London: Granta Books, 1997, pp. 1–35. 45 Stefan Zweig, Mental Healers, trans. Eden and Cedar Paul [1933]. New York: Unger, 1962, ch. 1; Ellenberger, Discovery, pp. 57–83; Jerome D. Frank, Persuasion and Healing: A Comparative Study in Psychotherapy. Baltimore: Johns Hopkins University Press, 1961, p. 4; T. W. Mitchell, Problems in Psychopathology. London: Kegan Paul, Tench, Trübner, 1927, pp. 6–17; B. Totman, Social Causes of Illness. London: Souvenir Press, pp. 37–8. 46 As well as the examples given below, see: H. Bernheim, Suggestive Therapeutics, [1886]. Westport, CT: Associated Booksellers, 1957. 47 Hart, ‘Development of Psychopathology and its Place in Medicine’, Lancet (20 March 1926): 585. 48 Clifford Allen, Modern Discoveries in Medical Psychology. London: Macmillan & Co., 1937, pp. 10–11. 49 Margaret Goldsmith, Franz Anton Mesmer. The History of an Idea. London: Arthur Baker, 1944, pp. 122–3. 50 Vincent Buranelli, The Wizard from Vienna: Franz Anton Mesmer. New York: Coward, McCann and Geoghagan, pp. 216–17. Frank Pattie, Mesmer and Animal Magnetism. Hamilton: Edmonston, 1994; Adam Crabtree, ‘Mesmerism, divided consciousness and multiple personality’, in Franz Schott (ed.) Franz Anton Mesmer und die Geschichte des Mesmerismus. Stuttgart: Franz Steiner, p. 198. 51 ‘Dissertation by F. A. Mesmer, Doctor of Medicine on his Discoveries’, in Mesmerism: A Translation of the Original Medical and Scientific Writings of

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58 59 60 61

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F. A. Mesmer, edited and translated by George Bloch. Los Altos, CA: William Kaufman Inc, 1980, pp. 89–130 on pp. 103, 106. ‘Catechism on Animal Magnetism’ in Ibid., pp. 81–5. Gauld, History of Hypnotism, p. 13; E. M. Thornton, Hypnotism, Hysteria and Epilepsy. London: Heinemann Medical, 1976; D. W. Forrest, Hypnotism: A History. London: Penguin books, 1998, pp. 67–8. Ellenberger and Anne Harrington, The Cure Within: A History of Mind-Body Medicine. New York: W. W. Norton and Co., 2008, pp. 51–2, 253. Patricia Fara, Sympathetic Attractions: Magnetic Practices, Belief and Symbolism in Eighteenth-century England. Princeton, NJ: Princeton University Press, 1986, pp. 189–90. John Bell, The General and Particular Principles of Animal Electricity and Magnetism in which are found Dr Bell’s Secrets and Practice. London: The Author, 1792, p. 23. [Anon]. The Wonders and Mysteries of Animal Magnetism Displayed. London: J. Sudbury, 1790, p. 18. George Winter, Animal Magnetism. History of its Origins, Progress and Present State; its Principles and Secrets Displayed, as Delivered by the late Dr Demainauduc. Bristol: Routh, 1801, pp. 36–7 and summary of De Mainauduc’s lectures, pp. 19–42. On the popularity of mesmerism in Britain from 1787 to 1800, see Winter, pp. 12–17; [Anon], Wonders and Mysteries of Animal Magnetism displayed. London: J. Sudbury, 1790, pp. 4–7. A Letter to a Physician in the Country on Animal Magnetism and his Answer. London: J. Debrett, 1786, pp. 4, 6. Elizabeth Inchbald, Animal Magnetism: A Farce in Three Acts [1786]. London: John Cumberland, n.d. Alasdair MacIntyre, The Unconscious: A Conceptual Study. London: Routledge and Kegan Paul, 1958, pp. 44–5. Wilkie Collins, The Moonstone, [1868]. London: Penguin Books, 1992; G. du Maurier, Trilby, [1893/4]. Oxford: Oxford World Classics, 1992. For background, see: Jenny Bourne Taylor, In the Secret Theatre of Home: Wilkie Collins, Sensation Literature and Nineteenth-Century Psychology. London: Routledge, 1988, ch. 5; Daniel Pick, Svengali’s Web: The Alien Enchanter in Modern Culture. New Haven: Yale University Press, 2000, pp. 34–6, 125–6. Esme Stuart, In his Grasp. London: W. H. Allen, 1887; Walter Besant, Herr Paulus. London: Chatto and Windus, 1888. Christopher Booth, John Haygarth, FRS, (1740–1827): A Physician of the Enlightenment. Philadelphia: American Philosophical Society, 2005, pp. 103–9; W. J. Bishop, ‘Elisha Perkins and his Metallic Tractors’, British J. Rheumatism 1 (1939): 193–206; Tuke, Influence II, 251–7.

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63 Benjamin Perkins, The Influence of Metallic Tractors on the Human Body etc. London: J. Johnson and Oglivy and Son, 1798; Charles C. Langworthy, A View of Perkinian Electricity, or an Enquiry into the Influence of Metallic Tractors etc. Bath: R. Crutwell, 1798. 64 John Haygarth, On the Imagination as a Cause and as a Cure of Disease of the Body Exemplified by Fictitious Tractors and Epidemical Convulsions. Bath: R. Crutwell, 1800. Thomas Dixon, ‘Patients and passions: languages of emotion and medicine, 1789–1850’, in Fay Bound-Alberti (ed.) Medicine, Emotion and Disease, 1700–1950, Basingstoke: Palgrave, 2006, pp. 31–2. 65 Ibid., p. 28. See also William Falconer (1744–1824), A Dissertation on the Influence of the Passions upon Disorders of the Body being an Essay to which the Fothergillian Medal was Adjudged. London: C. Dilly and T. Phillips, 1788 which gives a case by case outline on the curative powers of the imagination and the need for medical discretion. 66 C. E. McMahon, ‘The Role of Imagination in the Disease Process: Pre-Cartesian History’, Psychological Medicine 6 (1976): 179–84; Theodore M. Brown, ‘Descartes, dualism and psychosomatic medicine’, in William Bynum, Roy Porter and Michael Shepherd (eds) The Anatomy of Madness: Essays in the History of Psychiatry, vol. 1. London: Tavistock Publications, 1985, pp. 179–84; George Rousseau, Nervous Acts: Essays on Literature, Culture and Sensibility. Basingstoke: Palgrave, 2004, chs. 2–3; Stanley Jackson, ‘The Imagination and Psychological Healing’, Journal of the History of the Behavioral Sciences 26, 4 (1990): 345–58; Koen Vermeit, ‘The “physical prophet” and the powers of the imagination. Part I: a case study on the vapours and the imagination (1685–1710)’, Studies in the History and Philosophy of Biology and Biomedicine 35 (2004): 561–91. On the use of Baconian medicine by enlightenment physicians, see: A. Luyendijk-Elshout, ‘Of masks and mills: the enlightened doctor and his frightened patient’, in George Rousseau (ed.) Languages of the Psyche: Mind and Body in Enlightenment Thought. Berkeley: University of California Press, 1990, pp. 186–236. On the Baconian model of the imagination, see: Katharine Park, ‘Bacon, Galileo, and Descartes on Imagination and Analogy’, Isis 75 (1984): 287–326; G. P. Bouce, ‘Imagination, pregnant women and monsters, in eighteenth-century England and France’, in G. S. Rousseau and R. S. Porter (eds) Sexual Underworlds of the Enlightenment. Manchester: Manchester University Press, 1987, pp. 87–100. 67 Booth, Haygarth, p. 109; Ulrich Trohler, To Improve the Evidence of Medicine: The Eighteenth Century British Origins of a Critical Approach. Edinburgh: Royal College of Physicians of Edinburgh, 2000, p. 93. 68 Casimir Chardle, Essai de Psychologie Physiologique quoted in J. C. Colquhoun, Report of the Experiments on Animal Magnetism. Edinburgh: Robert Cadell, 1833, p. 92.

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69 Dugald Stewart, Elements of the Philosophy of the Human Mind, vol. III. London: William Tegg, 1827, p. 147. 70 James Braid, ‘On the power of the mind over the body: an experimental inquiry into the nature and cause of the phenomena attributed to Baron Reichenbach and other to the “new imponderable”’, Medical Times 14 (1846): 214–16, 252–4, 273–4 reprinted as, The Power of the Mind over the Body etc. London: John Churchill, 1846; Idem., Hypnotic Therapeutics. Edinburgh: Pentland Young, 1853. On Braid, see James Milne Bramwell, ‘James Braid, Surgeon and Hypnotist’, Brain (1895): 19, 90–153; Gauld, Hypnotism, pp. 279–88; Crabtree, Mesmer to Freud, pp. 155–62; Winter, Mesmerized, pp. 184–5. 71 Braid, ‘Magic, Mesmerism, Hypotism, etc.’, Medical Times 11 (1844): 296–9. 72 Henry Holland, ‘Effects of Medical Attention on Bodily Organs’, in Medical Notes and Reflections. London: Orme, Brown, Green and Longmans, 1839, pp. 64–75; Chapters on Mental Physiology. London: Longmans, 1852, ch. 2; [Anon], ‘Dr Holland on Mental Physiology’, British and Foreign Medical Chirurgical Review 10 (1852): 219–32, esp. 223–8; J. G. Millingen, Curiosities of Medical Experience, 2nd edn. London: R. Bentley, 1839, pp. 125–35. On Holland (1788–1873), see his Recollections of My Past Life. London: Longmans, 1871. For discussion see: Rick Rylance, Victorian Psychology and British Culture, 1850–1880. Oxford: Oxford University Press, 2000, pp. 127–43. Tuke, Influence 1, pp. 86–7, 101–2 for the effects of expectation on neuralgia and hydrophobia. 73 Braid, Magic, Witchcraft, Animal Magnestism, Hypnotism and Electro-Biology being a Digest of the Author’s Latest Views on these Subjects, 3rd edn. London: John Churchill, 1852. 74 Holland, Chapters, p. 224. 75 See for instance, the mid-Victorian crazes for ‘swing-swangs’ and the ‘willing game’ described in William Barrett, Psychical Research. London: Williams and Norgate, 1911, ch. 4. 76 See the cases reported in John Timbs, Doctors and Patients, vol. 1. London: R. Bentley and Sons, 1873, p. 113 (on self-induced hemorrhage through fear); George Johnson, ‘On overwork and anxiety as causes of mental and bodily disease among the poor’, in Lectures to Ladies on Practical Subjects. London: Macmillan and Co., 1855. 77 David Russell, Letters: Chiefly Practical and Consolatory 1. Edinburgh: Waugh and Innes, 1822, pp. 7–12, on p. 10. 78 William Stroud, A Treatise on the Physical Cause of the Death of Christ and its Relation to the Principles and Practice of Christianity. London: Hamilton and Adams, 1847, pp. 73–127, 389–98. Discussions of this theory continued throughout the nineteenth century, see: Edward Symes-Thompson, On the Physical Cause of the Death of Christ. London: SPCK, 1904 repr. W. D. Edwards.

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82 83

84 85

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Notes W. J. Gabel and F. E. Hosmer, ‘On the Physical Death of Jesus Christ’, JAMA 255 (21 March 1986): 1455–63; M. W. Maslen and P. D. Mitchell, ‘Medical Theories on the Cause of Death in the Crucifixion’, JRSM 99 (2006): 185–8. Stroud, Death of Christ, p. 74. William Carpenter, ‘Electrobiology and Mesmerism’, Quarterly Review 93 (1853): 501–57, on 507; Mesmerism, Spiritualism & c., Historically and Scientifically Considered. London: Longmans, Green and Co., 1877, p. 115. ‘On the Influence of Suggestion in Modifying and Directing Muscular Movements, Independently of Volition’, Proceedings of the Royal Institution 1 (1850): 147–53. ‘Electrobiology and mesmerism’, 518. As Carpenter notes in an ironic reference to the language of spiritualism: ‘Many of the victims of delusions have become the subjects of actual insanity: which is attributed by believers to “a spirit having entered and taken possession.” What kind of spirits they are which thus take possession of credulous and excitable minds, I hope that I have now sufficiently made plain: they are Dominant Ideas’. For overviews of mid-Victorian physiology, see: L. Daston, ‘British Responses to Psycho-Physiology, 1860–1900’, Isis 69, 247 (1978): 192–208. Eric Caplan, ‘Trains, Brains, and Sprains: Railway Spine and the Origins of Psycho-neuroses’, Bulletin of the History of Medicine 69 (1995): 387–419. Ralph Harrington, ‘The Railway Journey and the Neurosis of Modernity’, in R. Wrigley and G. Revill (eds) Pathologies of Travel. Amsterdam: Rodopi, 2000, pp. 229–59; Ralph Harrington, ‘The Railway Accident: Trains, Traumas and Technological Crises in Ninetieth-Century Britain’, in Mark Micale and Paul Lerner, Traumatic Pasts: History, Psychiatry and Trauma in the Modern Age, 1870–1930. Cambridge: Cambridge University Press, 2001; Ralph Harrington, ‘On the Tracks of Trauma: Railway Spine Reconsidered’, Social History of Medicine 16, 2 (2003): 209–23; Thomas Keller, ‘Railway Spine Revisited: Traumatic Neurosis or Neurotrauma’, Journal of the History of Medicine and Allied Sciences 50 (1995): 507–24; Anson Rabinbach, The Human Motor: Energy, Fatigue and the Origins of Modernity. Berkeley: CA, 1992. Clifford Allbutt, ‘Neurasthenia’, in C. Allbutt and H. D. Rolleston, A System of Medicine VIII. London: Macmillan, 1911, pp. 764–7. On railway spine as a precursor a precursor to PTSD, see: Ralph Harrington, ‘Railway Spine and Victorian Responses to PTSD’, Journal of the Psychosomatic Research 40, 1 (1996): 11–14; Ben Shephard, A War of Nerves. London: Cape, 2000, pp. 16–20. Edward M. Brown, ‘Regulating Damage Claims for Emotional Injuries before the First World War’, Behavioral Sciences and the Law 8 (1990): 421–34. Herbert W. Page, Injuries of the Spine and Spinal Cord. London: J. A. Churchill, 1883, pp. 147–51; Idem., Railway Injuries with Special Reference to those of

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the Back and Nervous System, 2nd edn, London: Charles Griffin, 1891, p. 29. Page drew upon the models of paralyses, fear and shock put forward by Henry Maudsley, Furneaux Jordan and James Paget: Henry Maudsley, Pathology of Mind, 3rd edn. London: Macmillan, 1879, pp. 360–9; Furneaux Jordan, Surgical Enquiries, Including the Hastings Essay on Shock. London: Churchill, 1880, pp. 27–37; James Paget, ‘Nervous Mimicry’, in Clinical Lectures and Essays. London: Longmans Green, 1875, pp. 172–252. Page, Injuries of the Spine, pp. 175–82; Railway Injuries, pp. 54–6, 66–7, 127–32. William Thorburn, ‘The Traumatic Neuroses’, Proc. RSM 7 (1914), [Section of Neurology], pp. 7, 2. C. f. Freud, ‘Psychical (or Mental) Treatment’ in SE7: 289. On Myers (1903), see: F. M. Turner, Between Science and Religion. New Haven: Yale University Press, 1974, ch. 5; Sidgwick, see: Bart Schulz, Henry Sidgwick: The Eye of the Universe. Cambridge: Cambridge University Press, 2002; Gurney, see: Trevor Hall, The Strange Case of Edmund Gurney. London: Duckworth, 1964. On the political work of the SPR, see my, Resisting History, ch. 2. E. Gurney, ‘Peculiarities of Certain Post-Hypnotic States’, Proceedings of the Society for Psychical Research (Proc. SPR) 4 (1886–87): 321. See also: see also E. Gurney, ‘Problems of Hypnotism’, Proc. SPR 2 (1883–84): 270–7; F. Myers, ‘Further Notes on the Unconscious Self, pt. 2’, Journal of the SPR (March 1886): 225. E. Gurney, F. W. H. Myers and F. Podmore, Phantasms of the Living, 2 vols. London: S.P.R. and Trübner & Co., 1886. Phantasms: xlii–iii; ‘On Telepathic Hypnotism and its Relation to Other Forms of Hypnotic Suggestion’, Proc. SPR 4 (1886–7): 185; ‘Multiplex Personality’ Proc. SPR 4 (1886–7): 496–514. On the German tradition, see: Thinking the Unconscious: Nineteenth Century German Thought, eds Angus Nicholls and Martin Liebscher. Cambridge: Cambridge University Press, 2009, i. For discussions of Gurney’s experiments in hypnosis, see: Gauld, Hypnotism: 389–93; T. W. Mitchell, ‘The Contribution of Psychical Research to Psychotherapeutics’, Proc. SPR 45 (1938–9): 175–86; Frederic Myers, ‘The Work of Edmund Gurney in Experimental Psychology’, Proc. SPR 5 (1888–9): 359–73; Williams, Victorian Psychical Research ch. 7, sect. 2. Hall (Edmund Gurney) has suggested that Gurney’s experimental results were produced through his subject’s deliberate deceit. ‘Problems of Hypnotism’, Proc. SPR 2 (1883–4): 265–92; ‘Further Problems of Hypnotism’, Mind 12 (1887): 212–32, 397–442. ‘Peculiarities of Certain Post-Hypnotic States’, Proc. SPR 4 (1885–7): 268–323; ‘Recent Experiments in Hypnotism’, Proc. SPR 5 (1888–9): 3–17. Arthur Pierce and Frank Podmore, ‘Subliminal Self or Unconscious Cerebration’, Proc. SPR 7 (1892): 317–32.

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100 also, ‘Human Personality in the Light of Hypnotic Suggestion’, Proc. SPR 4 (1886–7):1–24, repr. Nineteenth Century 20 (1886): 649–52. This view of psychodynamic research was shared by many continental researchers including Henry Beaunis, Auguste Forel and Kraft-Ebing: A. Moll, Hypnotism, including a study of the chief points of psychotherapeutics [1889]. 3rd edn. Trans. Arthur Hopkirk. London: Walter Scott, 1899, p. 333. 101 William James ‘Frederic Myers Service to Psychology’, [1901] repr. in Essays in Psychical Research. Cambridge, MA: Harvard University Press, 1986, p. 196; also his ‘Review of Human Personality and its Survival of Bodily Death’ in Ibid., pp. 211–2; also Theodore Flournoy’s review of same, Proc. SPR. 18 (1903): 46. 102 For an overview of the Charcot scholarship, see, Mark Micale, Approaching Hysteria. Princeton NJ: Princeton University Press, 1995, pp. 88–97. 103 Mark S. Micale, ‘On the “Disappearance of Hysteria”: Notes on the Clinical Deconstruction of a Diagnosis’, Isis 84 (1993): 496–526. 104 For the British argument, see: Robert Brudenell Carter, On the Pathology and Treatment of Hysteria. London: John Churchill, 1853. 105 Ruth Harris, ‘Introduction’ in J. M. Charcot, Clinical Lectures on Diseases of the Nervous System [1889] edited with an introduction by Ruth Harris. London: Tavistock/Routledge, 1991, pp. xxxix–xlvi; p. 3. 106 For the emphasis on the visual, see: Daphne De Maurneffe, ‘Looking and Listening: The Construction of Clinical Knowledge in Charcot and Freud’, Signs: Journal of Women in Culture and Society 17.1 (1991): 71–111. 107 Deborah Sadoff, ‘Experiments made by Nature: Mapping the Hysterical Body’, Victorian Newsletter 81 (1992): 41–4; Ian Hacking, Rewriting the Soul: Multiple Personality and the Sciences of Memory. Princeton, NJ: Princeton University Press, 1995, pp. 180–2. 108 For fuller discussions, see: Andre Leblanc, ‘The Origins of the Concept of Dissociation: Paul Janet, his Nephew Pierre, and the Problem of Post-hypnotic Suggestion’, History of Science 39 (2001): 57–69; Ellenberger, Discovery: ch. 6; Onno van der Hart & Barbara Friedman. ‘A Reader’s Guide to Pierre Janet’, Dissociation 2 (1989): 3–16. For Janet on the visualisation of hysteria, see: The Mental State of Hystericals [1901], (Washington DC: University Publications of America, 1977): 1–11. For Janet’s relationship to bioenergetic models, see: Sonu Shamdasani, ‘Claire, Lise, Jean, Nadia, and Gisele: Preliminary Notes towards a Characterisation of Pierre Janet’s Psychasthenia’, in Marijke Gijswijt-Hofstra and Roy Porter (eds) Cultures of Neurasthenia: From Beard to the First World War, [Clio Medica 63], (Amsterdam: Rodopi, 2002): 363–85. For role in the description of pathogenic trauma, see: Ruth Leys, ‘Traumatic Cures: Shellshock, Janet and the Question of Memory’, Critical Inquiry 20 (1994): 623–62; Idem., Trauma: A Genealogy. Chicago: Chicago University Press, 2000, ch. 2; Allan Young,

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1 11 112

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115 1 16 117

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The Harmony of Illusions: Inventing Post-Traumatic Stress Disorder. Princeton: Princeton University Press, 1995, pp. 32–5. Janet, Mental State of Hystericals, pp. 30–1; 68–73. On amnesia: pp. 78–91. Janet, L’Automatisme Psychologique. Paris: F, Alcan, 1889, pp. 128–33; Frank Podmore, Frank Podmore, Studies in Psychical Research. London: Kegan Paul, Trench, Trübner & Co. Ltd., 1897, pp. 389–91. Hystericals, p. 249. Hystericals, p. 202. This argument drew on the massive French medical literature on nostalgia and amnesia. See Mark Roth, ‘Remembering Forgetting: Maladies de la Memoire in Nineteenth Century France’, Representations 26 (1989): 49–68; Idem., ‘Dying of the Past: Medical Studies of Nostalgia in Nineteenth Century France’, History & Memory 3 (1991): 5–29. Hystericals, p. 440. C.f. Myers use of Breuer and Freud, ‘Studies on hysteria’ [1895], Pelican Freud Library, vol. 2. London: Penguin, 1984, pp. 5–6. Janet had however rejected Myers’ early attempt to develop a hemispheric explanation of possession: L’Automatisme Psychologique: pp. 413–19; Harrington, Anne Harrington, Medicine, Mind, and the Double Brain, Princeton University Press, 198, pp. 141–2. See his retrospective statement, Psychological Healing. London: Macmillan, 1925, pp. 590–606. Psychological Healing, p. 662. J. Dejerine and E. Glaucker, The Psychoneuroses and their Treatment by Psychotherapy, [1911]. trans. S. E. Jeliffe, London: J. B. Lippincott, [1915]; Paul Dubois, Psychic Treatment of Nervous Disorders, trans. S. E. Jelliffe, New York: Funk and Wagnalls, 1909; H. Babinski and J. Froment, Hysteria or Pithiatism, ed. E. Farquhar Buzzard, [Military Medical Manuals], London: University of London Press, 1918. Arthur Myers published the case history of Borru and Burot’s patient, Louis V: ‘Psychological Retrospect: The Life History of a Case of Multiple Personality’, Journal of Mental Science 31 (1886–7): 596–605, also discussed in Frederic Myers, ‘Human Personality in the Light of Hypnotic Suggestion’: 21–3; ‘Multiplex Personality’ 497–500. For further discussions of the French approach: F. Myers, ‘French Experiments on Strata of Personality’, Proc. SPR 6 (1888–9): 334–97; ‘Binet on the Consciousness of Hysterical Subjects’; ‘Janet’s L’Automatisme Psychologique’; ‘Noticeable Books VI: Janet’s Psychological Automatism’, Nineteenth Century 26 (1889): 341–3; ‘Dr Jules Janet on Hysteria and Double Personality’, Proc. SPR 7 (1889–90): 216–21; ‘Pseudo-possession’, Proc. SPR 15 (1900–1): 90–5. On A. T Myers (1851–94), see: D. C. Taylor and S. M. Marsh, ‘Hughlings Jackson’s Dr Z: the paradigm of temporal lobe epilepsy revealed’, Journal of Neurology, Neurosurgery, and Psychiatry, 43 (1980), 758–67.

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119 A. T. Myers ‘Hypnotism at Home and Abroad’. Practitioner (March 1890): 197–206; R. P. Smith and A. T. Myers, ‘Treatment by Hypnotic Suggestion’, JMS 36 (1890): 191–202. On the resistance to medical hypnotism in Britain, see: Teri Chettiar, ‘“Looking as Little like Patients as Persons Well Could”: Hypnotism, Medicine and the Problem of the Suggestible Subject in Late Nineteenth-Century Britain’, Medical History 56 (2012): 335–55. 120 For reports of the French experiments, see: Charles Lloyd Tuckey, ‘Faith Healing as a Medical Treatment’, Nineteenth Century 24 (1888): 839–50; H. Rolleston ‘Treatment by Hypnotic Suggestion’, Barts Hospital Reports (1889): 23–39; William Hale White, A Text book of General Therapeutics, London: Macmillan and Co, 1889, pp. 295–333; George M. Robertson, ‘Hypnotism at Paris and Nancy. Notes of a Visit’, JMS 38 (1892): 494–531. For a brief overview, William Parry Jones, ‘J.-M. Charcot’s Impact on Psychological Medicine in the 1880’s’, Bulletin of the Royal College of Psychiatrists 11 (1987): 150–3. 121 A. T. Myers and F. W. H. Myers, ‘Mind-cure, faith-cure and the miracles of Lourdes’, Proceedings of the Society for Psychical Research 9 (1893–94): 160–209. 122 Myers, ‘The subliminal consciousness VI: The mechanism of hysteria’, Proceedings of the Society for Psychical Research 9 (1893–94): 24–5. 123 Myers and Myers, ‘Mind cure, faith cure’: 208. 124 F. W. H. Myers, ‘The Psychology of Hypnotism’, BMJ (10 September 1898): 674–7 repr. Proc. SPR 14 (1899) 100–8. J. M. Bramwell also spoke: J. M. Bramwell, ‘A Discussion on the Phenomena of Hypnotism and the Theory as to its Nature’, BMJ (10 September 1898): 669–74. See also, Charles Lloyd Tuckey, Treatment by Hypnotism and Suggestion, [1889] 5th edn. London: Balliere, Tindall and Cox, 1907, app. note 5. 125 Ibid., p. 677. 126 For the controversy, see: M. E. Leighton, ‘“Hypnosis redivius”: Ernest Hart, the British Medical Journal, and the Hypnotism Controversy’, Victorian Periodicals Review 34 (2001): 104–27. 127 Ernest Hart, ‘The Revival of Witchcraft’, Nineteenth Century 33 (1893): 347–68 repr. in Hypnotism, Mesmerism and the New Witchcraft, London: Smith Elder & Co., 1898. For examples of the Lancet’s hostility, see: ‘Hypnotism: Retail and Wholesale’, Lancet (19 October 1889): 803; ‘Editorial’ Lancet (24 May 1890) 1133; (31 May 1890): 1202. 128 For an overview of these movements, see: Eric Caplan, Mind Games: American Culture and the Birth of Psychotherapy. Berkeley: University of California Press, 1998, pp. 69–82; Ann Taves, Fits, Trances and Visions. Princeton: Princeton University Press, 1999, pp. 215–32, 311–21. 129 M. B. Eddy, Science and Health with a Key to the Scriptures, [1875]. Boston: Christian Science Publishing House, 1975, ch. 35.

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130 Warren Felt Evans, The Mental Cure: Illustrating the Influence of the Mind on the Body, both in health and diseases and the psychological method of treatment. Glasgow: James McGeachy, 1870. 131 Frank Podmore, Mesmerism and Christian Science: A Short History of Mental Healing. London: Methuen and Co. 1909, p. 207. 132 Horatio Dresser, A History of the New Thought Movement. Philadelphia: Harrap, 1920, ch. 12. 133 F. L. Rawson, Man’s Power and Work [with a biographical sketch of the author]. London: Crystal Press, 1913; Life understood from a Scientific and Religious Point of View and a Practical Method of destroying Sin, Disease and Death. London: Crystal Press, 1912. Rawson published the popular healing magazine, Active Service from 1914–17, see O. D. Savage, F. L. Rawson: A Memoir. London: SPKPT, 1933. For an enthusiastic exposition, see: W. Owen Hughes, Divine Healing and Self Understanding, Westcliff on Sea: Williamson and Co., n.d. 134 For psychic trials, see: Marie Corelli, The Life Everlasting [1911]. London: Methuen, 1964; Idem., Ardath; The Story of Dead Self. London: Bentley, 1889. 135 A. Conan Doyle, The Parasite. London: Acme Library, 1894; Sheridan Jolly, The Soul of a Moor. London: Rider, 1912; Franz Hartmann, ‘Vampires’, The Borderland 3.2 (1896): 353–8. 136 The ‘psychic doctor’ first appears in Sheridan Le Fanu Green Tea, see Green Tea and other Ghost Stories, [1869]. London: Constable, 1893. On the popularity of these novels, see: Peter Keating, The Haunted Study: The English Novel, 1875–1914, London: Hutchison, 1984, pp. 120–4, 360–3; Julia Briggs, Night Visitors: The Rise and Fall of the English Ghost Story. London: Faber, 1982. 137 On his association with Edinburgh medicine, see: Mike Ashley, Starlight Man: The Extraordinary Life of Algernon Blackwood. London: Constable, 2001, pp. 38–40. On this new method of abductive logic, see: John Forrester, ‘If p, then What? Thinking in Cases’, History of the Human Sciences 9 (1996): 1–25; Carlo Ginzburg, ‘Morelli, Freud and Sherlock Holmes: Clues and Scientific Method’, History Workshop Journal 9 (1984): 7–36. 138 Algernon Blackwood, John Silence, [1907]. London: Arthur Baker, 1959, p. 7. 139 Blackwood, John Silence, p. 63. 140 Ashley, Starlight Man, pp. 135–7. 141 For an overview, see: Alex Owen, The Place of Enchantment: British Occultism and the Culture of the Modern. Chicago: Chicago University Press, 2004, pp. 52–62. On medical membership, see lists in: R. A. Gilbert, The Golden Dawn Scrapbook. The Rise and Fall of a Magical Order. Wellingborough: Aquarian Press, 1987. The Psycho-therapeutic Society, which is often held up as a forerunner of mainstream psychological healing institutions (Thomson, Shamdasani) was largely a spiritualist organisation practicing medical clairvoyance, see:

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145 146

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Notes Clinton Ambrose Billig, Practical Psychotherapeutics: Our Work. A Survey. London: Health Record, 1909; Arthur Hallam, ‘The Psycho-therapeutic Society – its Origins and Principles’, Health Record 13 (1914): 83–5; Idem., The Key to Perfect Health and the Successful Application of Psycho-therapeutics, London: St. Clements Press, 1912; Thomson, Psychological Subjects, pp. 26–31; Idem., ‘The popular, the practical, and the professional: Psychological identities in Britain, 1900–1950’, in G. Bunn, A. D. Lovie and G. Richards (eds) Psychology in Britain: Historical Essays and Personal Reflections, Leicester: British Psychological Society, 2001. William Wynn Westcott, ‘An Essay on the Constitution of Man: Spirit, Soul and Body’, in S. R I. A. Metropolitan College Transactions (1914): 57–67 repr. R. A. Gilbert, The Magical Mason. Wellingborough: The Aquarian Press1983, pp. 296–309. Tuckey, Hypnotism and Suggestion op. cit. On his priority in psychotherapeutics, see: Sonu Shamdasani, ‘Psychotherapy: The Invention of a Word’, History of the Human Sciences 18 (2005): 1–22. His later career largely guided by an Arabic demon, Ara ben Shemesh, and in 1912 he emigrated to New Zealand. See Ithel Colquhoun, The Sword of Wisdom: Macgregor Matthews and the Golden Dawn. New York: G. P. Putnam, 1975, pp. 178–9. R. W. Felkin, Hypnotism or Psycho-therapeutics. Edinburgh: Young J. Pentland, 1890, pp. 71, 78–82. [James Braid], Braid on Hypnotism: the Beginning of Modern Hypnosis: Embodying the Authors Later Views and Further Evidence on the Subject. ed. A. E. Waite, London: George Redway, 1896. A. E. Waite, The Secret Tradition in Alchemy. London: Kegan Paul, 1926, pp. 393–6. Times ‘Leader’ (20 July 1898): 11e. For the case see the Northern Circuit Law Reports Times (13 July 1898): 3f; (14 July 1898): 14c; (16 July 1898): 4f; (20 July 1898) 3f. See also Tuckey, Hypnotism, pp. 407–8. On hypnotism, see: George H. Savage, The Harveian Oration on Experimental Psychology and Hypnotism, delivered to the Royal College of Physicians, 18 October, 1908. London: Henry Frowde, 1909; Ralph Henry Vincent, The Elements of Hypnotism: the induction, the phenomena and physiology of hypnotism. London: Kegan Paul, Trench, Trübner, 1907; George C. Kingsbury, The Practice of Hypnotic Suggestion, being an elementary handbook for the use of medical professionals. Bristol: John Wright, 1891. John F. Woods, ‘On Hypnotism, illustrated by cases’, Transactions of the Hunterian Society (1893); ‘Neuralgia treated successfully by hypnotism’, Transactions of the Hunterian Society (1893); ‘On Hypnotism and the treatment by Suggestion in the removal of pain, illustrated by cases’, Transactions of the Hunterian Society (1894); ‘Sciatica treated successfully by hypnotism’, Transactions of the Hunterian Society (1894); ‘Chorea treated successfully by hypnotism’, Transactions of the Hunterian

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Society (1895). See also, Idem:, ‘The Treatment by Suggestion, with and without Hypnosis’, Journal of Mental Science 43 (1897): 248–76; Idem., ‘An Address on the Psychic Side of Therapeutics’, [Hunterian soc Annual Oration], Lancet (20 February 1904): 489–92. ‘Proposed Medico-Psychological Clinic in London’ BMJ (19 July 1913): 132. Edwin Ash, ‘On the Psychological Treatment of Certain Functional Conditions’, BMJ (22 October 1910): 1258–9. Edwin [Hopewell] Ash, Hypnotism and Suggestion. A practical handbook. London: J. Jacobs, 1906. 2nd edn. London: J. Jacobs, 1908. Cheap Reissue, London: Wm. Rider and Sons, 1912. ‘Hypnotism in Relation to Surgical Anaesthesia’, Proc RSM 4 (2 December 1910): 13–24; Idem. Medical Times 37 (1909): 35–54; Mind and Health: the mental factor and suggestion in treatment, with special reference to neurasthenia and other common nervous disorders. London: H. J. Glaisher, 1910; Idem., ‘On the Psychological Treatment of Certain Functional Conditions’, BMJ (22 October 1910): 1258–9. For his ideas on faith healing, see: Faith and Suggestion. Including an account of the remarkable experiences of Dorothy Kerin. London: Herbert and Daniel, [1912]. Thomson, Psychological Subjects, pp. 179–80. Hugh Crichton-Miller, Hypnotism and Disease: A Plea for a Rational Psychotherapy with an introduction by C. Lloyd Tuckey., London: T. Fisher Unwin, 1912. On Crichton-Miller, see the rather hagiographic account by E. F. Irvine, Hugh Crichton Miller: A Pioneer of the New Psychology, Chatham: Mackay, 1963. On medical attitudes to Bowden House, see Doris Odlum’s notes, Wellcome Library, Western Manuscripts: WMS/MS.7913/42. On the Emmanuel Movement, see Taves, Fits, Trances and Visions, pp. 314–25. For it American acceptance, Richard Cabot, ‘The American Type of Psychotherapy: a general introduction’ in W. B. Parker (ed.) Psychotherapy: A Course of Reading combining Sound Psychology, Sound Medicine and Sound Religion. New York: Center Publishing, 1908. For a more sceptical English reaction, Henry Morris, ‘Suggestion in the Treatment of Disease’, BMJ (18 June 1910): 1457–66. On the Church Medical Union, see, Ralph Vincent, The Elements of Hypnotism. London: Kegan Paul, Trench, Trübner, 1907; For later developments, see: Stuart Mews, ‘The revival of spiritual healing in the Church of England, 1920–26’ in W. J. Shiels (ed.) The Church and Healing [Studies in Church History no. 17]. Oxford: Blackwell, 1982, pp. 299–331. A good overview of early twentieth-century revival of faith healing is provided in: ‘Mental Healing’, BMJ (18 June 1910): 1483–1505. For the early history of the society, see: A. Hallam, ‘The Psycho-Therapeutic Society – It Origins and Principles’, Health Record 13 no, 149 (September 1914): 83–4; ‘The Psycho-Therapeutic Society – It Origins and Principles (cont.)’, Health Record 13 no, 150 (October–November 1914): 100. On George Spriggs.

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163 164

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166 167 168

169 170 171

Notes c.f. ‘Obituary’, Health Record (March 1912): 26–7; Arthur Hallam, The Key to Perfect Health and the Successful Application of Psycho-therapeutics. London: St. Clements Press, 1912, pp. 138–9. On Stenson Hooker, see: P. S. Brown, ‘Medically Qualified Naturopaths and the GMC’, Medical History 35 (1991): 50–77. Mathew Thomson, Psychological Subjects, pp. 26–31. ‘The Registration of the Society’, [The Psycho-Therapeutic Society], Ninth Report and Financial Statement, (London, 1910), pp. 8–9, ‘A Prejudiced Government Department’, Idem., pp. 10–11. [Psycho-Therapeutic Society. Application for License under Section 23 of the Companies Act, 1867], TNA: BT58/23/ COS/1911. [George Spriggs], ‘The President’s Statement’ Tenth Report and Financial Statement 1911, London: 1911, pp. 20–3. [The Psycho-Therapeutic Society], Eleventh Report and Financial Statement 1912, London: 1912, p. 7. ‘A Medical Society for the Study of Hypnotism’, JSPR XIII (January 1907): 14–15. The Society had 51 members by June February 1908, JSPR XIII (February 1908): 192. On Tuckey (1855–1925), see BMJ (25 August 1925): 363–4. T. Claye Shaw, ‘Some Considerations on the Occult’, BMJ (18 June 1910): 1472–7, quote 1474. Ex Cathedra Essays on Insanity, London: Adlard and Sons, 1904. [Shaw], ‘The Mind as a Therapeutic Agent’, BMJ (6 November 1909): 1353. See also: T. Claye Shaw, ‘The psychology of the inebriate’, Medical Record (12 July 1905), 32–3. See for example, J. Barker Smith, ‘Psychological Studies’, General Practitioner 2 (1901): 324–35, 355–6, 372–3, 388–90, 404–5, 419–21, 436–8, 452–4, 468–70, 483–4, 501–2, 515–16, 533–4, 550–2, 564–5, 580–3, 596–8; Leonard Williams, ‘The Quickening Spirit’, BMJ (1 October 1910): 928–31. A. J. Brock, ‘The Psychology of the Consumptive’, BMJ (18 June 1910): 1519; C. K. Muthu, ‘The Psychology of the Consumptive’, BMJ (2 July 1910): 55–6. James Rorie, ‘Abstract of a Lecture on Psycho-Pneumatology’, BMJ (18 June 1910): 1477–8. On Luys eccentric approach, see his ‘The Latest Discoveries in Hypnotism’, Fortnightly Review 47 (1890): 896–921; 48 (1890–91): 168–83: Gauld, Hypnotism (1992): 334–6. L. S. Forbes Winslow, ‘Mental Suggestion by Transference’, Practitioner 90 (1913): 870–1. [Anon], ‘Hypnotic Magic’, Penny Illustrated Paper, (22 April 1911): 530. For discussions of Forbes Winslow’s clientele, see, Practitioner 90 (1913): 874–6. On the pathogenic secret, see: H. Ellenberger, ‘The Pathogenic Secret and its Therapeutics’, Journal of the History of the Behavioral Sciences 2.1 (1966): 29–42

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repr. M. Micale (ed.) Beyond the Unconscious: Essays of Henri F. Ellenberger. Princeton NJ: Princeton University Press, 1993, pp. 341–59. C. Mercier, ‘A Problem in Diagnosis’, Lancet (10 March 1906): 670–1. George H. Savage, The Harveian Oration on Experimental Psychology and Hypnotism, delivered to the Royal College of Physicians, 18 October, 1908. London: Henry Frowde, 1909, pp. 35–45. John Milne Bramwell, Hypnotism or Treatment by Suggestion. London: Cassell, 1909, p. 56. The analogy is repeated in, ‘Hypnotism and Treatment by Suggestion’ in John Milne Bramwell, et al., The Modern Family Doctor: A Guide to Perfect Health, Edinburgh: T. C. and E. C. Jack, 1914., pp. 304–5. He went onto to abandon the use of hypnosis in favour of a (non-Freudian) talking cure, see: Harold Begbie, ‘Dr Milne Bramwell and Hypnotism’, Pall Mall Magazine (1903): 383–9. [Eder], ‘What the Doctors Say: The Subconscious Mind: Repressed Thoughts’, London Standard (19 December 1913) copy held Wellcome Library CMAC FPW/B.211/1–2 Box 102. On Hunter and Macalpine, see: Roy Porter, ‘Ida Macalpine and Richard Hunter. History between psychoanalysis and psychiatry’ in Roy Porter and Mark Micale (eds) Discovering the History of Psychiatry. Oxford: Oxford University Press, 1994, pp. 83–94. Ida Macalpine, ‘The Development of Transference’, Psychoanalytic Quarterly 19 (1950): 501039.

Chapter 2 1 Woolf, ‘Mrs Bennett and Mrs Brown’, The Captain’s Death Bed. London: Hogarth Press, 1950, pp. 90–111 and ‘Modern fiction’ in The Common Reader. London: Hogarth Press, 1948, pp. 184–95. For the dispute with Bennett, see: Samuel Hynes, ‘The whole contention between Mr Bennett and Mrs Woolf ’, Novel: A Forum 1 (1967): 34–44; David Trotter, The English Novel in History, 1895–1920. London: Routledge, 1993, pp. 132–5. 2 Woolf, ‘Bennett and Brown’, p. 99. 3 Woolf, ‘Modern fiction’, p. 185; ‘Bennett and Brown’, p. 99. Arnold Bennett, Hilda Lessways [1911]. London: Penguin, 1975. 4 Woolf, ‘Bennett and Brown’, p. 106. 5 Nicole Ward Jouve, ‘Viriginia Woolf and psychoanalysis’, in Sue Roe and Susan Sellars, The Cambridge Companion to Virginia Woolf. Cambridge: Cambridge University Press, 2000, ch. 12; J. Douglas Orr, ‘Virginia Woolf and Psychoanalysis’, International Journal of Psychoanalysis 16 (1989): 151–61.

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6 Stephen Trombley, All that Summer she was Mad: Virginia Woolf and her Doctors. London: Junction Books, 1981; Jonathan Andrews, ‘Savage, Sir George Henry (1842–1921)’, Oxford Dictionary of National Biography, Oxford University Press, September 2004; online edn, May 2007 [http://0-www.oxforddnb.com.catalogue. ulrls.lon.ac.uk/view/article/38635, accessed 21 June 2010]. 7 J. Goldstein, ‘The Woolfs Respond to Freud’, Psychoanalytic Quarterly 43 (1974): 439–65; J. Howard Woolmer. A Checklist of the Hogarth Press, 1917–1946. With a Short History of the Press, London: Woolmer/Brotherson, 1986; P. Meisel and W. Kendrick, Bloomsbury/Freud: The Letters of James and Alix Strachey. London: Chatto and Windus, 1986, pp. 1–43. 8 Wells, The New Machiavelli, [1911]. Harmondsworth: Penguin, 1970. 9 On Bennett (1867–1931) see, M. Drabble, Arnold Bennett: A Biography. London: Futura, 1975. For Bennett’s psychology, see his: How to Live on Twenty-four Hours a Day. London: New Age Press, 1908; Mental Efficiency. London: Hodder and Stoughton, 1912; Self and Self Management. London: Hodder and Stoughton, 1918. 10 Raymond Williams, The English Novel: From Dickens to Lawrence. London: The Hogarth Press, 1971, p. 121. 11 Arnold Bennett, Riceyman Steps: A Novel. London: Cassell & Co., 1923. 12 See for instance, Galsworthy’s description of young Jon Forsyte’s migraine in To Let (1921), pt. II, ch. 1. The work was held up by Geraldine Coster as one as an exemplary psychoanalytic novel, see: Psychoanalysis for Normal People, [1926] 3rd edn. Oxford: Geoffrey Cumberledge at the University Press, 1932, 3rd edn. 1947, app. 13 The Helpmate, London: Archibald Constable & Co., 1907. On Sinclair, see Suzanne Raitt, May Sinclair: A Modern Victorian. Oxford: Oxford University Press, 2001. 14 On this see her typescript, ‘The Way of Sublimation’, University of Pennsylvania, Rare Book and Manuscript Library Ms Coll. 184, folder 236; ‘Clinical Lectures on Symbolism and Sublimation’, Medical Press and Circular (9 August 1916): 118–22; (16 August 1916): 142–5. 15 The Life and Death of Harriet Frean, [1922]. New York: The Modern Library, 2003. 16 ‘The General Practitioner’, The General Practitioner (1 June 1906): 6. 17 For an overview, see: Irvine Loudon, ‘The Concept of the Family Doctor’, Bull. History of Medicine 58 (1984): 347–62. 18 James Pearse, ‘A Personal Retrospect of General Practice’, Lancet 1 (1919): 1 29–33. 19 David Armstrong has provided a perceptive and convincing outline of the relationship between the emergence of this temporal dimension and the identity of the general practitioner, see: ‘The Emancipation of Biographical Medicine’, Social Science and Medicine 13A (1979): 1–8; The Political Anatomy of the Body.

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21 22 23 24 25 26

27

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Cambridge: Cambridge University Press, 1983, pp. 76–81; Idem., ‘Space and Time in British General Practice’, Social Science and Medicine 20 (1985): 659–66. ‘The Temporal Body’ in Roger Cooter and John Pickstone (eds) Medicine in the Twentieth Century. Amsterdam: Harwood Academic Press, 2000, pp. 247–59; Idem., A New History of Identity: A Sociology of Medical Knowledge. Basingtoke: Palgrave, 2002, pp. 100–6, 133–57. A similar position, also strongly inflected by Foucauldian ideas, is developed by Thomas Osborne, ‘The Doctor’s View’ (1991), esp. pp. 144–8. While in broad agreement with Armstrong and Osborne, I would argue that the emergence of this temporal dimension should not be seen as an example of a Foucauldian ‘rupture’ rather it is sustained by specific material and historical developments. On Mackenzie (1853–1925), see: Alex Mair, Sir James Mackenzie, 1853–1925. London: Churchill Livingstone, 1973; Robert McNair Wilson, The Beloved Physician, Sir James Mackenzie. London: John Murray, 1936; Thomas Osborne, ‘James Mackenzie, General Practitioner; a Modest Contribution to the Archaeology of Clinical Reason’, Sociology of Health and Illness 15.4 (1993): 525–46; K. Annis Gillie, ‘James Mackenzie and General Practice Today’, JCGP 5.1 (1964): 5–21. James Mackenzie, The Future of Medicine. London: Henry Frowde for Oxford University Press, 1919, pp. 40–8. Quotation from Honigsbaum, Division, p. 55. James Mackenzie, Symptoms and their Interpretation. London: Shaw and Sons, 1909. Future of Medicine, pp. 48–54, 59–65, 183–6, 199–205. Future of Medicine, p. 200. For a summary and defence of this process, see: Sidney and Beatrice Webb, The State and the Doctor. London: Longman Green & Co., 1910. 1874 Births and Deaths Registration Act (37 and 38. Vict., c. 88); 1889 Infectious Diseases (Notification) Act (52 and 53 Vict., c. 72) 1899 Infectious Disease (Notification) Act (62 and 63 Vict., c.8); Rosemary Stevens, Medical Practice in Modern England. New Haven: Yale University Press, 1962, pp. 35–6. P. Bartrip, Workmen’s Compensation in Twentieth-Century Britain. Aldershot: Gower, 1987, pp. 120–2. Lynn Hollen Lees, The Solidarities of Strangers: The English Poor Laws and the People, 1700–1948. Cambridge: Cambridge University Press, 1998; Honigsbaum, Division in British Medicine, pp. 8–16. Norman Eder, ‘Medical Opinion and the First Year of National Health Insurance’, Albion 11 (1979): 157–71.; Idem., National health insurance and the medical profession in Britain, 1913–1939. New York: Garland Publishing, 1982, pp. 45–7, 189–90; Anne Digby, ‘The economic and social significance of the British National Health Insurance Act 1911’, in Martin Gorsky and Sally Sheard (eds) Financing Medicine; The British Experience since 1750. London: Routledge, 2006, pp. 182–98.

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34 35

Notes R. C. Buist, ‘Medical Etiquette, Ethics and Politics’, BMJ (21 March 1914): 642–3; [Anon], ‘The Case of the Malingerer’, Lancet 1 (1 February 1913): 330; Digby, ‘National Health Insurance’, pp. 184–6; A. Digby and N. Bosanquet, ‘Doctors and patients in an era of national health insurance and private practice, 1913–38’, Economic History Review 2nd series, XLI (1988): 79–94. Roger Cooter, ‘The moment of the accident: culture, militarism and modernity in late Victorian Britain’, in Roger Cooter and Bill Luckin (eds) Accidents in History: Injuries, Fatalities and Social Relations. Amsterdam: Rodopi, 1997; Idem., ‘Malingering in modernity: Psychological scripts and adversarial encounters during the first world war’ in Roger Cooter, Mark Harrison and Steve Sturdy (eds) War, Medicine and Modernity, Stroud: Sutton Publishing, (1999): 125–48. Thomson, ‘Neurasthenia in Britain: An Overview’, in Marijke Gijswijt-Hofstra and Roy Porter (eds) Cultures of Neurasthenia: From Beard to the First World War, [Clio Medica 63]. Amsterdam: Rodopi, 2002, pp. 85–8; Joanna Bourke, Dismembering the Male, pp. 79–84. [Editorial], ‘Traumatic Hysteria’, BMJ (17 June 1905): 1355; John Collie, ‘The Malingerer’, in Douglas Knocker (ed.) Accidents in their Medico-Legal Aspect by Leading Medical and Surgical Authorities. London: Balliere, Tindall and Cox, 1910. A. M’Kendrick, Malingering and its Detection under the Workmen’s Compensation and other Acts. Edinburgh: E. & S. Livingstone, 1912, pp. 25–6. Collie, ‘Malingering’, BMJ (13 September 1913): 645. W. H. Brook, ‘On the working of the Workmen’s Compensation Act of 1906’, BMJ (16 July 1910): 133–5, on 134; A. Murri, ‘Traumatic Neuroses’, Universal Medical Record, 2 (August 1912): 97–116; J. W. Geary Grant, ‘The Traumatic Neuroses’, The Practitioner XCIII (July 1914): 26–43, esp. pp. 42–3 on the intermixing of hysteria and malingering. Lumsden, ‘The Psychology of Malingering and Functional Neuroses in Peace and War’, Lancet (18 November 1916): 861. On military pensions, see: Peter Leese, ‘Problems Returning Home’: The British Psychological Casualties of the Great War’, Historical Journal 40 (1997): 1061, 1063; Barham, Forgotten Lunatics, pp. 298–308, 352–4. On the relationship between psychological models and workmen’s compensation, see: Karl Figlio, ‘How does illness mediate social relations? Workmen’s compensation and medico-legal practices, 1900–1940’ in P. Wright and A. Treacher (eds) The Problem of Medical Knowledge. Edinburgh: University Press, 1982, pp. 174–224, esp. 194–5. The main point of reference for the debate over the psychologisation of compensation occurred in the MRC investigations into miners’ nystagmus. Culpin, employed by the IHRB at this time, was the main promoter of the psychological approach, arguing that small injuries were aggravated by the unconscious desire for award, see: Millais Culpin, ‘The Problem of the

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Neurasthenic Pensioner’, British Journal of Medical Psychology 10 (1921): 316–28; ‘A Study of the Incidence of the Minor Psychoses: their Clinical and Industrial Importance’, Lancet (1928): 220–4. ‘Nervous Disease and its Significance in Industry’, Medical Standard 52 (1929): 9–14; ‘The Need for Psychopathology’, Lancet 219 (1930): 725; Idem., ‘Some cases of “traumatic neurasthenia”’, Lancet 1 (1931) 233–7, also editorial ‘The Psychology of Accident Neuroses’, Lancet 1 (1931): 87; ‘The Nervous Temperament: its Assessment and its Clinical Aspect’, British Journal of Medical Psychology 11 (1931): 32–9; Idem., Recent Advances in the Study of Psychoneuroses. London: Churchill, 1931, pp. 192–200. See also, T. A. Ross, ‘Some Evils of Compensation’, Mental Hygiene 3, 4 (1937): 141–5; ‘Heart and Mind’ in C. M. Bevan Brown, G. E. S. Ward and F. G. Crookshank, Individual Psychology Theory and Practice [I.P. Pamphlet no, 15]. London: C. W. Daniel, 1936, p. 46. T. Muirhead Martin, ‘Malingering and National Insurance’, Clinical Journal 43.1 (1914): 14–16; [G.P]. [GP], This Panel Business, Involving the Future of the General Practitioner of Medicine. London: John Bale & Co., 1933, pp. 34–6. Willam Thorburn, ‘The Traumatic Neuroses’, Proc. R.S.M. [Neurological Section], 7 (1914): 13. The same argument (inspired by Hurst’s work at Seal Hayne), see: A. W. Gill, ‘Hysteria and the Workmen’s Compensation Act’, Lancet (20 April 1929): 811–14; M. Culpin, ‘Some cases of “traumatic neurasthenia”’, Lancet (1 August 1931) 233–7. J. Purves Stewart, ‘Discussion on Traumatic Neurasthenia and the Litigation Neurosis’, Proc. RSM (1927): 360. [ANON], ‘Mind: Doctor or Patient’, The Listener (4 July 1934): 35. William Brown, ‘Psychology and medicine’, in William Brown (ed.) Psychology and the Sciences. London: A. & C. Black, 1924, p. 145. Roger Cooter, ‘The Moment of the Accident: Culture, Militarism and Modernity in Late Victorian Britain’, in Roger Cooter and Bill Luckin (eds) Accidents in History: Injuries, Fatalities and Social Relations. Amsterdam: Rodopi, 1997; Ralph Harrington, ‘The Railway Accident: Trains, Traumas and Technological Crises in Nineteenth-Century Britain’ in in Mark Micale and Paul Lerner, Traumatic Pasts: History, Psychiatry and Trauma in the Modern Age, 1870–1930. Cambridge: Cambridge University Press, 2001; Idem., ‘On the tracks of trauma: Railway Spine Reconsidered’, Social History of Medicine 16.2 (2003): 209–23. That is, when the mental illness is not consequent on actual physical injury: compare Victorian Railways v. Coultas [1888] App. C. 222 (J.C.P.C); Dulieu v. White [1901] 2 K.B. 669; and Hambrook v. Stokes [1925] 1 K.B. 141 (C.A.). Note that these first two cases occurred before the popularization of nervous shock as a concept, following World War I, see: Danuta Mendelson, The Interfaces of Medicine and Law: The History of the Liability for negligently caused Psychiatric

160

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45 46 47 48 49 50

51

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Notes Injury. Aldershot: Ashgate, 1998; Peter Bartlett, ‘Legal Madness in the Nineteenth Century’, Social History of Medicine 14.1 (2001): 107–31. In the Matter of Arbitration between Etherington and the Lancashire and Yorkshire Accident Insurance Company [1909] 1 KB591, 598 repr in John Lowry and Phillip Rawlings, ‘Proximate Causation in Insurance Law’, Modern Law Review 68.2 (2005): 310–19. Gilbert Stone and William Andrew Woods, Workmen’s Compensation and Insurance Reports. London: Stevens and Co., 1933, p. 118. The most famous extension being the ‘snail in the bottle case’ of 1932 in which claims of psychic shock and gastroenteritis following the discovery of small snail in a Barr’s ginger beer was used to refine the idea of manufacturer’s duty of care: Donoghue vs. Stevenson 1932 [A.c. 1932]. Hubert Winston Smith, ‘Emotions to Injury and Disease: Legal Liability for Psychic Stimuli’, Virginia Law Review 30. 2 (1944): 193–317; see also Hubert Winston Smith and Harry C. Solomon, ‘Traumatic Neuroses in Court’, Virginia Law Review 30.1 (1943): 87–175; Danuta Mendelson, The Interfaces of Medicine and Law: The History of the Liability for Negligently Caused Psychiatric Injury. Aldershot: Ashgate and Dartmouth, 1998; Peter Bartlett, ‘Legal Madness in the Nineteenth Century’, Social History of Medicine 14.1 (2001): 107–31. Eder, National Health Insurance, pp, 155–6; Honigsbaum, Division, pp. 94–9. TNA: MH62/130 Conferences of doctors and departmental committees. James Mackenzie, ‘Appendix’ to Interdepartmental Committee on Insurance Medical Records [Rolleston Report], (Cmd. 836). London: HMSO 1920. W. P. D. Logan, Studies on Medical and Population Subjects no. 7: General Practitioners Records. London: HMSO, 1953. F. L. Hughes, ‘Scientific Writing and Scientific Discovery’, Isis 78 (1987): 220–35 on record keeping making available larger units of meaning. David Armstrong, ‘The Temporal Body’ in Roger Cooter and John Pickstone (eds) Medicine in the Twentieth Century. Amsterdam: Harwood Academic Press, 2000, p. 51–2; Idem., ‘Space and Time in British General Practice’, Social Science and Medicine 20 (1985): 659–66; A New History of Identity: A Sociology of Medical Knowledge. Basingtoke: Palgrave, 2002, pp. 59–62, 144–5. On the dismay surrounding new administrative regimes, see: Eder, National Health Insurance, pp. 156–8; Honigsbaum, Division, pp. 95–6. This dismay was later turned into grudging acceptance as the cards became a crucial element in practice success, see: G. F. Pratt, ‘Experiences of the National Health Insurance Act’ BMJ (21 March 1914): 645–9. See for example: Wellcome’s Medical Diary and Visiting List; Wellcome’s Photographic Record and Diary; Silverlocks Medical Diary; Letts Ideal Medical Diary; The ABC Medical Diary and Visiting List; De la Rue Medical Memorandum and Visiting List; The Sanitary Record Dairy and the Bayer Medical Diary.

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53 On the idea of administration as the key to successful practice, see Teviot S. Eimerl, ‘The Keeping of Records in General Practice’, JCGP 3 (1960): 411–33; R. J. F. H. Pinsent, An Approach to General Practice. Edinburgh: E. & S. Livingstone, 1953, pp. 50–67; Stephen Taylor, Good General Practice (1954), ch. 6; T. Eimerl and J. Laidlaw (eds) A Handbook for Research in General Practice, [1962]. Edinburgh: E. & S. Livingstone, 1969, pp. 39–82, 106–13, 146–54; T. Osborne, The Doctor’s View: Clinical and Governmental Rationality in Twentieth-Century Medical Practice, Brunel University: Ph.D., 1991, pp. 143–4.; Fry and Blake, BMJ Supp. 1 339. McGregor and Pott, Medical World 85 (1956): 555. 54 See Paul Connerton, How Societies Remember. Cambridge: Cambridge University Press, 1989; Jack Goody, The Domestication of the Savage Mind. Cambridge: Cambridge University Press, 1989. For the relationship between inscription and medical power, see: M. Foucault, Discipline and Punish. London: Penguin Books, 1977, pp. 189–90; Nikolas Rose, ‘Medicine, history and the present’, in C. Jones and R. Porter (eds) Reassessing Foucault: Power, Medicine and the Body. London: Routledge, 1997. pp. 53, 62. 55 C. A. H. Watts, ‘In My Own Time: General Practice’, BMJ (27 October 1979): 1055–6; Julian Tudor Hart, ‘Going to the Doctor’, in Roger Cooter and John Pickstone (eds) Medicine in the Twentieth Century. Amsterdam: Harwood Academic Press, 2000, pp. 551–2. The worst cases were highlighted in the Collings Report of 1950, J. S. Collings, ‘General Practice in England Today’, Lancet (25 March 1950): see: 555–8, 573. 56 A. Digby and N. Bosanquet, ‘Doctors and patients’, 83–4, 90–1. 57 The widest concern was issues of medical confidentiality and the possibility that records might be cited as evidence in court, see: TNA MH62/131 Production of Record Cards in Courts of Law; ‘The Insurance Record Cards’, BMJ (8 January 1921): 59; ‘The Record Card as Evidence’, BMJ (28 January 1920): 199. Reports of the parliamentary debate (21 February 1920) on medical records, see ‘Medical Records’, BMJ (26 February 1920): 316; Lancet (26 February 1920): 463–4; ‘Records and Medical Secrecy’ Lancet (26 February 1920): 463–4; See also A. A. G. Morrice, ‘Honours and interests’: medical ethics in Britain and the work of the British Medical Association Central Ethical Committee, 1902–1939, M.D. thesis, University of London, 1999, pp. 265–87. 58 TNA: MH62/130 also. 59 The conversation was recalled by McNair Wilson, Beloved Physician, pp. 285–6. 60 Both spiritualists and psychical researcher’s relied on technology to demonstrate that inspired messages or actions did not originate in the subjects consciousness, see: Daniel Cottom, ‘On the Dignity of Tables’, Critical Inquiry, 14 (1985): 765–83. 61 Tim Lenoir, ‘Models and instruments in the development of electrophysiology, 1845–1912’, Historical Studies in the Physical Sciences 17 (1986), pp. 1–54; Stanley Joel Reiser, Medicine and Reign of Technology, ch. 5.

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62 Angelo Mosso, Fear, 5th edn., trans. E. Lough and F. Kiesow, London: Longmans and Green, 1896. On Mosso’s influence, see: Otniel E. Dror, ‘The Affect of Experiment: the Turn to Emotions in Anglo-American Physiology, 1900–1940’, Isis 90 (1999): 205–37. 63 James ‘What is an Emotion’, Mind 19 (1884): 191–2. 64 Robert Frank, ‘The Telltale Heart: Physiological Instruments, Graphic Methods and Clinical Hopes, 1854–1914’, in William Coleman and Frederic Holmes (eds) The Investigative Enterprise: Experimental Physiology in NineteenthCentury Medicine. Los Angeles: University of California Press, 1988; Soraya de Chadarevian, ‘Graphical Method and Discipline: Self-Recording Instruments in Nineteenth-Century Physiology’, Studies in the History and Philosophy of Science 24 (1993): 267–91; Dror, ‘The affect of experiment’, op. cit. 65 Future of Medicine, pp. 84–94; Alex Mair, Sir James Mackenzie, M.D., 1853–1925, General Practitioner. Edinburgh: Churchill Livingstone, 1973, p. 91; C. Lawrence, ‘Physiological Apparatus in the Wellcome Museum II. The Dudgeon Sphygmograph and its Descendants’, Medical History 23 (1979): 99–100. 66 Future of Medicine, p. 94. 67 Wilson on Mackenzie 258; John W. Linnell, ‘Dr Linnell remembers’ in Alex Mair, Sir James Mackenzie, p. 242; Adolphe Abrahams, ‘Soldier’s Heart’, Lancet 1 (1917): 443–4. Stanley Reiser, Medicine and the Reign of Technology. Cambridge: Cambridge University Press, 1978, pp. 174–5; Christopher Lawrence, ‘Moderns and ancients: The “new cardiology” in Britain 1880–1930’, Medical History, Supp. no. 5 (1985): 1–33; Joel D. Howell, ‘“Soldier’s Heart”: The Redefinition of Heart Disease and Specialty Formation in Early Twentieth-Century Great Britain’, Medical history, Supp. no. 5 (1985): 34–52. 68 ‘The War Terror’. 69 Waller, ‘Galvanometric Records of the Emotive Response to Air Raids’, Lancet (23 February 1918). 70 A. B. Reeve, The War Terror, London: Harpers, 1915. For popular enthusiasm, see: F. Gordon Bell, ‘Stunts and Gadgets Ltd.’ [1964] in Medical Tales from ‘Blackwood’. Edinburgh: William Blackwood, 1968, pp. 122–41. 71 F. Peterson, ‘The Galvanometer as a Measurer of Emotions’, BMJ (28 September 1907): 804–6; Frederick Peterson and C. G. Jung, ‘Psychophysical Investigations with the Galvanometer and Plethsymograph in Normal and Insane Individuals’, Brain 30 (1907): 153–218. For British popularisation see, W. H. B. Stoddart, ‘The New Psychiatry II’, Lancet (27 March 1915): 640. 72 ‘The Galvanometer in the Study of Mental Disease’, BMJ (26 October 1907): 1175–76; ‘The Galvanometer and Subconscious Ideas’, BMJ (26 September 1908): 938–9. 73 Mott, War Neuroses, pp. 289–92. They also used word association, pp. 287–9. On galvanic testing in national insurance malingering, see: Martin, ‘Malingering and National Insurance’, Clinical Journal 43.1 (1914): 14–16;

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74 F. L. Golla, ‘The Objective Study of Neurosis Pt. IV’, Lancet (20 August 1921), pp. 373–9; see also his: ‘The Organic Basis of the Hysterical Syndrome’, Proc. RSM (Section of Psychiatry) (1923), 16, pp. 1–12; A. D. Waller, ‘The Measurement of Human Emotion and its Voluntary Control’, Proc. RSM 13 (1919–20): 41–56. 75 William Brown, ‘Psychology and medicine’, pp. 144–5. W. Whatley Smith, The Measurement of Emotion London: Kegan and Paul, 1923; Scott, People’s Physician, pp. 822–4; E. Prideaux, ‘Suggestion and Suggestibility’, British Journal of Psychology 10 (1920): 236. 76 W. Whately Smith, ‘Experiments on the Association Test as a Criterion of Individuality’, British Journal of Psychology (Medical Section) 2 (1921): 121–30. 77 For an overview, see: Otniel E. Dror, ‘The Scientific Image of Emotion: Experience and Technologies of Inscription’. Configurations (1999), 7, pp. 355–401; ‘The Affect of Experiment: The Turn to Emotions on Anglo-American Physiology, 1900–1940’. Isis (1999), 90, 2, pp. 205–37; ‘Techniques of the Brain and the Paradox of Emotions, 1880–1930’, Science in Context (2001), 14.4, pp. 643–60. Geoff Bunn, The Lie Detector, Wonder Woman and Liberty: The Life and Work of William Moulton Marston’, History of the Human Sciences (1999) 10: 91–119; Rhodri Hayward, ‘The Tortoise and the Love-Machine: Grey Walter and the Politics of Electro-encephalography’, Science in Context (2001), 14.4, pp. 615–41. 78 ‘The Betraying Light’ Daily Express (11 February 1920), commenting on A. D. Waller’s experiments. See Waller, ‘The Measurement of Human Emotion and of its Voluntary Control’ Proc. RSM (1919–20), 13, pp. 41–56; James Barr, ‘Measurement of Emotion’ BMJ (13 March 1920); p. 381. 79 C.f. Simon Schaffer, ‘Astronomers Mark Time: Discipline and the Personal Equation’, Science in Context 2 (1988): 115–45. 80 The classic Darwinian statement on instinct was provided by Conway Lloyd Morgan, Instinct and Experience. London: Methuen, 1912. For an overview: R. N. Soffer, ‘New Elitism: Social Psychology in Pre-war England’, Journal of British Studies 8.2 (1969): 111–40; Mathew Thomson, ‘“Savage civilisation”: race, culture and mind in Britain, 1898–1939’, in W. Ernst and B. Harris (eds) Race, Science and Medicine: Racial Categories and the Production of Medical Knowledge, 1700–1960. London: Routledge, 1999. On the relations between Cannon and instinct theory (including that of McDougall (discussed below)), see: Allan Young, ‘Walter Cannon and the psychophysiology of fear’. in Christopher Lawrence and George Weisz (eds) Greater than the Parts: Holism in Biomedicine, 1920–1950. New York: Oxford University Press, 1998, pp. 235–8. 81 W. B. Stoddart, The New Psychiatry: Being the Morrison Lectures delivered at the Royal College of Physicians in Edinburgh in March 1915. London: Balliere, Tindall and Cox, 1915, p. 4. 82 For early mechanical models of shellshock, see: F. W. Mott, ‘The Effects of High Explosive on the Central Nervous System’, Lancet 1 (1916): 331–8; 441–9; 545–53

164

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84 85

86 87

88 89

90

91

Notes and, ‘Special Discussion on Shell Shock without Visible Signs of Injury’, Proc. RSM (1916): 1–44. W. H. R. Rivers, ‘Psychology and the war’ [1919]. repr. Instinct and the Unconscious, 2nd edn. Cambridge: Cambridge University Press, 1922, app. VII, p. 252. On Parsons (1868–1957), see S. Duke Elder in Biographical Memoirs of the Fellows of the Royal Society 4 (1958): 204–14. C. S. Myers, ‘Contribution to the Study of Shell-Shock’, Lancet (13 February 1915): 316–20; E. G. Fearnsides and M. Culpin, ‘Frostbite’, British Medical Journal 1 (8 January 1915): 84. J. Herbert Parsons, ‘The Psychology of Traumatic Amblyopia following Explosion of Shells’, Proc. RSM 8 [Neurological Section] (1915): 55–68. For this model see, Susan L. Star, Regions of the Mind. Stanford: Stanford University Press, 1989; Roger Smith, Inhibition: History and Meaning in the Sciences of Mind and Brain. London: Free Association Books, 1992, ch. 2. For a related model see Janet Oppeheim’s discussion of James Crichton Browne’s evolutionary psychiatry, Shattered Nerves. Cambridge: Cambridge University Press, 1991, ch. 2. See Charles S. Myers. ‘A Contribution to the Study of Shellshock’, Lancet (13 February 1915): 317–20. Harold Wiltshire, ‘A Contribution to the Aetiology of Shellshock’, Lancet (17 June 1916): 1207–12, on 1209; Arthur Hurst, ‘What the War Has Taught Us about Hysteria’ in Contributions to Medical and Biological Research [Osler Memorial]. Oxford: Oxford University Press, 1919, pp. 600–10. Idem.; ‘An Address on Hysteria in the Light of the Experience of War’, Lancet (1 November 1919): 771–5; Arthur Hurst, The Psychology of the Special Senses and their Functional Disorders. Oxford: Oxford University Press, 1920, see also: [Leader], ‘Hysteria as Purposive Inattention’, Lancet (21 August 1920): 407–8. F. W. Mott, War Neuroses. London: Henry Frowde and Hodder and Stoughton, 1919, p. 110–14; Burton-Fanning, ‘Neurasthenia in Soldiers of the Home Forces’, Lancet (16 June 1917): 17–18. These arguments came to prominence during the Lord Southborough’s investigation into shellshock, see: [Great Britain: War Office], Report of the War Office Committee of Enquiry into ‘Shell-Shock’. London: HMSO, 1922; Ted Bogacz, ‘War Neurosis and Cultural Change in England, 1914–22: The Work of the War Office Committee of Enquiry into “Shell-Shock” ’, Journal of Contemporary History, 24 (1989): 227–56; Barham, Forgotten Lunatics, pp. 234–5. W. H. R. Rivers, ‘Freud’s Psychology of the Unconscious’, Lancet 1 (1917): 912–14. See also, F. C. Bartlett, Psychology and the Soldier. Cambridge: Cambridge University Press, 1927, pp. 196–202.

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92 Hugh Crichton-Miller, ‘Anxiety states: the mother complex’, in Hugh CrichtonMiller (ed.) Functional Nerve Disease: An Epitome of Wartime Experience for the Practitioner. London: Hodder and Stoughton, 1920, p. 120; C. Stanford Read, ‘A Study of Two Epileptoid Cases in Soldiers’, Journal of Abnormal Psychology 13 (April 1918): 33–41; William Brown, Suggestion and Mental Analysis: An Outline of the Theory and Practice of Mind Cure. London: University of London Press, 1922, pp. 43–66. 93 On racial elements, see: T. McCurdy, The Psychology of War. London: William Heinemann, 1917, pp. 13–38; 94 Walter Langdon-Brown, ‘The Return to Aesculapius’, in Walter Langdon Brown. O. H. Woodcock et al., Individual Psychology and Psychosomatic Disorders 1. London: C. W. Daniel, [Individual Psychology Medical Pamphlets no. 4], 1932., p. 17. Brown was referring to the Mentou caves. 95 M. D. Eder, ‘An Address on the Psychopathology of War the Neuroses’, The Lancet (12 August 1916): 247, see also, War Shock: The Psychoneuroses in War Psychology and Treatment. London: William Heinemann, 1917, pp. 113–14. 96 William Brown, ‘Psychopathology in Relation to Psychical Research’, The Psychic Research Quarterly 1.4 (April 1921): 356–66. William Brown (1881–1952) had held the readership in psychology at Kings College, London before joining the RAMC in 1914, see: P. Lovie and A. D. Lovie, ‘Brown, William (1881–1952)’, Oxford Dictionary of National Biography, Oxford University Press, 2004. [http://www.oxforddnb.com/view/article/58395, accessed 7 February 2005]. 97 Rickman Godlee, Our Attitude toward Modern Miracles. Birmingham: Birmingham and Midland Institute, 1919. 98 E. E. Southard, Shellshock and other Neuropsychiatric Problems. Boston: W. M. Leonard, 1919, p. 894. 99 Charles Raven, Science, Medicine and Morals: A Survey and a Suggestion. London: Hodder and Stoughton, 1959, p. 110. The Biblical comparison was common: Arthur Pannell, Miracles Which Happen. London: Nisbet, 1920; E. R. Micklem, Miracles and the New Psychology. Oxford: Oxford University Press, 1920. 100 Culpin, Nervous Patient, p. 15; J. A. Hadfield, Psychology and Morals, [1923]. London: Methuen, 1939, pp. 180–1; Thomson, Psychological Subjects, ch. 3. 101 Rivers, ‘Freud’s psychology’: 913–14; Idem., ‘The Repression of War Experience’, Proc. RSM 11 [Psychiatry Section] (1918): 1–17/20; Idem., ‘Instinct and the Unconscious. (I.)’, British Journal of Medical Psychology 9, 1919, 1–7; Idem., Instinct and the Unconscious: A Contribution to a Biological Theory of the PsychoNeuroses [The Cambridge Medical Series]. Cambridge: Cambridge University Press, 1922., chs. 2–3; Idem. ‘Affect in the dream’, British Journal of Psychology 12 (1920) repr. Conflict and Dream, London: Kegan Paul, Trench, Trübner & Co., 1923, ch. 5; John Thomas McCurdy, Problems in Dynamic Psychology: A Critique

166

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104 105

106

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Notes of Psychoanalysis and Suggested Formulations. Cambridge: The University Press, 1923, pp. 209–16; T. A. Ross, Some Points about Repression’, Proc. RSM 15.3 (1922) [Section of Psychiatry]: 31–8, esp. 32–3; Allan Young, ‘W H R Rivers and the War Neuroses’, Journal of the History of the Behavioral Sciences 35 (1999): 359–378; Shephard, War of Nerves, pp. 85–90. See McCurdy, Problems, pp. 217–29. Wilfred Trotter, ‘The Herd Instinct and its Bearing on the Psychology of Civilised Man’, Sociological Review 1 (1908): 227–48; Idem., Instincts of the Herd in Peace and War, [1916]. London: T. Fisher Unwin, 9th edn., 1924; William McDougall, ‘The Definition of the Sexual Instinct’, Proc. RSM 7–3 (1913–14): 65–78; Idem., ‘Instinct and the Unconscious. (VI.)’, British Journal of Medical Psychology 9 (1919): 35–42; Idem., Social Psychology. London: Methuen, 1908; Alexander Shand, The Foundations of Character [1914]. London: Macmillan, 1920. ‘The Present Position in Clinical Psychology’, Journal of Mental Science 65 (1919): 147, 152. William Brown, ‘Shell shock without visible signs of injury’, Proc. RSM [Section of Psychiatry] (1915–16): 30–2; ‘Criticism of Present-day Psycho-analysis’, Journal of Mental Science 67 (1921): 26, also in Talks on Psychotherapy. London: University of London Press, 1923, p. 103. See also his, ‘Psychopathology and Dissociation’, BMJ 1 (1920): 139–42; 2 (1920): 847–5; ‘Suggestion and Personality’, British Journal of Medical Psychology 5 (1925): 29–341 reported in ‘Hypnotism and Hysteria: War Time Experiences’, Times (1 September 1925): 7g; William McDougall, An Outline of Abnormal Psychology. London: Methuen, 1926, 456–7; W. H. R. Rivers, ‘Psychotherapeutics’, in James Hastings (ed.) Encyclopedia of Religion and Ethics 10 (Edinburgh: T. & T. Clark, 1919), p. 433–5. c.f. Idem., ‘War neurosis and military training’ in Instinct and the Unconscious app. iv. p. 227. Brown introduces the neologism in 1916 specifically to escape the Freudian connotation, see ‘Functional Nerve Disease’ Lancet (29 January 1916): 265. Donkin, ‘Functional Nerve Disease’, Lancet (5 February 1916): 318. For the ongoing criticism of the psychoanalytic obsession with the sex factor, see: See for instance the BMJ editorials, ‘Sane Psycho-Therapy’, BMJ (23 October 1915): 60; ‘Quack-analysis’, BMJ (22 January 1921): 133–4. Charles Mercier’s attack on David Forsyth, ‘Functional Nervous Disease’, Lancet (15 January 1916): 154; Idem., ‘Psychoanalysis’, BMJ (30 December 1916): 897–900; J. Shaw, ‘The Myth of the Unconscious Mind’, Journal of Mental Science 72 (1926): 25–38; Idem., ‘Psychoanalysis’, English Review (November 1926): 556–64. For an overview, see: Trevor Turner, ‘James Crichton-Browne and the Anti-Psychoanalysts’, in Hugh Freeman and German Berrios, 150 Years of British Psychiatry: Volume II: The Aftermath. London: Athlone, 1996, pp. 144–55. On Nietzschean and Oedipal models see below. On social organisation, see ch. 3. On posture see the work of F. M. Alexander, Man’s Supreme Inheritance: Conscious

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Guidance and Control in Relation to Human Evolution in Civilisation, with an introduction by John Dewey and Frank Granger. London: Methuen, 2nd edn., 1918; Idem., Conscious Control of the Individual, with an introduction by John Dewey, London: Methuen, 1921; Idem., The Use of the Self. Its conscious direction in relation to diagnosis, functioning and the control of reaction, etc. London: Methuen, 1931. Although Alexander’s work won a wide audience it had little impact on general practice. W. H. Bryce, ‘Some Considerations in Psycho-therapy.’, Journal of Mental-Science 67 (1921): 195–205, on 198. Luther Lee Bernard. ‘Instincts and the Psychoanalysts’, Journal of Abnormal Psychology and Social Psychology, 27 (1922): 350–66. Frank Kermode ‘Institutional Control of Interpretation’, Salmagundi 43 (1979): 72–86. ‘British Psychiatry’, Universal Medical Review 2 (November 1912): 414–15. “we quite agree that the word is atrocious, illiterate and unpronounceable. Luisa Passerini, Love in Europe, Europe in Love: Imagination and Politics between the Wars. London: Tauris, 1999; Andrew Rigby, Initiation and Initiative: An Exploration of the Life and Ideas of Dmitrije Mitrinovic [East European Monographs no. 164], Boulder: EEM, 1984, Thomson, Psychological Subjects, pp. 87–94. Adler, The Neurotic Constitution: Outlines of a Comparative Individualistic Psychology and Psychotherapy, trans. B. Glueck and J. E. Lind. London: Kegan Paul, Trench, Trübner, 1018. Bottome, Adler, pp. 287–8. On the society, see: Walter Langdon-Brown and Drs. O. H. Woodcock, Alexander Baldie, Wilhelm Stekel, Allan Worsley, Culver Barker, H. V. Dicks, Ellis Stungo, Early phases of medical psychology; history of the society; post war planning; active psychotherapy in war-time; the approach to the patient; analysis under hypnotics, London: C.W. Daniel, [Individual psychology medical pamphlets; no. 23], 1943; ‘Medical Society Of Individual Psychology’, Lancet (18 April 1931): 865–7; 218 (24 October 1931): 909; (21 November 1931): 1135; (19 December 1931): 1356–7; 219 (27 February 1932): 456–7; (18 June 1932): page; 220 (22 October 1932): 899–900; (19 November 1932): 1110–111; 220 (17 December 1932): 1334–5; 221(18 February 1933): 364–5; 221 (18 March 1933): 583; 221 (6 May 1933): 968; 221 (20 May 1933): 1074–5; 221 (17 June 1933): 1289–90; 222 (30 December 1933): 1484; (27 October 1934): 932; (24 November 1934): 1163–4; (25 May 1935): 1218; 227 (16 May 1936): 1117–18; (6 June 1936): 1300–1; (17 October 1936): 919; (19 December 1936): 1468; (26 June 1937): 1525; (18 December 1937): 1433; (2 April 1938): 783–4; (29 October 1938): 1001–2; (31 December 1938): 1524; (29 April 1939) 990; (30 December 1939): 1371.

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116 On Crookshank (1873–1933), Munks 4, pp. 567–8; BMJ (4 November 1933), p. 848; Bottome, Alfred Adler: Apostle of Freedom 2nd edn. London: Faber and Faber, 1953, pp. 212–13. 117 Crookshank, The Mongol in our Midst: A Study of Man and his Three Faces 3rd edn. London: Kegan Paul, Trench Trübner and Co., 1931. 118 Hugh Pennington, ‘Degeneration by Proxy’, London Review of Books (21 October 2004): 3. 119 ‘Supplement II: The Importance of the Theory of Signs and the Critique of Language in the Study of Medicine’, in C. K. Ogden and I. A. Richards, The Meaning of Meaning, a study of the influence of language upon thought and of the science of symbolism, London: International Library of Philosophy, Psychology and Scientific Method, 1923, 516. On the relationship between linguistic nominalism and interwar patrician medicine, see: David Cantor, ‘The Name and the Word: Neo-Hippocratism and Language in Interwar Britain’, in David Cantor (ed.) Reinventing Hippocrates. Aldershot: Ashgate, 2002, pp. 280–301. On Adler’s debt to Vaihinger’s linguistic nominalism, see: Crookshank’s introduction to Adler’s Problems of neurosis: a book of case-histories edited by Philippe Mairet, London: Kegan Paul, Trench, Trübner, 1929; Idem., ‘Individual Psychology and the Bases of Science’, Psyche 11 (1931): 25–43. 120 Crookshank, ‘Word Magic in Modern Medicine’, Cambridge Magazine I (1923): 57–64 on 59; Supplement II etc., p. 518. See also ‘Diagnosis and the Syndrome’ in Individual Diagnosis, pp. 11–12. Crookshank cited Clifford Allbutt’s introductory essay to the first edition of the System of Medicine in support of his position. 121 For examples of its influence, see: Edward Mapother, ‘Tough or Tender. A Plea for Nominalism in Psychiatry’ [RSM Psychiatry Section – President’s Address], Proceedings of the Royal Society of Medicine 27 (1934): 1687–712; F. L. Golla, ‘The Eighteenth Maudsley Lecture: Science and Psychiatry’, Journal of Mental Science 84 (1938): 4–20. 122 ‘Discussion on epidemiology’, Proc. RSM [Section of Epidemiology] 12 (1918–19), 1–102; Editorial. ‘Etiology of Influenza’, BMJ 2 (1911): 494–5, Olga Amsterdamska, ‘Demarcating Epidemiology’, Science, Technology and Human Values 30.1 (2005), 17–51; Andrew J. Mendelsohn, ‘From eradication to equilibrium: How epidemics became complex after World War One’, in Christopher Lawrence and George Weisz (eds) Greater than the Parts: Holism in Biomedicine, 1920–1950. Cambridge: Cambridge University Press, 1998, pp. 315–16. 123 Crookshank, ‘First principles and epidemiology’, Proc. RSM [Section of Epidemiology and State Medicine 13 (1919–20): 178–9; Influenza: Essays by Several Authors, London: William Heinemann, 1922. 124 On this movement see: Christopher Lawrence, ‘Still Incommunicable: Clinical Holists and Medical Knowledge in Interwar Britain’, in Christopher Lawrence

Notes

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126 127

128

129

130

131

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and George Weisz (eds) Greater than the Parts: Holism in Biomedicine, 1920–1950. Cambridge: Cambridge University Press, pp. 94–111; Idem., ‘Edward Jenner’s Jockey boots and the Great Tradition in English Medicine, 1918–39’, in Christopher Lawrence and Anna-K. Mayer (eds) Regenerating England: Science, Medicine and Culture in Inter-War Britain. Amsterdam: Rodopi, 2000, pp. 45–66. Groddeck, ‘Psychical Treatment of Organic Disease’, British Journal of Medical Psychology 9 (1929): 179–86); Alfred Adler, Problems of neurosis: a book of casehistories with a prefatory essay by F. G. Crookshank; edited by Philippe Mairet, London: Kegan Paul, Trench, Trübner, 1929; Adler, The Case of Mrs A.: The Diagnosis of Life-Style [Individual Psychology Medical Pamphlets no. 1]. London: C. W. Daniel, 1931. ‘The style of life’ in Thus We Are Men, pp. 115–16. See also: ‘Art and Fashion in Medicine’, BMJ Supp. (16 March 1935), 94–8 on 97. Langdon Brown, ‘Adler’s Contribution to General Medicine’, p. 50; F. G. Crookshank, ‘Individual Psychology: A Retrospect and Valuation’, in A. Adler, Problems of Neurosis. London: Kegan Paul Trench Trübner, 1929, pp. vii–xxxvii. Adler, Study of Organ Inferiority and its Psychical Compensation [1907]. New York: Nervous and Mental Diseases Publishing, 1917; Crookshank, ‘Organ States and Emotional Correlatives’, Psyche 10 (1930), 65–79. Crookshank, Migraine and Other Common Neuroses: a Psychological Study, [Psyche Miniatures. Medical Series (1)]. London: K. Paul, Trench, Trübner, 1926, p. 40. Crookshank, ‘Psychological Interest in General Practice’, BMJ (2 April 1932): 599–604. See also his, ‘Organ Jargon’, British Journal of Medical Psychology (1930), 10, pp. 295–311; ‘Organ Inferiorities’ in Langdon Brown et al., The Place of Psychology in the Medical Curriculum and other Papers. London: C. W. Daniel, [Individual psychology medical pamphlets; no. 16], 1936, pp. 53–60; ‘Organ States and Emotional Correlatives’, Psyche (1930), 10 (1930), pp. 65–79. M. Robb, ‘Organ Jargon’ in Walter Langdon Brown. O. H. Woodcock et al., Individual Psychology and Psychosomatic Disorders 1. London: C. W. Daniel, [Individual Psychology Medical Pamphlets no. 4], 1932, 61–7. For a contemporary Freudian use of organ jargon see the work of the eye surgeon, W. S. Inman who argued that squint could be correlated with a desire for childbearing, see: W. S. Inman, Styes and Wedding Rings, Churchill Livingstone, 1973; W. S. Inman, ‘Eye Symptoms’ in M. Culpin, Nervous Patient. London: H. K. Lewis, 1924, ch. 16; W. S. Inman, ‘The Symbolic Significance of Glass and its Relation to Diseases of the Eye’, British Journal of Medical Psychology (1939), 18, pp. 122–40. Lectures on Dyspepsia 2nd edn. London: Edward Arnold, 1927; Gillespie, Hypochondria, [Psyche Miniatures Medical Series no. 12]. London: Kegan Paul

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Notes Trench Trübner, 1929, p. 44; O’Donvan, Dermatological Neuroses. London: Kegan, Paul, Trench, Trübner, 1927, p. 171. On the relationship between physical defect and complaint, see: Hutchison, ‘Physiological Personality’, Lancet (31 March 1928): 682–6. Frank Gray, The Place of Psychology in the Medical Curriculum. London: C. W. Daniel, 1936; Hugh Crichton-Miller, ‘Psychotherapeutic Clinics in Fact and Fancy’, BMJ (15 June 1935), 1205. [E. Wexberg]. ‘Individual Psychology and Psychoanalysis’, Lancet (28 November 1931): 1331. ‘The Return to Aesculapius’, in Walter Langdon Brown. O. H. Woodcock et al., Individual Psychology and Psychosomatic Disorders 1. London: C. W. Daniel, [Individual Psychology Medical Pamphlets no. 4], 1932., p. 21. Ernest Jones, Free Associations: Memories of a Psychoanalyst. London: The Hogarth Press, 1959; Vincent Brome, Ernest Jones: Freud’s Alter Ego. London: Caliban Books, 1982; Brenda Maddox, Freud’s Wizard: Ernest Jones and the Transformation of Psychoanalysis in Britain. London: John Murray, 2006. For a clear statement of Jones’s commitment to orthodoxy, see: Ernest Jones, ‘Discussion on Lay Analysis’, International Journal of Psychoanalysis 8 (1927): 174–98. Jones, Free Associations, pp. 229–30. On Forsyth (1877–1941), see: Paul Roazen, Paul Roazen, Oedipus in Britain: Edward Glover and the Struggle over Klein. New York: Other Press, 2000, pp. 41–2; Jones, Free, p. 239. On Mitchell (1849–1944), see; John Rickman and M. B. Wright, ‘Obituary: Thomas Walker Mitchell, 1869–1944’, British Journal of Medical Psychology 20 (1945) 203–6. R. D. Hinshelwood, ‘The Organizing of Psychoanalysis in Britain’, Psychoanalysis and History 1 (1998): 96. British Psychoanalytical Society Archives. SA/01/02. The constitutive group were: Douglas Bryan; Henry Devine; David Forsyth; Eric Hiller; Ernest Jones; Barbara Low; Charles Stanford Read and W. H. B. Stoddart. On Murray and Turner, see: Elizabeth R. Valentine, ‘“A Brilliant and Many Sided Personality”: Jessie Margaret Murray, Founder of the Medico-Psychological Clinic’, Journal of the History of the Behavioral Sciences 45.2 (2009): 145–61. For histories of the clinic, see: T. E. M. Boll, ‘May Sinclair and the Medico-Psychological Clinic of London’, Proceedings of the American Philosophical Society 106 (1962): 310–26; Susan Raitt, ‘Early British Psychoanalysis and the Medico-Psychological Clinic’, HWJ 58 (2004): 64–85. The presidents were Percy Nunn and L. T. Hobhouse. Staff physicians: James Glover, E. B. M. Herford; J. Stewart Mcintosh; Munro and Murray. The consultants included: Hector Munro; H. G. Adamson; W. E. Armstrong, George W. Badgerow, Morel Chadburn; Charles Gibbs; Arthur Charles Jordan; A. M. Leatham; W. McDougall and Agnes Savilll.

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142 On Glover (1877–1926), see: E. Jones, ‘James Glover 1882–1926’. International Journal of Psycho-Analysis, 8 (1927): 1–9. 143 Laura Price to T. E. M. Boll 23/10/1959. University of Pennsylvania, Rare Book and Manuscript Library Ms Coll. 184, folder 530. 144 Turner was far more conventional in her outlook than Constance Long for instance, Julia Turner, The Dream and the Anxiety Hypothesis. London: Kegan Paul and Co., 1923. 145 Gerhard Wittenberger and Christfried Togel (eds) Der Rundbriefe des ‘Gehimen Komitees’ Band 1: 1913–20, Tubingen: Edition Diskord, 1999 p. 140, 29/11/20L. 146 Wittenberger and Togel, Rundbrefe, p. 143: 2.11.1920/L Ernest Jones to International Psychoanalytical Association; Jones Vol II, pp. 170–2: 21.5.1921/L: 170–2. 147 Laura Price to T. E. M. Boll, (6 March 1962), May Sinclair Papers. 148 Raitt, ‘Medico-Psychological Clinic’, p. 82. 149 British Psychoanalytical Society Archives S/N/01/01 Humphrey H. King, Lincoln’s Inn, 14 February 1921. 150 Barbara Low, Psycho-Analysis. Freudian Theory. London: Unwin, 1922; Barbara Low, ‘Psycho-analysis Dangers: Need for Protection against Quacks who Exploit Hysterical Women’ Lloyds Sunday News, (5 February 1922): 5. 151 British Psychoanalytical Society Archives P04 c-d-03 LOW, Jones to Low 12 February 1922. 152 Gilbert K. Chesterton, ‘The Game of Psychoanalysis’, Century Magazine 106 (1) (1923): 34–43; E. R. Dodds, ‘Psychological Parlour Games’, The Athenaeum 4682 (23 January 1920): 112–13. 153 Joseph Ralph, Brain Building. Being a Brief Outline of the Psychology and Physiology of Mental and Moral Culture and General Therapeutics. London: L. N. Fowler & Co., 1905; George Kenneth Prattt, Your Mind and You. London: Mental Health, 1924. Charles Godfrey, Have you a Strong Will? How to Develop Will Power Memory or Any Other Faculty of the Mind, by Easy Process of Selfhypnotism, 7th edn. London: Rider [New Thought Library], 1929; Arnold Hahn, Use Your Mind: The Road to Successful Thinking. London: George Routledge, 1931; William Aitcher, ‘Do you Suffer from Nerves?’, Armchair Science 5.5, (August 1933): 299–301; Prince Leopold Lowenstein and William Gerhardie, Meet Yourself as You Really Are: different from others because you combine uniquely features present in everyone, London: Faber and Faber, 1936; H. Ernest Hunt, Practical Psychoanalysis. London: W. Foulsham and Co, 1938; Joseph Ralph, Get to Know Yourself: A Series of Psychological Tests. London: Chaterson, 1943; Idem., Joseph, How to Psycho-analyse Yourself. London: Watts, 1945; Arnold S. Jackson, The Answer is . . . Your Nerves. Kingswood: The World’s Work, 1947; Henry Clay, How to Understand Yourself and Other People. London: Rider, [1954].

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154 Leopold Lowenstein and William Gerhardie, Meet Yourself as You Really Are: different from others because you combine uniquely features present in everyone, London: Faber and Faber, 1936. On the excitement surrounding its publication, see: Dido Davies, William Gehardie: A Biography. Oxford: Oxford University Press, 1991, p. 304. 155 J. Penry, How to Judge Character from the Face. A Complete Explanation of Character as It Is Shown by the Size, Proportion, and Texture of Each Feature. London: Hutchinson, 1937. Later developed by Waddy’s Games as Physogs: The New and Novel Card Game. On the rise of popular psychology in the women’s pages, see: Adrian Bingham, Gender, Modernity and the Popular Press in Interwar England, Oxford: Clarendon Press, 2004, ch. 3. On general popular uptake, Ellesley, Psychoanalysis, pp. 160–200. 156 On ‘A Young Barrister’s Suicide’, Times (29 December 1925): 7d. On the suicide of Frank Armitage, the coroners for Hackney (Edwin smith) and Centrla Middlesex (George Cohen) agreed that exposure of the mind debases the individual and is a dangerous weapon in a large number of cases. [Editorial] ‘Psycho-Analysis’ Times (31/12/25)11d – calls for enquiry. Douglas Bryan, ‘Psycho-analysis: Inquiry by Competent Persons’, [Letter], Times (5 January 1926): 8b. 157 L. A. Parry, ‘Memorandum on psycho-analytic practices, 1925’, CMAC: SA/BMA C. 378. For an attempt to distance analysts from these scandals, see: ‘Psycho-Analysis’, Times (20/1/26):8g. 158 BPAS Archives S/N/01/01: [Glover] Tribute to Ernest Jones c. 1930. Old ref; GO1/ BF.0/1E. 159 See: BPAS Archives S/N/01/01: Jones to Parry 22 July 1925, Old ref: G/0/BA/ Fo6/05 22/7/1925 Jones joined the committee in July 1927. The other members were: Godwin Baynes (a Jungian); H. B. Brackenbury (chair of the BMA); H. C. Bristowe; R. G. Brown; R. G. Gordon; Bishop Harman (BMA treasurer); C. O. Hawthorne; Isabel Hutton; Jones; Ronald Langdon Down (the chair); E. Le Fleming; L. R. Lempiere; Peter MacDonald; Ewen Maclean; J. S. Manson; Hugh Miller; L. A. Parry; J. R. Rees; T. A. Ross and C. A. Worster-Drought. The majority of members. 160 On Baynes, see: Diana Baynes Jansen, Jung’s Apprentice, Einsiedeln: Daimon Verlag, 2003. 161 ‘Supplementary Report of Council, Appendix II’, BMJ Supp. (29 June 1929): 262–70, 70. 162 ‘The Position of Psycho-analysis’, Lancet (2 November 1939): 934–5. 163 E. Graham Howe, Motives and Mechanisms of the Mind: An Introduction to Psychopathology and Applied Psychology, [Post-graduate Medical Series vol. 1]. London: The Lancet, 1931. On the reception of Howe, see: H. E. Thorn, ‘A Retrospect on Psychiatry after Forty Years in General Practice’, JCGP 1.4 (1958): 362–5.

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164 Ernest Jones, ‘The Unconscious Mind and Medical Practice’, BMJ: British Medical Journal 1, 1938, 1354–9.; David Forsyth, The Technique of Psychoanalysis. London: Kegan Paul, 1922; Idem., ‘The Place of Psychology in the Medical Curriculum’, Proc. RSM 2 (1931–2), p. 1200; Idem., ‘The Diagnosis of Neurotic Conditions in General Practice’, BMJ 1 (27 February 1932): 370–4; Edward Glover, ‘The Psychology of the Psychotherapist’, British Journal of Medical Psychology 9 (1929): 1–16, ‘Divergent Tendencies in Psychotherapy’, British Journal of Medical Psychology 6 (1926): 93–109. 165 Wellcome CMAC: SA/BMA B.82. The section had faded into inactivity during the mid-1920s but was reconstituted in 1937. 166 Virginia Woolf, ‘Freudian Fiction,’ Times Literary Supplement, March 25, 1925, p. 199 Describing J. D. Beresford’s An Imperfect Mother. London: Collins, 1925. 167 Wells, Secret Places of the Heart London: Cassell, 1922. Martineau is probably is an oblique reference to Harriet Martineau whose cure by mesmerism was well known, see: ‘Harriet Martineau and the Reform of the Invalid in Victorian England’, Historical Journal 38 (1995): 597–616. Martineau acts as mouthpiece for many of Jung’s ideas. 168 Secret Places, p. 139. 169 Edwin Bramwell, ‘A Lecture on Psychotherapy in General Practice’, Edinburgh Medical Journal 30 n. s. (1923): 37–59.; M. Marcus, ‘Psycho-therapy in General Practice’, Practitioner (1936): 341–4. 170 J. A. C. Brown, Freud and the Post-Freudians, [1961]. (London: Penguin, 1989), p. 64. 171 Aubrey Lewis, ‘Psychiatry and General Medicine’, in C. P. Wakeley (ed.) Modern Treatment in General Practice vol. 3. London: Medical Press and Circular, 1937, p. 408. 172 R. D. Gillespie. ‘Psychological Medicine and the Family Doctor’, BMJ 2 (1944): 263–8; Edwin Bramwell, ‘A Lecture on Psychotherapy in General Practice’, Edinburgh Medical Journal 30 n. s. (1923): 37–59; Henry Yellowlees, Clinical Lectures on Psychological Medicine. London: J. & A. Churchill, 1932, pp. 4–5, 268–71; Thomas Arthur Ross, ‘Psychological Diagnosis and Treatment in General Practice’, Practitioner CXLI (1938): 1–9; Idem., An Enquiry into the Prognosis in the Neuroses. Cambridge: Cambridge University Press, 1937; Ian Skottowe, Clinical Psychiatry for Practitioners and Students. London: Eyre & Spottiswode and the Practitioner, 1954, pp. 5–6, 84–6. 173 On calls for curricular reform, see: Hugh Wingfield, ‘Psychotherapy’, BMJ (22 October 1910): 1470; Bernard Hart, ‘What Is Wrong with the Medical Curriculum? VII’, Lancet (23 July 1932): 199–201; T. A. Ross, ‘The Teaching of the Neuroses to Medical Students’, Edinburgh Medical Journal 42 (1935): 445–57; Leading article, ‘Teaching of Medical Psychology’, Lancet (23 November 1935):

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180 1 81 182

Notes 1185 Hugh Crichton-Miller, ‘The Training of the General Practitioner’, Lancet 2 (1945): 231. John Crammer, ‘Training and Education in British Psychiatry, 1770–1970’, in Berrios and Freeman (eds) 150 Years of British Psychiatry II. London: Athlone, 1996, pp. 209–42. For pedagogic articles, see: Henry Yellowlees, ‘Modern Technique in Treatment: A Series of Special Articles, contributed by invitation, on the Treatment of Medical and Surgical Conditions’, Lancet (12, 19 January 1924): 90–1, 146–7; Howe (op. cit.), Ian Skottowe, ‘Psychological Medicine: Current Methods of Treatment’, Lancet 1 (1944): 329; articles reprinted in Alan Moncrieff (ed.) Psychology in General Practice, London: Eyre and Spottiswode and the Practitioner, 1946. For a programmatic statement see, Frank Gray (BMA president and ex member of the Medical Society for Individual Psychology), ‘They Way Divides’ BMJ Supp. (12 August 1950): 55–7; Fraser Darling, ‘The Art and Science of Prognosis in General Practice’, JCGP 1.2 (1958): 129–40. John Fry, Lord Hunt of Frawley and R. F. J. H. Pinsent, A History of the Royal College of General Practitioners: The First Twenty Five Years. Lancaster: Maid To Perfection, 1983. C. A. H. Watts and B. M. Watts, Psychiatry in General Practice. London: Churchill, 1952, p. 13, 223–5; L. W. Batten, ‘Psychiatry and General Practice’, BMJ (20 December 1952): 1342–3; Marshall Marinker, ‘ “What is Wrong” and “How We Know It”: Changing Concepts of Illness in General Practice’ in Irvine Loudon, John Horder and Charles Webster, General Practice under the National Health Service. London: Clarendon Press, 1999. pp. 68–9. Watts, Psychiatry, pp. 12–13; G. Kagan, ‘Psychoneuroses in General Practice’, Practitioner 182 (1959): 498–500; Thorne, ‘Retrospect on Psychiatry’; S. Taylor and S. Chave, Mental Health and Environment. London: Longmans, 1964, p. 117; On changing patterns of presentation see Chapter 3, also John Horder, ‘Working with General Practitioners’, British Journal of Psychiatry 153 (1988): 513–20, esp. 514–15. Watts, Psychiatry, p. 40–2. On the cathartic consultation, see: T. J. Hennelly in Alan Moncrieff (ed.) Psychology in General Practice, pp. 79–80; Charles Berg, War in the Mind: The Casebook of a Medical Psychologist, 2nd edn. London: The Macaulay Press, 1948; John Horder, ‘The Role of the General Practitioner in Psychological Medicine’, Proc. RSM 60 (1967): 261–70, see also ch. 4. ‘Research in General Practice’, Lancet (7 May 1955): 953–4. RCGP Working Party on Psychological Medicine A/CE/G/12/2. [CGP], ‘Psychological Medicine in General Practice’, BMJ (6 September 1958): 587. See Watts ‘Introductory Note to Mental Health Standing Advisory Committee: Psychiatry and the General Doctor’, Copy held at RCGP A CE/G5.

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Chapter 3 1 W. H. Auden, Collected Poems. London: Faber, 1991, p. 273. 2 For the relationship of the Auden Group to psychotherapy, see: Valentine Cunningham, British Writers of the 1930s. London: Oxford University Press, 1988, pp. 94–7. 3 Auden had convinced himself that a rectal fissure he suffered in the winter of 1929 was symbolic of his pained relationship with homosexuality, see: Richard Davenport-Hines, Auden, London: Minerva, 1996, pp. 104–5; 4 Richard Overy, The Morbid Age. London: Penguin, 2010. 5 W. H. Auden, ‘The Group Movement and the Middle Classes’, in Oxford and the Groups edited by R. H. S. Crossman. Oxford: Basil Blackwell, 1934, pp. 89–101. 6 For more detailed discussion, see my: ‘The Pursuit of Serenity: Psychological Knowledge and the Making of the British Welfare State’, in Sally Alexander and Barbara Taylor (eds) History and Psyche: Culture, Psychoanalysis and the Past. Basingstoke: Palgrave, 2012, ch. 14, and: ‘The Invention of the Psychosocial’, History of the Human Sciences 25.5 (2012): 3–10. 7 On Taylor (1910–88), see his autobiography, A Natural History of Everyday Life (London: The Memoir Club, 1988); ‘Lord Taylor of Harlow, MD, FRCP, FRCGP, FFOM’, BMJ 1 (1988): 578. 8 Stephen Taylor, ‘The Suburban Neurosis’, Lancet (26 March 1938): 759–61. For an overview: ‘Desperate Housewives and Model Amoebae: the invention of suburban neurosis in inter-war Britain’ in M. Jackson (ed.) Health and the Modern Home. London: Routledge, 2007: 42–62. 9 On the new health consciousness, see: Ina Zwengier-Bargielowksa, ‘“Raising a Nation of Good Animals”: The New Health Society and Health Education Campaigns in Interwar Britain’, Social History of Medicine 20.1 (2007): 73–89; John Welshman, ‘“Bringing beauty and brightness to the back streets”: Health education and public health in England and Wales, 1890–1940’, Health Education Journal 56 (1996): 31–48. On mental hygiene in Britain, see: Mathew Thomson, ‘British Intellectuals, Democracy and Mental Health in Mid-Century Crisis’, in Regenerating England, edited by C. Lawrence and A. K. Mayer. Amsterdam: Rodopi., 2000, pp. 231–50; John Toms, Mental Hygiene and Psychiatry in Modern Britain. Basingstoke: Palgrave, 2013. 10 Robert Hutchison, ‘Hypochondriasis: Individual, Vicarious and Communal’, British Medical Journal (3 March 1934): 365. Provokes large correspondence: 505, 548, 643, 731, 776. Annotation 541 See also Maurice Cassidy, ‘Doctor and Patient’, Lancet (15 January 1938): 176. 11 Hypochondria [Psyche Miniatures Medical Series no. 12]. London: Kegan Paul Trench Trübner, 1929, p. 94. See also Gillespie’s paper on hypochondria given

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Notes at the RSM, October, 1928 and Hutchison’s Response: ‘Hypochondria’, (3 November 1928): 795–7. The Mind in Daily Life, London: Methuen, 1933, pp. 84–90. Gillespie would reverse this position five years later claiming that a knowledge of psychophysiology would allow the patient to consciously engage with learnt illnesses, Gillespie, ‘Psychoneurosies and psychotherapy’, p. 252. ‘Morrison Lectures’, Edinburgh Medical Journal 42 (1935), p. 445; c.f. LangdonBrown, ‘Psychology in the Medical Curriculum’: in the Place of Psychology in the Medical Curriculum and Other Papers. London: C.W. Daniel, [Individual psychology medical pamphlets; no. 16], 1936: 7–19. See also [Stephen Taylor], ‘Grains and scruples by a Voice in the Wilderness’, Lancet (1 and 29 October 1938), 801–3, 1021–2 repr. ‘The biology of war and a word on the modern woman’ in Henry Bashford (ed.) Doctors in Shirt Sleeves. London: Kegan Paul, Trench, Trübner and co., 1939, 241–8. On the flight to the suburbs see: J. Burnett, A Social History of Housing. London: Methuen, 1986, pp. 254–7; D. Feldman, ‘Migration’ in M. Daunton (ed.) The Cambridge Urban History of Britain. Cambridge: Cambridge University Press, 2000, pp. 185–206, esp. 202–4. Approximately 2,886,000 private homes were built between 1 January 1919 and 31 March 1939, see: Marian Bowley, Housing and the State [1945], (New York: Garland, 1985), 271, Appendix II, Table II. Roughly half of these (49.1%) were owner occupied, see: M. Swenarton and S. Taylor, ‘The Scale and Nature of the Growth of Owner Occupation in Britain between the Wars’, Economic History Review 2, 38 (1985): 373–92 (383). On the growth of leisure, see: Claire Langhamer, Women’s Leisure in England, 1920–1960. Manchester: Manchester University Press, 2000. For arguments over its psychological effects: Gary Cross, Time and Money: The Making of Consumer Culture. London: Routledge, 1999, pp. 51–60. ‘Suburban Neurosis’, 761; ‘Grains and Scruples’, 1021. Taylor, ‘Suburban Neuroses’: 759. D. Matless, Landscape and Englishness. London: Reaktion Books, 1998, 34–8; R. Colls, Identity of England. Oxford: Oxford University Press, 2002, 217–19; D. L. North, ‘Middle Class Suburban Lifestyles and Culture in England’, D. Phil. diss, University of Oxford, 1989, pp.29–39; M. Swenarton, ‘Tudor Walters and Tudorbethan: Reassessing Britain’s Inter-War Suburbs’, Planning Perspectives 17 (2002): 267–76. Short quotations from J. B. Priestley, English Journey [1934], London: Heinemann, 1984, 92. Clough Williams Ellis, England and the Octopus. London: Geoffrey Bles, 1928, p. 40. For overviews of interwar suburban contempt: D. L. North, ‘Middle Class Suburban Lifestyles’, pp. 41–54; Andrzej Olechnowicz, Working Class

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Housing in England between the Wars: The Beacontree Estate. Oxford: Clarendon Press, 1997, pp. 145–8; Paul Oliver, Ian Davis and Ian Bentley, Dunroamin: The Suburban Semi and its Enemies. London: Barrie and Jenkins, 1981, pp. 27–53, 86–90; V. Cunningham, British Writers, pp. 256–60. Guy Chapman, Culture and Survival. London: Edward Arnold, 1940. Charles Duff, Anthropological Report on a London Suburb by Professor Vladimir Chernichowski. London: Grayson and Grayson, [1935], p. 60. Orwell, Coming up for Air [1939]. London: Penguin Books, 1998. On ‘Stockbroker Tudor’ and Suburban Architectural Taste: Osbert Lancaster, Pillar to Post [1938]. London: John Murray, 1956. On the dangers of menfolk being infected by their wives suburban aspirations, James Hammerton, ‘Pooterism or Partnership? Marriage and Masculine Identity in the Lower Middle Class, 1870–1920’, Journal of British Studies 38 (1999): 291–321. This image of the anxious housewife had demonstrated remarkable tenacity, for an overview on its recent deployment, see Mark Clapson, Invincible Green Suburbs, Brave New Towns: Social Change and Urban Dispersal in Post War England. Manchester: Manchester University Press, 1998, pp. 5–16. George Rosen, ‘Social Stress and Mental Disease from the Eighteenth Century to the Present: Some Origins of Social Psychiatry’, Milbank Memorial Fund Quarterly 37.1 (1959): 5–32.; Charles Rosenberg, ‘Pathologies of progress: The idea of civilization as risk’ Bulletin of the History of Medicine 72 (1998), 714–30; R. Porter. ‘Diseases of civilization’, in W. F. Bynum and R. Porter (eds) Companion Encyclopedia to the History of Medicine 1. London: Routledge, 1993, pp. 585–600. Tom Lutz, American Nervousness, 1903: An Anecdotal History. Ithaca, NY: Cornell University Press, 1991; Simon Wessley, ‘Neurasthenia and fatigue syndromes’, in Berrios, German and Porter, Roy (eds) A History of Clinical Psychiatry: the Origin and History of Psychiatric Disorders. London: Athlone, 1995, pp. 509–32; Roy Porter, ‘Nervousness, eighteenth and nineteenth-century style: from luxury to labour’ in Marijke Gijswijt-Hofstra and Roy Porter (eds) Cultures of Neurasthenia: From Beard to the First World War, [Clio Medica 63]. Amsterdam: Rodopi, 2002, pp. 31–49. M. Logan, Nerves and Narratives: A Cultural History of Hysteria. Berkeley: University of California Press, 1997; Kenneth Levin, Freud’s Early Psychology of the Neuroses. Brighton: Harvester, 1978. Taylor, ‘Suburban neurosis’: 760. Edward Carpenter, Civilisation: Its Cause and Cure, London: Swann Sonnenschien, 1889. For discussion, see: J. Weeks and S. Rowbotham, Socialism and the New Life: The Personal and Sexual Politics of Edward Carpenter and Havelock Ellis. London: Pluto Press, 1977; L. Hall, ‘“Arrows of desire”: British sexual utopians and the politics of health’, in R. Bivins and J. V. Pickstone, (eds) Medicine, Madness and Social History. Basingtoke: Palgrave, 2007; S. Rowbotham, Edward Carpenter: A Life of Liberty and Love. London: Verso, 2009.

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28 S. Freud, Civilisation and its Discontents, [International Psycho-analytical Library no. 17]. London: Institute of Psycho-Analysis, 1930. Riviere had originally proposed Civilisation and Disease as a title. 29 D. H. Lawrence, Fantasia of the Unconscious, London: Martin Secker, 1933; Psychoanalysis and the Unconscious. London: Martin Secker, 1923; Karen Horney, The Neurotic Personality of out Time. London: Kegan Paul, 1937. Perhaps the fiercest critic of the repressive aspects of bourgeois psychology was Christopher Caudwell [St John Sprigge], ‘Consciousness: A Study in Bourgeois Psychology’, in Further Studies in a Dying Culture [1936]. London: The Bodley Head, 1949, IV: pp. 156–209. 30 Crookshank, The New Psychology and the Health of the People. London: C. W. Daniel, [Individual Psychology Medical Pamphlets reprinted from Purpose, July–September 1932], 1932., pp. 6–7. 31 Trotter, Instincts of the Herd in Peace and War, [1916]. London: T. Fisher Unwin, 9th edn., 1924; For a detailed discussion of this theme drawing on the work of Walter Langdon Brown and Thomas Horder, see: Christopher Lawrence, see: Christopher Lawrence, ‘A Tale of Two Sciences: Bedside and Bench in TwentiethCentury Britain’, Medical History 43 (1999): 421–49, Idem. ‘Edward Jenner’s Jockey boots and the Great Tradition in English Medicine, 1918–39’, in Christopher Lawrence and Anna-K. Mayer (eds) Regenerating England: Science, Medicine and Culture in Inter-War Britain. Amsterdam: Rodopi, 2000, pp. 45–66. Further examples can be found in the work of the surgeon, Percy Lockhart Mummery and the humanist physician, Arthur Brock. See Lockhart-Mummery, ‘Medical science and social progress’, British Medical Journal II (1936) 1022; After Us, or the World as it Might Be, London: Stanley Paul, 1936; A. J. Brock, Health and Conduct. London: Williams and Norgate, 1923. On Lockhart-Mummery, see: P. Palladino, ‘Icarus Flight: On the Dialogue between the Historian and the Historical Actor’, Rethinking History 4 (2000): 21–36. On Brock (1879–1947), see: David Cantor, ‘Between Galen, Geddes, and the Gael: Arthur Brock, Modernity, and Medical Humanism in Early Twentieth-Century Scotland’, Journal of the History of Medicine and Allied Sciences 60.1 (2005): 1–41. 32 Langdon Brown, ‘The Biology of Social Life’, [Maudsley Lecture, 1936], repr. Thus We Are Men. London: Longmans, 1938:, p. 13. 33 ‘A. J. Brock, ‘Social Pathology’, BMJ (8 October 1938): 762; F. A. Pickworth, ‘Social Pathology’, BMJ (15 October 1938): 814; James Halliday, ‘Social Pathology’, BMJ (12 November 1938), 1012–13; A. J. Brock, ‘Social Pathology’, BMJ (26 November 1938), 1114; Hilda Weber, ‘Social Pathology’, BMJ (26 November 1938), 1115; Morley Roberts, ‘Social Pathology’, BMJ (31 December 1938), 1392–3; Frank Bryam, ‘Social Pathology’, BMJ (31 December 1938), 139; A. J. Brock, ‘Social Pathology’, BMJ (7 January 1939), 40; Morley Roberts, ‘Social Pathology’, BMJ (14 January 1939),

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89; Emily A. Wilson, ‘Social Pathology’, BMJ (28 January 1939), 191; F. S. A. Doran, ‘Social Pathology’, BMJ (28 January 1939), 191–2. op. cit.: 1230. op. cit.: 763. A. E. Carver, ‘Rising Incidence of Psychosomatic Illness’, BMJ (16 July 1938): 149. J. Flind, ‘Some Practical Considerations in Relation to Inpatient and Outpatient Treatment in Psychoneuroses’, Journal of Mental Science 85 (1939): 886–91. Rows, ‘Psychological and Psychiatrical Clinics in Germany’, British Medical Journal (20/6/1908): 1534–7; Bedford Pierce, ‘Discussion on the Treatment of Incipient Insanity’, BMJ (19 September 1908): 818–21; R. G. Rows, ‘A Report on the Conditions of the Lunacy Service and the Teaching of Psychiatric Medicine in Germany’, Journal of Mental Science 58 (October 1912): 610–22; R. G. Rows, ‘A Report on the Conditions of the Lunacy Service and the Teaching of Psychiatric Medicine in Germany’, Journal of Mental Science 58 (October 1912): 610–22; Bedford Pierce, ‘Absence of Proper Facilities for the Treatment of Mental Disorders in their Early Stages’, BMJ (8 January 1916): 41–4; L. A. Weatherly, ‘The Work of Registered Hospitals for the Insane’, Lancet (5 August 1916): 248. On Rows, see: Ben Shepard, ‘“The early treatment of mental disorders”: R. G. Rows and Maghull, 1914–18’ in G Berrios and H. Freeman (eds) 150 Years of British Psychiatry, 1841–1991 vol. 2. London: Athlone, 1996, pp. 434–64. On Pierce (1861–1932), see: Times (12 July 1932): 11c. On the provision of shell shock clinics c. f. T. J. Mitchell and G. M. Smith, Casualties and Medical Statistics. London: HMSO, 1931, pp. 307–14, [Anon], ‘War Neuroses’, BMJ (3 January 1920): 36. C. H. Bond, ‘The Position of Psychological Medicine in Medical and Allied Services’, Journal of Mental Science 67 (1921): 404–49, esp. 428–35; Helen Boyle, ‘The Early Treatment of Psychoses and Psychoneuroses’, BMJ (18 August 1928): 304–6; Idem., ‘the Ideal Clinic for the Treatment of Nervous and Borderline Cases’, Proc. RSM 15 (1922): 39–48; Idem., ‘The provision for early treatment for nervous and borderland patients’, in J. R. Lord (ed.) Contributions to Psychiatry, Neurology and Sociology Dedicated to the Late Sir Frederick Mott. London: H. K. Lewis, 1929. C. P. Blacker, Neurosis and Mental Health Services. Oxford: Humphrey Milford, 1946, pp. 9, 134–7. On the building of outpatient clinks, see; Kathleen Jones, Asylums and After: A Revised History of the Mental Health Services. London: Athlone, 1993, pp. 127–40; Edgar Jones, ‘War and the practice of psychotherapy: the UK experience, 1939–60’, Medical History 48 (2004), 493–510. For the new rhetoric, see: E. Farquhar Buzzard, ‘Psycho-therapeutics’, Lancet 201 (17 February 1923): 330; J. G. Porter Phillips, ‘The Early Treatment of Mental Disorder: a Critical Survey of Out-patient Clinics’, Journal of Mental Science 69

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45

46

47

48 49 50 51

52

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Notes (1923): 471–82. [Macmillan Commssion], Report of the Royal Commission on Lunacy and Mental Disorder, (Cmd. 2700). London: HMS0, 1926, para. 98. T. H. Pear and Grafton Eliot Smith, Shell Shock and its Lessons. Manchester: Manchester University Press, 1919, pp. 84–5. W. A. Potts, ‘Psychic Clinics’, Journal of the Royal Sanitary Institute, 41 (1920): 53–7. T. F. Main, ‘The Cassel Hospital for Functional and Nervous Diseases’ [1968] held at Wellcome WMS 7913/41. T. S. Good, ‘The Oxford Clinic’, Journal of Mental Science 68 (1922): 17–23; Idem. T. S. Good, ‘An Attempt to Investigate and Treat Psycho-neuroses and Psychoses at an Out-patient Clinic’, British Journal of Medical Psychology 7 (1927) 36–72. H. V. Dicks, Fifty Years of the Tavistock Clinic. London: Routledge & Kegan Paul, 1970. Patricia Allderidge, ‘The foundation of the Maudsley Hospital’, in G. Berrios and H. Freeman, (eds) 150 Years of British Psychiatry, 1841–1991. London: Gaskell, 1991: pp. 84–90; Alexander Walk, ‘Medico-psychologists, Maudsley and the Maudsley’, British J. Psychiatry 128 (1976): 28–30; Edgar Jones, Shahina Rahman and Robin Woolven, ‘The Maudsley Hospital: Design and Strategic Direction, 1923–1939’, Medical History 51 (2007): 357–78, esp. 369–71. Ian Skottowe, ‘The Psychiatric Out-patient Clinic’, BMJ 1 (14 March 1931): 452–3; Charles Stanford Read, ‘Out-patient Psychiatry’, Lancet 221 (1931): 1438–41; J. R. Rees, ‘Psychotherapeutic clinics’, in M. Culpin, Recent Advances in the Study of Psychoneuroses. London: Churchill, 1931, pp. 310–29. John L. Crammer, ‘Training and Education in British Psychiatry, 1770–1970’, in Berrios and Freeman (eds) 150 Years of British Psychiatry II. London: Athlone, 1996, pp. 209–42. Taylor, Natural History, pp. 435–6. David Armstrong, ‘The Rise of Surveillance Medicine’, Sociology of Health and Illness 17.3 (1995): 393–404. M. Cassidy, ‘The Treatment of Cardiac Cases’, BMJ (13 January 1934): 45–7. T. A. Ross, ‘The Mental Factors in Medicine’, BMJ (30 July 1938): 209–11, see also: ‘Mental Factors in Illness‘, Times (22 August 1938): 11c. For other follow up studies, see: Arthur Harris, ‘The Prognosis of Anxiety States’, BMJ 2 (1938): 649–54. D. Bruce Pearson, ‘Psycho-neuroses in Hospital Practice’, Lancet (19 February 1938): 451–6; R. D. Gillespie, ‘Psychoneurosis and psychotherapy’, Humphrey Rolleston (ed.) British Encyclopedia of Medical Practice 10. London: Butterworth & Co., 1938, p. 248. For Gillespie’s criteria, see: ‘The Clinical Differentiation of Psychogenic and Physiogenic Disorders’, Brain 51 (1928): 254–75. Charles Shearer ‘Incidence of Psychoneurotic Illness’, BMJ (4 March 1939): 473–4. See also BMJ (1 April 1939) 606–7.

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54 MacFie Campbell, A Present Day Conception of Nervous Disorders. Cambridge MA: Harvard University Press, 1924, p. 25. 55 Michael Gelder, ‘Adolf Meyer and his influence on British psychiatry’ in Berrios and Freeman, (eds) 150 Years of British Psychiatry, 1841–1991. London: Gaskell, 1991, pp. 419–35. 56 Meyer produced a single synthetic work summarising his approach, but for useful introduction, see: Wendell Muncie, Psychobiology and Psychiatry: A Textbook of Normal and Abnormal Behaviour, St Louis: C. V. Mosby, 1939. For discussions of Meyer’s approach, see: S. W. Jackson, Melancholia and Depression: From Hippocratic to Modern Times. New Haven: Yale University Press, 1986, pp. 188–208. 57 Bethlem Royal Hospital Archive: Mapother Box 1. Edward Mapother, ‘An Appeal for the endowment of an Institute of Psychiatry and Psychopathology at the Maudsley Hospital and the Central Pathological Laboratory: March 1931’: 3. Copy also held at Rockefeller Archive Center (RAC): RF. 1.1 Series 401A Box 20 Folder 263. 58 Edward Mapother, Maudsley Hospital: Medical Superintendent’s Report. Period from 1st January 1927 to 31st December 1931. London: LCC, 1932: 22. 59 For statements on the continuity of depression, see: Desmond Curran, ‘The Differentiation of Neuroses and Manic Depressive Psychoses’, Journal of Mental Science 83, (1937): 156–74; E. S. Stern, ‘The Psychopathology of Manic-depressive Disorder and Involutional Melancholia’, British Journal of Medical Psychology 20 (1944): 20–32. On its hidden distribution throughout the community: B. Andratschke, and C. H. Rogerson, ‘Mild Depressive Psychosis’, BMJ (26 June 1943): 780–3. 60 Aubrey Lewis, ‘Melancholia: Prognostic Study and Case-material’, Journal of Mental Science 82 (1936): 488–558; Idem., ‘Neurosis and Unemployment’, Lancet (1935), 293–7; Idem. ‘States of Depression: their Clinical and Aetiological Differentiation’, BMJ (29 October 1938): 875–8. 61 Lewis, ‘States of depression’, 875. 62 S. Taylor, ‘Mental Illness as a Clue to Normality’, Lancet (13, 20 April 1940): 677–80; 730–4; Idem., ‘The Psychopathic Tenth’, Lancet (1941): 321–3. 63 ‘Psychopathic tenth’: 322. 64 See Phillip Boardman, The Worlds of Patrick Geddes. London: Routledge Kegan Paul, 1978; Volker Welter, Biopolis: Patrick Geddes and the City of Life. Cambridge MA: MIT Press, 2002; Chris Renwick, ‘The Practice of Spencerian Science: Patrick Geddes’s Biosocial Program, 1876–1889’, Isis 100 (2009): 36–57. 65 I. H. Pearse and G. S. Williamson, The Case for Action. London: Faber and Faber, 1931. 66 Jane Lewis and B. Brookes, ‘The Peckham Health Centre, “PEP” and the Concept of General Practice during the 1930s and 1940s’, Medical History 2 (1983): 152–3; Abigail Beach, ‘Potential for participation: health centres and the ideal

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68 69

70

71 72

73 74

75 76 77 78

79 80

81 82

Notes of citizenship, c. 1920–1940’ in C. Lawrence and A-K. Mayer (eds) Regenerating England: Science, Medicine and Culture between the Wars. Amsterdam: Rodopi, 2000, pp. 203–30. Jane Lewis, ‘The Peckham Health Centre: an Inquiry into the Nature of Living’, Bulletin for the Social History of Medicine 30–1 (1982): 39–43; Idem., ‘A Reassessment of the Work of the Peckham Health Centre, 1926–51’, Milbank Memorial Fund Quarterly 61.2 (1983): 307–51. ‘Suburban neurosis’: 761. I. Pearse, ‘Pioneering in London: the Peckham Experiment’, in [Community Service Society], The Family in a Democratic Society. New York: Columbia University Press, 1949, p. 170. On their neglect of psychological models, see: I. H. Pearse and L H. Crocker, The Peckham Experiment: A Study of the Living Structure of Society. London: George Allen and Unwin, 1943, pp. 272–3. See Lewis and Brookes, ‘Reassessment’: 313–14. See the posthumous statement in Williamson and Pearse, Science, Synthesis and Sanity: An Inquiry into the Nature of Living by the Founders of the Peckham Experiment. London: Collins, 1965, pp. 76–84. I. H. Pearse and L. H. Crocker, Peckham Experiment, pp. 21–2. On the surveillance mechanisms deployed at Peckham, see: David Armstrong, The Political Anatomy of the Body. Cambridge: Cambridge University Press, 1983, pp. 36–8. I. H. Pearse and G. Scott Williamson, Biologists in Search of Material. London: Faber and Faber, 1948, p. 47. Pearse and Crocker, Peckham Experiment, p. 249–50. C.f. the case studies given in The Case for Action, 32–3. Pearse and Crocker, Peckham Experiment, p. 259. Wellcome Library for the History and Public Understanding of Medicine, Contemporary Medical Archives (CMAC), SA/PHC/D.3/22/1/10 G. Scott Williamson, ‘Homesteads and Nutrition as the Basis for Industrial Planning’ [1945], 2–3; The Case for Action, 52–6. Pearse and Crocker, Peckham Experiment, 248; Pearse, ‘Houses vs. Homes’, CMAC SA/PHC/e.9; Pearse, ‘Pioneering’: 182. See, for instance, ‘Did your ears burn?’, Daily Herald (9 February 1938); ‘Science aids the Friendless’ The People (19 February 1939) and other cuttings held in CMAC SA/PHC/A. William Hamer, Epidemics Old and New. London: Kegan Paul Trench Trübner, 1928, p. 158. The figures are contested, see: Alice Reid, ‘The Effects of the 1918–19 Influenza Pandemic Infant and Child Health in Derbyshire’, Medical History 49 (2005):

Notes

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84 85 86

87

88 89

90

91

92 93

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29–54. Niall Johnson, Britain and the 1918–19 Influenza Pandemic: a Dark Epilogue. London, New York: Routledge, 2006, p. 73. On Greenwood (1880–1949), see Lise Wilkinson, ‘Greenwood, Major (1880–1949)’, Oxford Dictionary of National Biography. Oxford University Press, 2004 [http:// www.oxforddnb.com/view/article/51797, accessed 4 January 2007]. On his relationship to the biometric tradition, see: A. Hardy and E. Magnello, ‘Statistical methods in epidemiology: Karl Pearson, Ronald Ross, Major Greenwood and Austin Bradford Hill, 1900–1945’, Sozial und Praeventivmedizin 47 (2002): 80–9; J. Rosser Matthews, J. R. Matthews, ‘The British Biometric School and Bacteriology: the Creation of Major Greenwood as a Medical Statistician’, Quantification and the Quest for Medical Certainty. Princeton NJ: Princeton University Press, 1995. There is a passing reference to his interest in psychology in his entry in Munks Roll IV: 592–3. On Groddeck, see: Carl M. Grossman and Sylva Grossman, The Wild Analyst: The Life and Work of Georg Groddeck, London L Barrie and Rockliff, 1965. For his interest in psychosomatic medicine, see: W. S. Inman, Styes and Wedding Rings. Edinburgh: Churchill Livingstone, 1973, pp. 34–5; Greenwood and May Smith, ‘Some Pioneers of Medical Psychology II’, British Journal of Medical Psychology 14 (1934): 158–91. M. Greenwood, A. B. Hill, W. W. C Topley, and J. Wilson, Experimental Epidemiology [MRC Special Report Series no. 209]. London: HMSO, 1936, pp. 8–10. Greenwood, Epidemics and Crowd Diseases. London: Williams and Norgate, 1935. Ibid. p. 124. Greenwood was referring to: The Registrar General’s Decennial Supplement 1921. Part II: Occupational Mortality, Fertility and Infant Mortality. London: HMSO, 1927. On the growth of information gathering and the refinement of statistical methods, see: Edward Higgs, ‘Medical Statistics, Patronage and the State: The Development of the MRC Statistical Unit, 1911–1948’, Medical History 44 (2000): 323–40; E. Magnello, ‘The introduction of mathematical statistics into medical research’, in E. Magnello and A. Hardy (eds) The Road to Medical Statistics. Amsterdam: Rodopi, 2002, pp. 95–123. On Halliday (1898–1983), see: BMJ 287 (3 September 1983): 697; Rhodri Hayward, ‘James Halliday and the Invention of the Psycho-Social’, Isis 100 (December 2009): 827–38. ‘Psychoneuroses among insured persons II’, 104. L. P. Lockhart, ‘Industrialized man and his background’, Lancet 226, (21 April 1934), 825–9. Halliday, ‘Approach to Asthma’, British Journal of Medical Psychology 17 (1937): 1–47; Idem., ‘Principles of Aetiology’, British Journal of Medical Psychology 19 (1943): 367–80. He was influenced by complex aetiologies of pre-bacteriological

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98 99

1 00 101 102 103

1 04 105 106

107

108

109

Notes work, see: C. Murchison, The Continued Fevers. London: Longmans, Green and Co., 1873. Halliday, Psychosocial Medicine: A Study of the Sick Society. London: William Heinemann Medical Books, 1949, pp. 40–5. For his debt to Crookshank, see: ‘The Significance of the Concept of Psychosomatic Affections’, Psychosomatic Medicine 7.4 (1945): 240–5. ‘Principles of aetiology’, British Journal of Medical Psychology 19 (1943), 71–84. Halliday, Psychosocial Medicine, 111–26. On this argument, see: J. Campbell McClure, ‘Psychology and the Practice of Medicine’, British Medical Journal 1 (29 March 1931): 611. On this transition, see: Micale, ‘On the “Disappearance of Hysteria”: Notes on the Clinical Deconstruction of a Diagnosis’, Isis 84 (1993): 496–526. Halliday, ‘The Rising Incidence of Psycho-somatic Illness’, BMJ (2 July 1938): 11–14. M. Jackson, Allergy: The History of a Modern Malady (London: Reaktion, 2006), 185–6; Halliday, ‘Psycho-somatic Medicine and the Declining Birth Rate’, Lancet (12 May 1945): 605; Psychosocial Medicine, p. 138. E. Charles, The Menace of Under-Population London: Watts, 1936; essays by Charles and Glass in Hogben, Political Arithmetic. London: Allen and Unwin, 1938. ‘Grains and scruples’: 802. ‘Suburban neurosis’: 761. Quoted in V. Cunningham, British Writers, p. 95. On the relationship of the EMS to the NHS, see: Richard Titmuss, Problems of Social Policy [History of the Second World War: United Kingdom Civil Series], London: HMSO, 1950, pp. 502–5; James Ross Stirling, The National Health Service in Great Britain. London: Geoffrey Cumberledge/Oxford University Press, 1952, pp. 76–8. Taylor, Natural History, p. 264. [S. Taylor], ‘A Plan for Hospitals’, Lancet (28 October 1939): 945–51. ‘The Medical Planning Committee’, Lancet (11 January 1941): 45; Honigsbaum, Division, pp. 175–84; Francis Wilson, Dawson of Penn, London: Chatto and Windus, 1950. Taylor, Natural History, pp. 265–71; F. Honigsbaum, Health, Happiness and Security: The Creation of the National Health Service. London: Routledge, 1989, pp. 81–5. [Medical Planning Commission], ‘Draft Interim Report’, BMJ (20 June 1942): 743–53 [Medical Planning Research], ‘Interim General Report’, Lancet (21 November 1942): 599–622. ‘Interim General Report’, 601–2, 622.

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110 Ian McLaine, Ministry of Morale: Home Front Morale and the Ministry of Information in World War II. London: Allen and Unwin, 1979; Mariel Grant, ‘Toward a Central Office of Information: Continuity and Change in British Government Information Policy’, Journal of Contemporary History 34 (1999): 49–67. 111 Penny Summerfield, ‘Mass Observation: Social Research or Social Movement’, J. Contemporary History 20 (1985): 439–52; Angus Calder, ‘Mass Observation, 1937–1939’ in Martin Bulmer (ed.) Essays on the History of Sociological Research. Cambridge: Cambridge University Press, 1985. 112 Wilfred Bion, ‘“The War of Nerves”: Civilian reaction, morale and prophylaxis’ in E. Miller, The Neuroses in War. London: Macmillan, 1940; Hugh Crichton Miller, ‘Neuroses in War-time’, BMJ (28 January 1939): 169–70; J. A. Hadfield. ‘Neuroses in War-time: General Aetiology and Psychogenesis of the Psychoneuroses’, BMJ (21 January 1939): 127–8; G. R. Hargreaves, ‘Psychological Casualties in War’, BMJ 2 (9 December 1939): 1161–2; John Rickman, ‘Mental Aspects of the A.R.P. ’ , BMJ (26 August 1939): 457–8; M B. Wright, ‘Psychological Emergencies in Wartime’, BMJ (9, 16 September 1939): 576–8. 113 Richard Titmuss, Problems of Social Policy, chs. 16 and 17. The resilience of the civilian population remains a matter of some debate. Titmuss’s account was attacked by Angus Calder, Myth of the Blitz. London: Pimlico, 1992, but see: M. Smith, Britain and 1940: History, Myth and Popular Memory. London: Routledge, 2000; R. Mackay, Half the Battle: Civilian Morale in Britain during the Second World War. Manchester: Manchester University Press, 2002; Edgar Jones, Robin Woolven, Bill Durodie and Simon Wessely, ‘Civilian Morale during the Second World War: Responses to Air Raid Re-examined’, Social History of Medicine 17.3 (2004): 463–79; Edgar Jones, Robin Woolven, Bill Durodie and Simon Wessely, ‘Public Panic and Morale: Second World War Civilian Responses Re-examined in the Light of the Current Anti-terrorist Campaign’, Journal of Risk Research 9.1 (2006): 57–73. 114 E. Glover, ‘Notes on the Psychological Effects of War Conditions on the Civilian Population’, International Journal of Psychoanalysis 23 (1942): 17–37; Phillip Vernon, ‘Psychological Research in War Time’, Eugenics Review 32 (1940–41): 28–41: Aubrey Lewis, ‘Incidence of Neurosis in England under War Conditions’, Lancet (15 August 1942): 175–83. J. Whitby, ‘Neurosis in a London General Practice during the Second and Third Years of War’, Proc. RSM 36 (1942): 123–8. For an overview of approaches, see: Martin Roisier, ‘Social psychology and social concern in 1930s Britain’ in G. C. Bunn, A. D. Lovie and G. D. Richards, Psychology in Britain: Historical Essays and Personal Reflections. Leicester: British Psychological Society, 2001, pp. 169–87. 115 E. Glover, ‘The Birth of Social Psychiatry’, Lancet (24 August 1940): 239. 116 For useful surveys of the wide dispersal of this notion during World War II, see: J. B. Coates, Ten Modern Prophets. London: Frederick Muller, 1944; Idem.,

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119 120

121

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1 24 125

126

Notes The Crisis of the Human Person: Some Personalist Interpretations. London: Longmans, 1949. J. Huxley, ‘The Growth of a Group Mind in Britain Under Influence of War’, The Hibbert Journal 39 (1941), 337–40. See also, Idem., On Living in a Revolution. London: Chatto and Windus, 1944. Olaf Stapledon, Death into Life. London: Methuen & Co., 1946. For other examples of this rhetoric, see: Eric Graham Howe, War the Healer. [Guild of Pastoral Psychology. Guild lecture. no. 21]. London: GPP, 1943; C. E. M. Joad, Philosophy for our Times, London: Nelson, 1940. John A. Ryle, Changing Disciplines: Lectures on the History, Method and Motives of Social Pathology [1948]. New Brunswick, NJ: Transaction, 1994, p. 19. On the rhetoric of social medicine in Britain, see: Dorothy Porter, ‘Social Medicine and Scientific Humanism in Mid-twentieth Century Britain’, Journal of the Historical Sociology 9 (1996): 168–87; Idem., Health, Civilization and the State: A History of Public Health from Ancient to Modern Times. London: Routledge, 1996, chs. 9–10; Idem., ‘From Social Structure to Social Behavior in Britain after the Second World War’, Contemporary British History 16 (2002): 58–80; Idem. with R. Porter, ‘What Was Social Medicine? An Historiographical Essay’. Journal of Historical Sociology 1 (1988): 90–106. Nikolas Rose and Thomas Osborne, ‘Do the Social Sciences Create Phenomena? The Case of Public Opinion Research’, British Journal of Sociology 50.3 (2002) 367–96. Maclaine, Ministry of Morale, p. 65f. See references to Whitby’s general practice investigations in Willesden and Lewis’s attempt to integrate a national sample of general practice returns, see: fn. 100. Kathleen Box and Geoffrey Thomas, ‘The Wartime Social Survey’, Journal of the Royal Statistical Society 107 (1944): 151–89; W. P. Logan and K. M. Brooke. Studies on Medical and Population Subjects no, 12. The Survey of Sickness 1943–52. London: HMSO, 1957. See Stocks addendum. Taylor, ‘Socialism and public opinion’ in David Munro (ed.) Socialism: The British Way London: Essential Books, 1948, 223–55. On the links between the Labour party programme of social reconstruction and psychological reconstruction, see: Stephen Fielding, ‘To make men and women better than they are? Labour and the building of socialism in the 1940s’ in J. Fyrth (ed.) Labour’s Promised Land? Culture and Society in Labour Britain, 1945–51 London: Lawrence and Wishart, 1995, pp. 16–25; J. Nuttall, Psychological Socialism. The Labour Party and the Qualities of Mind and Character. Manchester: Manchester University Press, 2006. S. Taylor, Battle for Health: A Primer of Social Medicine. London: Nicholson and Watson, 1944, pp. 122–4.

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1 27 As well as Honigsbaum and Webster op. cit. 128 Reprinted in Charles Webster (ed.) Aneurin Bevan on the National Health Service, Oxford: University of Oxford Wellcome Unit for the History of Medicine, 1991, p. 19. 129 A. Bevan, In Place of Fear, London: William Heinemann, 1952, pp. 37–8. 130 For an overview, see: The Shaping of Psychiatry by War. London: Chapman and Hall Ltd, 1945, ch. 1. 131 [Royal College of Physicians, British Medical Association and the Royal Medico-Psychological Association], Memorandum on the Future Organisation of the Psychiatric Services [1945] repr. BMJ Supp. (16 June 1945): 111–16, on 111; D. R. Macalaman, ‘The Development of Psychiatry within the NHS’, Proc. RSM 42 (1949): 365–6; Desmond Curran, ‘Psychiatry Limited’ [Presidential Address to the Section on Psychiatry of the RSM], Journal of Mental Science 98 (1952): 373–81. 132 Blacker, Neurosis, p. 102 and passim. Also the programmatic statements put out at the 1947 World Congress for Mental Health, International Congress on Mental Health London 1948: Vol 1, History, Development, and Organisation. London: H.K. Lewis & Co. Ltd, 1948; Alan Caruth Stevenson, Recent Advances in Social Medicine. London: J. & A. Churchill, 1950, pp. 213–18. 133 E. D. Adrian, ‘Organisers of Health’, BMJ (26 May 1956): 1189–92; Honigsbaum, Division, pp. 188–9. 134 On the work of the committee, see: Charles Webster, ‘Psychiatry and the early National Health Service: The role of the Mental Health Standing Advisory Committee’, in German Berrios and Hugh Freeman (eds) 150 Years of British Psychiatry, 1841–1991. London: Gaskell, 1991, pp. 103–16. 135 TNA MH 133/507, 508 Organisation of preventative psychiatry by local health authorities. 136 TNA MH 133/501 The part of the family doctor in the mental health services. 137 C. A. H. Watts, Psychiatry in General Practice. London: Churchill, 1952, pp. 11–12. Note Lewis attitude to Watts in MH 133/501. 138 See the discussion in the BMJ: A. W. F., ‘Extent of Psychoneuroses’, BMJ (24 January 1948): 175–6; A. G. Buck, ‘Extent of psychoneuroses’, BMJ (7 February 1948): 277; H. Bolton Tipler, ‘Extent of Psychoneuroses’, BMJ (20 March 1948): 570–1; Phillip Hopkins, ‘Psychotherapy in General Practice’, Lancet (1 September 1956): 455–7. G. Kagan, ‘Psychoneuroses in General Practice’, Practitioner 182 (1959): 498–500; John Pemberton, ‘Illness in General Practice’, BMJ (19 February 1949): 306–8. 139 Fry notes in RCGP B Fry C7/1 Research Clinical Depression and Mental Illness; Idem., ‘The Psychoneurotic in General Practice’ Medical World (June 1954): 657–66; ‘Neurosis in General Practice’, BMJ (1October 1955): 853–4.

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140 J. D. Paulett, ‘Neurotic Ill Health: a Study in General Practice’, Lancet 2 (7 July 1956): 37–8. 141 Anthony Ryle, ‘The Neuroses in a General Practice Population’, Journal of College of General Practitioners 3 (1960): 313–28. 142 W. J. N. Kessel, ‘Psychiatric Morbidity in a London General Practice’, British J. Preventative and Social Medicine 14 (1960), 16–22. 143 This will be discussed in Chapter 4. 144 Mark Jackson, The Age of Stress: Science and the Search for Stability. Oxford: Oxford University Press, 2013, ch. 4. 145 See Heneage Oglivie (President of the College of General Practitioners) preface to Hans Selye, The Stress of Life. London: Longmans, 1956; B. Finlay, K. Gillson, D. Hart, R. W. Mason, N. Mond, L. Page and Desmond O’Neill, ‘General Practitioner’s Forum: Stress and Distress in General Practice’, Practitioner 172 (1954): 183–96; Arthur Watts, Desmond O’Neill, N, Malleson, John Horder, Phillip Hopkins, David Hart and Brian Finlay et al. ‘The Management of Stress Disorders in General Practice’, Practitioner 177 (1956): 729–43; R. J. Pinsent, ‘Preventing Stress Disorders’, Medical World 80 (1954): 182–9; Harry Levit and Desmond O’Neill, ‘Stress Problems in General Practice’, Medical World 88 (1958): 213–16; Phillip Hopkins, ‘The General Practitioner and the Psychosomatic Approach’ in Desmond O’Neill (ed.) Modern Trends in Psychosomatic Medicine. London: Butterworth, 1955. 146 I realise that my analysis here goes against recent sociological critiques of the concept of stress, however stress does seem to perform a political function in these early surveys, c.f. Allan Young, ‘The Discourse on Stress and the Reproduction of Conventional Knowledge’, Social Science and Medicine 148 (1980): 133–46; K. Pollack, ‘On the Nature of Social Stress: Production of a Modern Mythology’, Social Science and Medicine 26 (1988): 381–92. 147 F. A. E. Crew, ‘Opportunity for Adventure’, Lancet (27 August 1949): 357–8. 148 W. Eric Adams, The New Town of Harlow. Harlow: Harlow Development Corporation, 1967. 149 Sir Frederick Gibberd, Harlow New Town: A Plan prepared for Harlow Development Corporation. London: HMSO, 1947. 150 Taylor, Natural History, pp. 397–8. 151 On the idea of the ‘neighbourhood unit’ and its place in Harlow, see: Mark Llewellyn, ‘Producing and Experiencing Harlow: Neighbourhood Units and Narratives of New Town Life 1947–53’, Planning Perspectives 19 (2004): 155–74. 152 J. Attfield ‘Inside pram town: a case study of Harlow house interiors, 1951–61’, in J. Attfield and P. Kirkham (eds) A View from the Interior: Feminism, Women and Design. London: The Women’s Press, 1989, 215–37; Taylor, Natural History, 397–8.

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1 53 See Sidney Chave, ‘Making the Plan’ [Diary], CMAC: GC/178/A2/1. 154 On Chave, see: M. Warren, ‘Prologue: An appreciation of Sidney Chave’, in M. Warren and H. Francis (eds) Recalling the Medical Officer of Health: Writings by Sidney Chave, Ondon: King Edward’s Hospital Fund, 1987, pp. 15–18. On the LSHTM investigations, see: F. M. Martin, J. H. F. Brotherston and S. P. W. Chave. ‘Incidence of Neurosis on a New Housing Estate’, British Journal of Preventative and Social Medicine 11 (1957): 196–202. 155 Chave, ‘Mental Health in Harlow New Town’, Journal of Psychosomatic Research 10 (1966): 39. 156 Taylor and Chave, Mental Health and Environment. London: Longmans, 1964, ch. 4. 157 Sidney Chave ‘Diary’ (Wellcome CMAC: GC/178/A.2/10). Entry for 5 September. 158 W. P. D. Logan and A. Cushion, Morbidity Statistics from General Practice 1 [General Studies on Medical and Population Subjects no. 14] (London: H.M.S.O., 1958). 159 J. H. F. Brotherston and S. P. W. Chave, ‘General Practice on a New Housing Estate’, British Journal of Preventative and Social Medicine 10 (1956): 200–7; F. M. Martin, J. H. F. Brotherston and S. P. W. Chave, ‘Incidence of Neurosis in a New Housing Estate’, British Journal of Preventative and Social Medicine 11 (1957): 196–202; [Anon], ‘Suburban Neurosis Up to Date’, Lancet (18 January 1958): 146–7. 160 Young and Willmott, Family and Kinship, pp. 147–64; H. V. Dicks, ‘The Predicament of the Family in the Modern World’, Lancet (5 February 1955): 295–7. 161 Taylor and Chave, Mental Health and Environment, pp. 125–6. 162 Ibid., pp. 168–9. 163 Chave, ‘Mental health in Harlow New Town’: 43. 164 As Harlow’s doctors commented, anxiety states ‘tend to be self-curing as hire purchase payments come to an end’, C. Taylor et al., ‘The Health Centres of Harlow: an Essay in Cooperation’, Lancet (22 October 1955): 863. 165 R. W. Clark, A Biography of the Nuffield Foundation. London: Longmans, 1972. 166 J. S. Collings, ‘General Practice in England Today’, Lancet (25 March 1950): 555–85. For discussion, see: Roland Petchey, ‘Collings Report on general practice in England: unrecognised pioneering piece of British social policy’, BMJ (1995), 40–2; Stephen Taylor, Good General Practice: A Report of a Survey. London: Geoffrey Cumberledge and Oxford University Press, 1954, pp. 6–12. For some idea of the report’s reception see the 35 letters of response in BMJ 1 (1950): passim. 167 Collings, 555. 168 Stephen Hadfield, ‘A Field Survey of General Practice’, BMJ (26 September 1953): 683–706 also editorial: ‘General Practice Today and Tomorrow’, BMJ (26 September 1953): 717–19.

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169 Irvine Loudon and Mark Drury, ‘Some aspects of clinical care in general practice’, p. 94 and n. 14. 170 R. J. F. H. Pinsent, An Approach to General Practice. Edinburgh: E. & S. Livingstone, 1953, p. 36. 171 Taylor, Good General Practice, p. 85. 172 Ibid., p. 415. 173 Ibid., p. 416. 174 R. P. C. Handfield Jones, ‘The Organisation and Administration of a General Practice’, JCGP 1.3 (1958): 205–24; On the organisation of the group practice, see Arm 137 and J. Richard, ‘The Stranraer Health Centre’, JCGP 5 (1962): 256–64, A. J. Whitaker, ‘A Study of Purpose Built Group Practice Premises’, JCGP 10 (1965): 265–71. Also Taylor on Harlow. On the rise of operational research methods, see: R. J. F. H. Pinsent, ‘Research in General Practice’, JCGP 1.1 (1958): 26. Hodgkin K. The radio-telephone in general practice. Lancet (25 December 1954); 2: 1323. 175 John Hunt, ‘The renaissance of general practice’, BMJ rev. repr. in James Farndale (ed.) Trends in the National Health Service. Oxford: Pergamon Press, 1964, 179. 176 On the wartime origins of ergonomic and operations research, see: R. Hayward, ‘“Our Friends Electric”: mechanical models of mind in post-war Britain’ in G. Bunn, A. D. Lovie and G. Richards, (eds) Psychology in Britain: Historical Essays and Personal Reflections. Leicester: British Psychological Society, 2001, ch. 14; M. W. Kirby, Operations Research in War and Peace. London: Imperial College Press, 2003. 177 As well as Pinsent and Taylor cited above, see R. P. Handfield Jones, ‘General practice today and tomorrow’, Practitioner 170 (1953) 567–61.On the new attention to practice organisation see, David Armstrong, A New History of Identity, pp. 135–3, 140–1; Idem., ‘Space and Time in British General Practice’, Social Science and Medicine 20 (1985): 659–66; Osborne, The Doctor’s View, pp. 152–6. Also Handfield Jones, ‘General Practice Today and Tomorrow’, Practitioner 170 (1953): 567–61. 178 E. Maurice Backett, J. A. Heady and J. C. G. Evans, ‘Studies of General Practice II: The Doctor’s Job in an Urban Area’. BMJ (16 January 1954): 115–20. For background, see Sean Murphy. ‘The Early Days of the MRC Social Medicine Research Unit’, Social History of Medicine 12 (1999): 395. 179 C.f. Simon Schaffer, ‘Astronomers Mark Time: Discipline and the Personal Equation’, Science in Context 2 (1988), 115–45. Lorraine Daston, ‘The Moral Economy of Science’, in Osiris 10 (1995): Constructing Knowledge in the History of Science ed. Arnold Thackray, pp. 3–24; Michael Balint and Enid Balint, Psychotherapeutic Techniques in Medicine. London: Tavistock Publications, 1961, 114–15; H. J. Walton and N. Carstairs., ‘Differences between Physically-minded and Psychologically Minded Medical Practitioners’, British Journal of Psychiatry 112 (1966): 1097–102.

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Chapter 4 1 On Clyne (1910–2000), see: Michael Clyne, ‘Max Berthold Clyne’, BMJ 320 (15 April 2000): 1079; Interview with Michael Bevan: Transcript cat. No. 70/Tape 1/Side A and Side B CMAC GP/29/2/70. 2 David Armstrong, ‘The Emancipation of Biographical Medicine’, Social Science and Medicine 13A (1979): 1–8. 3 See the injunction in William Osler, Aequanimitas and Other Addresses to Medical Students, Nurses and Practitioners of Medicine, 3rd edn. London: H. K. Lewis, 1932, ch. 1: K. M. Hunter, Doctors’ Stories: The Narrative Structure of Medical Knowledge. Princeton NJ: Princeton University Press, 1991; Mary-Jo DelVecchio Good and Byron J. Good. ‘Clinical Narratives and the Study of Contemporary Doctor-Patient Relationships’ in Gary L. Albrecht, Ray Fitzpatrick and Susan C. Scrimshaw, (eds) The Handbook of Social Studies in Health and Medicine. London: Sage Publications Ltd., 2000; J. L. Coulehan, ‘Tenderness and Steadiness: Emotions in Medical Practice’, Literature and Medicine 14.2 (1995): 222–36. 4 Max B. Clyne, ‘The Doctor’s Attitude to his Patient’, Lancet (1 February 1958): 233. 5 This theories of the patient group drew upon the extended models of selfhood discussed in the previous chapter. For an outline of its application in paediatric work, see: F. R. Casson, ‘Some Interpersonal Factors in Illness’, Lancet 1 (15 October 1949), 681–4. 6 Clyne, ‘Doctor’s attitude’, 233. 7 Nick Lee and Steven D. Brown, ‘The Disposal of Fear: Childhood, Trauma and Complexity’, in John Law and Annemarie Mol (eds) Complexities: Social Studies of Scientific Knowledge. Durham NC: Duke University Press, 2002, pp. 258–79. 8 Clyne, ‘Doctor’s attitude’, 233. 9 Ibid., 234. 10 See the discussion in Chapter 2 above. 11 Clyne, ‘Doctor’s attitude’, 234. 12 On these narrative acts of temporal reconfiguration, see: David Carr, Time, Narrative and History. Bloomington: Indiana University Press, 11881, pp. 45–57. 13 On the political agendas behind competing models of influence, see: Paula Young Lee, ‘Modern Architecture and the Ideology of Influence’, Assemblage 34 (1997): 6–29; Frederic Jameson, The Political Unconscious: Narrative as Socially Symbolic Act. London: University Paperbacks, 1981, pp. 39–69. 14 On the utility of opacity, see; Genevieve Paicheler, The Psychology of Social Influence. Cambridge: Cambridge University Press, 1988, p. 41. 15 James M. Baldwin, Dictionary of Philosophy and Psychology. [1905] repr. Gloucester, MA: Peter Smith, 1960., q. v. 16 For early twentieth-century definitions of suggestion, see: Boris, Sidis, The Psychology of Suggestion. New York: D. Appleton, 1903, p. 15; Hippolyte Bernheim,

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Notes Suggestive Therapeutics: A Treatise on the Nature and Uses of Hypnotism 2nd edn. trans. C. A. Herter [1888]. Westport, CT.: Associated Booksellers, 1957, pp. 14–16; Albert Moll, Hypnotism, Including a Study of the Chief Points of Psychotherapeutics [1889]. 3rd edn. trans. Arthur Hopkirk. London: Walter Scott, 1899, pp. 10–11. Freud’s, ‘Preface to the translation of Bernheim’s Suggestion’ [1888–9] in SE: 1, p. 82. See Paicheler, Psychology, pp. 1–21. Georges Canguilhem, ‘The Role of Epistemology in Contemporary History of Science’ repr. in Ideology and Rationality in the History of the Life Sciences. Cambridge MA: The MIT Press, 1988; Skinner, Visions of Politics vol 1: Regarding Method. Cambridge: Cambridge University Press, 2002; Skinner, ‘Limits of Historical Explanations’, Philosophy 41 (1961): 199–215; Cooter, ‘Anticontagionism and History’s Medical Record’ in Peter Wright and Andrew Treacher, The Problem of Medical Knowledge. Edinburgh: Edinburgh University Press, 1982. See also: Barry Barnes, ‘Transcending the discourse of social influences’, in P. Machamer and G. Wolters (eds) Science, Values and Objectivity. Pittsburgh: Pittsburgh University Press, 2004. Skinner, Visions (2002), pp. 75–6; Cooter, ‘Anticontagionism’ (1982), p. 92. On cognitive maps and the distribution of power, see: John Law, ‘Power, Discretion, Strategy’, in John Law (ed.) A Sociology of Monsters: Essays on Power, Technology and Domination. London: Routledge, 1991; Barry Barnes, The Nature of Power. Cambridge: Polity Press, 1988. See above Chapter 1, and for cultural context, Daniel Pick, Svengali’s Web. The Place of the Alien Enchanter in Modern Culture. New Haven: Yale University Press, 2001. Robert Douglas-Fairhurst, Victorian Afterlives: The Shaping of Influence in Nineteenth-Century Literature. Oxford: Oxford University Press, 2002., ch. 2; John D. Rosenberg, Carlyle and the Burden of History. Oxford: Clarendon Press, 1985, pp. 35–7.; Jonathan Arac, Commissioned Spirits: The Shaping of Social Motion in Dickens, Carlyle, Melville, and Hawthorne. New Brunswick, NJ: Rutgers University Press, 1987. Galatians. iv. 19; William Sanday, Outlines of the Life of Christ. Edinburgh: T. & T. Clark, 1906, p. 228. There was a considerable literature which argued for the formation of character through the imitation of Christ: W. S. Bruce, The Formation of Christian Character. Edinburgh: T. & T. Clark, 1902, pp. 87–93, ch. 5; R. W. Church, The Discipline of Christian Character. London: Macmillan & Co., 1885, pp. 102–13, 128–30; John Richardson Illingworth, Christian Character. London: Macmillan, 1904, pp. 33–8; J. R. Miller, The Building of Character, London: Sunday School Union, n.d., ch. 3. For an overview of nineteenth-century

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models, see: Stefan Collini, ‘The Idea of “Character” in Victorian Political Thought’, Transactions of the Royal Historical Society, 5th ser. xxxv (1985): 29–50. Edmund Gurney, F. W. H. Myers and W. F. Barrett, ‘Second Report on Thought Transference’, Proc. SPR 1 (1882–83), p. 70. For an overview of the Creery sisters, see Janet Oppenheim, The Other World. Cambridge: Cambridge University Press, 1991, pp. 358–61; Trevor Hall, The Strange Case of Edmund Gurney. London: Duckworth, 1964, pp. 55–63. On Stümpf (1848–1936), see: Carl Murchison, A History of Psychology in Autobiography, I. Worcester, MA: Clark University Press, 1930, pp. 389–441. Oskar Pfungst, Clever Hans (The Horse of Mr Von Osten). A History of Experimental Animal and Human Psychology. New York: Henry Holt, 1911. Thomas Sebeok and Robert Rosenthal (eds) The Clever Hans Phenomenon. New York: New York Academy of Sciences, 1980. See Chapter 1. Stuart Cumberland, ‘Illusionary and Fraudulent Aspects of Spiritualism’, Journal of Mental Science (1881–82), pp. 280–7; 628–35; Cumberland, ‘A Thought Reader’s Experiences’ Nineteenth Century 20, pp. 689; Roger Luckhurst, ‘Passages in the Invention of the Psyche: Mind-Reading in London, 1881–84’, in Roger Luckhurst and Josephine McDonagh (eds) Transactions and Encounters: Science in Victorian Culture. Manchester: Manchester University Press, 2002, pp. 117–50. Christopher Goetz, Michel Bonduelle and Toby Gelfand, Charcot: Constructing Neurology. Oxford: Oxford University Press, 1995, pp. 53, 241f; Leon Chertok and Isabelle Stengers, A Critique of Psychoanalytic Reason: Hypnosis as a Scientific Problem from Lavoisier to Lacan. Stanford, CA: Stanford University Press, 1992, pp. 36–8. Ellenberger, Discovery of the Unconscious (1970), 171f; Crabtree, Mesmer to Freud, pp. 164–8. Freud, ‘Preface to Bernheim’, SE 1, pp. 77–8. Mark S. Micale, Approaching Hysteria: Disease and Its Interpretations. Princeton: Princeton University Press, 1995, p. 518. On Babinski’s rejection of Charcot, see: ‘Definition de l’hysterie’, Revue Neurologie (1901), 9, pp. 1074–80; ‘Démemberment de l’hystérie traditionelle: pithiatisme’, Semaine Médicale (6 January 1909), pp. 66–7; Goetz, Bonduelle and Gelfand, Charcot, pp. 321–2; Chertok and Stengers, Critique pp. 230–33. On Hurst (1879–1944), see Alex Sakula, ‘Sir Arthur Hurst: Master of Medicine’, Journal of Medical Biography 7.3, (1999): 125–9; Sir Arthur Hurst, A Twentieth Century Physician. London: Edward Arnold & Co., 1949. esp. ch. 6; Shephard, War of Nerves, pp. 78–80. A. F. Hurst, ‘Nerves and the Men’, Reveille (1918), 2; Medical Diseases of the War. London: Edward Arnold, 1918.

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36 Babinski and Froment, p. 223, see 224f. Marc Roudebush, ‘A Battle of Nerves: Hysteria and its Treatments in France during World War One’, in M. Micale and P. Lerner, Traumatic Pasts, p. 262; Hurst, Medical Diseases of War. 37 ‘What the War has taught us about hysteria’ in Contributions to Medical and Biological Research [Osler Memorial]. Oxford: Oxford University Press, 1919, pp. 600–10; William Aldren Turner, ‘The Bradshaw Lecture on the Neurosis and Psychosis of War’, Lancet (9 September 1918): 613–17. 38 Ross, Common Neuroses, London: Edward Arnold, 1923, p. 131. On Ross (1875–1941), see Munk’s Roll 5. London: Royal College of Physicians, 1968, pp. 359–60. 39 Culpin, Psychoneuroses of War and Peace. Cambridge: Cambridge University Press, 1920, pp. 27–8; The Nervous Patient. London: H. K. Lewis, 1924, pp. 74–5. On Culpin (1874–1952), see: Frances Millais MacKeith, ‘Culpin, Millais (1874–1952)’, Oxford Dictionary of National Biography, Oxford University Press, 2004 [http://www.oxforddnb.com/view/article/51592, accessed 10 October 2005]. 40 F. L. Golla, ‘The Objective Study of Neurosis’, Lancet (20 August 1921), p. 376. On Golla (1877–1968), see: Rhodri Hayward, ‘Golla, Frederick Lucien (1877–1968)’, Oxford Dictionary of National Biography, Oxford University Press, 2004 [http://www.oxforddnb.com/view/article/71668, accessed 10 October 2005]. 41 Ibid., p. 378. 42 For a similar statement, see: Robert Armstrong Jones ‘Forgetting: Psychological Repression’, BMJ (17 January 1920): 98. 43 J. C. Flower, ‘Suggestion’, British Journal of Medical Psychology 3, 1923, 39–50. For discussion on the British connection of suggestibility to the process of neurological dissolution described by Hughlings Jackson, see Allan Young, ‘W. H. R. Rivers’: 364–6. 44 R. N. Soffer, ‘New Elitism: Social Psychology in Prewar England’, The Journal of British Studies 8.2 (1969): 111–40; Mathew Thomson, ‘“Savage Civilisation”: Race, Culture and Mind in Britain, 1898–1939’, in W. Ernst and B. Harris (eds) Race, Science and Medicine: Racial Categories and the Production of Medical Knowledge, 1700–1960. London: Routledge, 1999. 45 Even the mere act of avoiding fellow pedestrians was held up by Rivers as a persisting form of primitive influence, see: Instinct and the Unconscious, p. 93; William Brown, Psychological Methods of Healing. London: University of London Press, 1938, pp. 91–2. 46 Robert Armstrong Jones, ‘Suggestion in Social Life’, Lancet (4 April 1925): 705–10. 47 For the rise of this positive psychology, see: Thomson, Psychological Subjects. Oxford: Oxford University Press, 2006, pp. 32–53. For examples of the literature, see works by James Warren Achorn, James Allen, Beaufoy Barker, B. C. Bean, E. C. Boulnois, H. N. Dawson, Harold Dearden Hopewell Ash and H. Ernest Hunt,

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48 G. E. S., ‘Heart and Mind’ in C. M. Bevan Brown, G. E. S. Ward and F. G. Crookshank, Individual Psychology Theory and Practice [I.P. Pamphlet no, 15]. London: C. W. Daniel, 1936, pp. 43–59. 49 Hayden Brown, The Secret of Human Power. London: George Allen and Unwin, 1915. Idem., Advanced Suggestion (Neuroinduction). London: Balliere, Tindall and Cox, 1918. 50 Alfred Betts Taplin, Hypnotism, Liverpool: Littlebury Bros., 1912; Idem. Hypnotic Suggestion and Psycho-Therapeutics. London: Simpkin Marshall, 1918. 51 Clifford Allen, ‘Some Experiments in Reinforcing Mental Analysis in Cases of Psychosis’, British Journal of Medical Psychology 13 (1933): 151–64. 52 Brown, Advanced Suggestion, ch. 14; Bertrand Russell, The Conquest of Happiness. London: George Allen and Unwin, 1930. 53 Arthur Hurst, ‘The Hysterical Treatment in Disease and its Treatment by Psychotherapy’, Cambridge University Medical Society Magazine 4.2 (1927): 89–91. 54 McDougall, Introduction to Social Psychology [1908], 14th edn. London: Methuen. McDougall’s definition is cited by Brown, Dearden, Howe, Laddell, Walker Mitchell and Yellowlees among others. For references see below. 55 On Brown (1881–1952), see: J. D. Sutherland, ‘William Brown’, British Journal of Medical Psychology, 26 (1953), 120–2; P. Lovie and A. D. Lovie, ‘Brown, William (1881–1952)’, Oxford Dictionary of National Biography, Oxford University Press, [http://www.oxforddnb.com/view/article/58395, accessed 7 February 2005]. 56 William Brown, ‘Psychology and Medicine’, in William Brown (ed.) Psychology and the Sciences. London: A. & C. Black, 1924., pp. 141–57. ‘Idem., Suggestion and Personality’, British Journal of Medical Psychology 5 (1925): 29–34; ‘Suggestion and the Will’ [Report to BAAS York 1932], BMJ 2 (17 September 1932): 567; Idem., ‘The Psychology of Personal Influence’, Lancet 225 (25 November 1933): 1191–3; ‘Theories of Suggestion’, BMJ 1 (18 February 1928): 251–5; Idem., Psychological Methods of Healing: An Introduction to Psychotherapy. London: University of London Press, 1938. 57 Harold Dearden, The Science of Happiness. London: William Heinemann, 1925, pp. 146–52. See also Dearden’s play, Two White Arms. Charles Hayward, What is Psychology? With Sections treating of Suggestion and Autosuggestion. London: Allen and Unwin, 1923, pp. 136–47; R. Allan Bennett, Suggestion and Common Sense. Bristol: John Wright and Sons, 1922; M. P. Leahy, The Mind in Disease: Some Conditions Caused by Suggestion. London: William Heinemann Medical Books, 1926. 58 The champions of persuasion were Charles Paul Dubois and Joseph Dejerine. For English translations of their work, see Dubois, ‘Rational Psycho-Therapeutics’, BMJ (29 September 1906): 767; Idem., The Influence of Mind on Body, trans. l. Gallatin. London: Rider’s Health and Body Handbooks, 1910; Dubois, The Psychic

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Treatment of Nervous Disorders: The Psychoneuroses and their Modern Treatment trans. Smith Ely Jeliffe, New York: Funk and Wagnalls, 1909; Dejerine and E. Glauckler, The Psychoneuroses and their Treatment by Psychotherapy. Philadelphia: J. B. Lippincott, [1915]. On the distinction between persuasion and suggestion, see: J. A. Hadfield, ‘Treatment by suggestion and persusation’, in H. Crichton Miller, Functional Nerve Disease: An Epitome of War Experience. London: Hodder and Stoughton, 1920, pp. 63–6. 59 For discussions of hypnotism and its ethics, see: Alex Erskine, A Hypnotist’s Case Book. London: Rider, [1932]; J. Louis Orton, Hypnotism, the Friend of Man. London: Thorsons, 1933; B. Layton Lloyd, Hypnosis in the Treatment of Disease. London: John Bale and Danielson, 1934; A. Philllip Magonnet, The Healing Voice: Treatment by Hypnosis. London: Heinemann, 1959; William Moodie, Hypnosis in Treatment. London: Faber and Faber, 1959; S. J. van Pelt, Gordon Ambrose and George Newbold, Medical Hypnosis: New Hope for Mankind. London: Victor Gollancz, 1959; S. J. van Pelt, Hypnotism and the Power Within. London: Skeffington, [1950]. H. Stewart, A. A. Mason and C. A. H. Watts, ‘Discussion on Hypnotism in General Practice’, Practitioner 180 (1958): 597–600. These ethical problems were avoided in paediatric medicine where the inequality of the relationship was already established, see: Gordon Ambrose ‘The Value of Hypnotic Suggestion in the Anxiety Reactions of Children’, British Journal of Medical Hypnotism 3 (1951): 20–2. Idem., ‘Positive Hypnotherapy versus Negative Psychotherapy in Child Psychiatry’, British Journal of Medical Hypnotism 4 (1953): 26–30. John Forrester has suggested that hypnotism was rejected as it granted too much agency to the patient who might refuse the treatment; British worries however concerned the breakdown of the professional contract, see: John Forrester, ‘Contracting the disease of love: Authority and freedom in the origins of psychoanalysis’, in William Bynum, Roy Porter, and Michael Shepherd (eds) The Anatomy of Madness: Essays in the History of Psychiatry vol. 1. London: Tavistock Publications, 1985, pp. 255–70. 60 See, for instance, the riots provoked among Glasgow medical students by the stage hypnotism of Walford Bodie (Walford Bodie, The Bodie Book. London: Caxton Press, 1909); Alexander Cannon’s performances at the Albert Hall, film adaptations of Du Maurier’s Trilby such as Warner Bros/Vitaphone production, Svengali (1931); The Hypnotist (Merton Park, 1957); Horrors of the Black Museum (Anglo Amalgamated, 1959) and The Hypnotic Eye (Allied Artists, 1960); as well as pulp paperbacks such as Alan Mitchell, Harley Street Hypnotist. London: Four Square, 1960. For a portrait of the post-war association of hypnotherapy with sexual promise, see Francis Wheen, Who was Charlotte Bach?, London: Short Books, 2002. 61 T. W. Mitchell, Problems in Psychopathology. London: Kegan Paul, Tench, Trubner, 1927, pp. 146–7.

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62 For Coué’s model of health, see: Emil Coueé, Self-Mastery through Conscious Auto-suggestion. London: Allen and Unwin, 1922 and Cyrus Harry The Practice of Autosuggestion by the Method of Emil Coue. London: Allen and Unwin, 1923. For popular uptake: [ANON], ‘Can we Cure Ourselves? The Power of Mind over Matter’, Review of Reviews (December 1921): 426–9; Wilfred Lay ‘Your Successful Self ’, Nash’s and Pall Mall Magazine 68 (1921): 201–8. C. C. Martindale ‘Moden Mind Healing’, Contemporary Review 121 (1922): 612–19; Emile Caillard, ‘Reason and the Subconscious’, National Review 460 (1921): 553–61; [Anon]. ‘Notes of the Month – Emile Coué & Auto-Suggestion’, Occult Review 35 (1922): 249–56. For discussion, see: Dean Rapp, ‘Couéism as a Psychological Craze of the Twenties in England,’ Studies in Popular Culture II (1987), pp. 17–36; Alison Adburgham, A Punch History of Manners and Modes, 1841–1940. London: Hutchinson, 1961, p. 297; Ellesely, Popularisation of Psychoanalysis, p. 149; Thomson, Psychological Subjects, pp. 37–8. 63 One notable convert was the neurologist, Bernard Hollander, see: Bernard Hollander, ‘How to Use Suggestion and Autosuggestion’, repr, from The Ethological Journal (April 1924) which found in Coué an endorsement of his own belief in the commanding personality c,f, ‘The Power of Suggestion’, Health Record 11 no. 126 (May 1912): 50–3. 64 ‘Suggestion in Medicine’ Lancet (15 April 1922): 751. Psychoanalytically inclined authors saw in Coué’s work an example of infantile regression to a belief in the omnipotence of thought, see: Charles Moxon, ‘M. Coué’s Theory and Practice of Auto-suggestion’, British Journal of Medical Psychology 3 (1923): 320–26. 65 On the threat to clinical research, see: W. E. Dixon, ‘The Future of Drug Therapy’, Lancet (13 October 1923): 845–6. On the ability to control influence, see: E. L. Hopewell Ash, Manipulative Methods in the Treatment of Functional Nerve Disease. London: John Bale Sons and Danielson Ltd., 1935, pp. 91–2. 66 C. Stanford Read, ‘Psychotherapy in General Practice’, BMJ (26 May 1934): 932. 67 ‘Doctor and Patient’, Lancet (15 January 1938): 175. 68 H. C. Banister, Psychology and Health, p. 110. For a reiteration of the poker analogy, see: ‘Another Trick or Two Played in Hospital’, Topical Therapy (January 1937): 9; ‘Two Down Doubled: A Whimsey around a Double Malingerer’, Topical Therapy (April 1937): 7–8. 69 Noble, The Importance of Suggestion’, Lancet (12 December 1936), p. 1432. 70 For the physiological effects of unwitting suggestions, see Golla, ‘Croonian lectures’; J. Arthur Hadfield, ‘The Influence of Hypnotic Suggestion on Inflammatory Conditions’, Lancet (3 November 1917): 678–9; Idem., ‘The Influence of Suggestion on Body Temperature’, Lancet (16 July 1920): 68–9; Barton Hall, ‘The Blood Pressure in Psychoneurosis’, Lancet 1 (10 September 1927): 540–3. The post-war literature on hypertension remained an important source,

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78 79 80

Notes ‘Emotional Stress and Hypertension’, Medical Times 86.7 (July 1958), 855–9; John Hambling, ‘Psychosomatic Aspects of Arterial Hypertension’, British Journal of Medical Psychology 25 (1952): 39–47. For an overview, see: Flanders Dunbar, Emotions and Bodily Changes: A Survey of the Literature on Psychosomatic Changes, 1910–1954. New York: Columbia University Press, 1954; Jackson, Age of Stress, pp. 88–96. Walter Langdon Brown, ‘Individual Psychology and the Sympathetic Mechanism’, BMJ 2 (24 October 1931): 753; See also ‘The Endocrines and Some Associated Psychoneuroses’, BMJ 1 (6 February 1932): 223–6. ‘Psychoneuroses and Endocrines’ [Leading Article], BMJ 1 (6 February 1932): 245–6. Hugh Crichton Miller, ‘Primitive Man and Modern Patient’, BMJ (3 September 1932): 430–32; See also his, ‘The Physical Basis of Emotional Disorder’, Proc. RSM 17 (1923–24), p. 27; Idem., ‘The Stewardship of Mental Health’, Lancet (1 June 1935): 1292–5; Idem., ‘The Priest and the Doctor in the Treatment of Nervous and Mental Disorder’, Mental Hygiene 2 (February 1936): 23–9. C.f. J. A. Hadfield, ‘Anxiety States’, British Journal of Medical Psychology 9 (1929) 33–7. These three terms were all twentieth-century inventions. ‘Empathy’ was coined in 1904 by the occult novelist and aesthete, Vernon Lee. Transference and projection were introduced to anglophone audiences by Constance Long’s translations of Jung, Collected Papers on Analytical Psychology. London: William Heinemann, 1917; Rhodri Hayward, ‘Empathy’ Lancet (24 September 2005): 1071; J. Laplanche and J.-B. Pontalis, The Language of Psychoanalysis, trans. D. Nicholson-Smith. New York: W. W. Norton, 1973, pp. 455–62 Oxford English Dictionary, 2nd edn. 1989. The emphasis on fantasy restored a certain agency to patient – albeit an agency that was located in the unconscious. On the uptake of idea of transference in psychoanalysis, see Joseph Schwartz, Cassandra’s Daughter. London: Penguin Books, 1998, pp. 138–9. W. H. R. Rivers, Conflict and Dream. Cambridge: Cambridge University Press, 1923, pp. 34–6; William McDougall, ‘Conclusion’ in Cricthon Miller, Functional Nerve Disease, 181–98. Henry Yellowlees, Manual of Psychotherapy for Practitioners and Students. London: A. & C. Black, 1923, 106, pp. 181–2. Compare his anecdote of violence induced in a patient through expectation, Yellowlees, Frames of Mind. London: William Kimber, 1957, p. 22. On Yellowlees (1888–1971), see: Munks Roll 6 (London: Royal College of Physicians, 1982), pp. 481–2. Ross, Common Neuroses, pp. 134–5. William J. Jago, ‘Transference and Trends’, The Practitioner (1923): 150–3, on 150. Evans, Wooden Doctor, Oxford: Blackwell, 1933.

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81 For a later more optimistic treatment of medical sexual attraction leading to cure, see: John Braine, The Vodi, Harmondsworth: Penguin Books, 1958. 82 M. O. Raven, ‘Medicine as an Art’, Lancet (10 September 1932): 602–3. 83 Brackenbury, Patient and Doctor. London: Hodder & Stoughton, 1935, p. 74. 84 Crichton Miller, ‘Primitive Man’, p. 431. 85 Mind and Medicine: A Lecture, [repr. from Bull. John Rylands Library 5.3. (1919)]. London: Longmans Green & Co., 1923; ‘Psychology and the War’, Instinct and the Unconscious. Cambridge: Cambridge University Press, 1922, App. 8, pp. 257–8. 86 Mary C. Bell, ‘The Use and Abuse of the Relationship between Doctor and Patient in the Practice of Psychotherapy’, Proc. RSM 16 (1923): 12–20. 87 Christopher Lawrence, ‘Edward Jenner’s Jockey boots and the Great Tradition in English Medicine, 1918–39’, in Christopher Lawrence and Anna-K. Mayer (eds) Regenerating England: Science, Medicine and Culture in Inter-War Britain. Amsterdam: Rodopi, 2000, pp. 45–66; Hayward, ‘From Clever Hans to Michael Balint’. 88 Schofield, Unconscious Therapeutics. London: J. & A. Churchill, 1904, ch. 4 passim; Springs of Character. London: Hodder & Stoughton, [1905], 143f; Oppenheim, Shattered nerves, pp. 139–40. For this argument on medical work as an imitation of Christ, see J. Russell Reynolds, Essays and Addresses London: Macmillan, 1896. On the therapeutic power of the physicians example, see: Cuming Walters, ‘Magic and Medicine’, in William Andrews (ed.) The Doctor in History, Literature, Medicine and Folklore. Hull: William Andrews & Co and the Hull Press, 1896, pp. 42–75; Sir Clifford Allbutt, ‘Reflections on Faith Healing’, BMJ (18 June 1910): 1453–7, esp. 1454–5. Leonard Williams, ‘The Quickening Spirit’, BMJ (1 October 1910): 928–31. 89 Schofield, Unconscious Therapeutics. London: J. & A. Churchill, 1904: ch. 4 passim; Springs of Character. London: Hodder & Stoughton, [1905], p. 143f; Oppenheim, Shattered nerves: 139–40. On the Christian basis of Schofield’s work, see: Hayward, ‘Neurology and the Resurgence of Demonology in Edwardian Britain’, Bulletin of the History of Medicine 78 (2004): 37–58. 90 The Mental Factor in Medicine. (London: J. & A. Churchill, 1902): 188. 91 M. de Fleury, Medicine and the Mind, [trans. Stacy B. Collins]. London: Downey, 1900, p. 54. 92 Christopher Lawrence, ‘Incommunicable Knowledge: Science, Technology and Clinical Art in Britain, 1850–1914’, Journal of Contemporary History 20 (1985): 503–20; Idem., ‘Still Incommunicable: Clinical Holists and Medical Knowledge in Interwar Britain’, in Christopher Lawrence and George Weisz (eds) Greater than the Parts: Holism in Biomedicine, 1920–1950. Cambridge: Cambridge University Press, 1998, pp. 94–111. 93 J. Russell Reynolds, Essays and Addresses. London: Macmillan, 1896.

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94 On this historical rhetoric in interwar science and medicine, see: Christopher Lawrence, ‘Edward Jenner’s Jockey’; David Cantor, ‘The Name and the Word: Neo-Hippocratism and Language in Interwar Britain’, in David Cantor (ed.) Reinventing Hippocrates. Aldershot: Ashgate, 2002, pp. 280–301; Anna-Katherina Mayer, ‘Moralizing Science: the Use of Science’s Past in National Education in the 1920s’, BJHS 30.1 (1997): 51–70. Anna-Katherina Mayer, ‘Setting up a Discipline II: British History of Science and “The End of Ideology” 1931–1948,’ Studies in History and Philosophy of Science 35 (2004): 41–72. 95 Duckworth, Harveian Oration. London: Longmans, 1898. 96 On Campbell (1860–1938): see Munks 4, pp. 385–6; Lancet (16 July 1938): 167–8. 97 Harry Campbell, On Treatment, Balliere, Tindall and Cox, 1907, 1909 etc. Later reissued and expanded as Fundamental Principles in Treatment, Balliere, Tindall and Cox, 1924. 98 Ibid., pp. 20–1. 99 Ibid., pp. 25–6. Campbell later formalized this operation through reference to the suggestive qualities of Trotterr’s herd instinct, see his Man’s Mental Evolution: Past and Future. London: Balliere, Tindall and Cox, 1923, pp. 59–65. 100 George M. Robertson, ‘Personality, Magic and Medicine’, Lancet (1 August 1925): 213–14. On Robertson’s embrace of psychoanalysis, see Malcolm Pines, ‘The Development of the Psychodynamic Movement’, in G Berrios and H. Freeman (eds) 150 Years of British Psychiatry vol. 1. London: Gaskell, p. 209. 101 Crookshank, Diagnosis: and Spiritual Healing (London: Kegan Paul, Trench, Trübner, [Psyche miniatures. Medical series no. 6], 1927), p. 95; C. M. BevanBrown, ‘Psychological Schools a Plea for Correlation’ in C. M. Bevan Brown, G. E. S. Ward and F. G. Crookshank, (eds) Individual Psychology Theory and Practice [I.P. Pamphlet no, 15]. London: C. W. Daniel, 1936, pp. 9–42 esp. 20. 102 Henry Yellowless, Clinical Lectures on Psychological Medicine. London: J. & Churchill, 1932, p. 237. 103 Adrian Laing, R. D. Laing. London: Harper Collins, 1994, pp. 64, 87–9; John Clay, R. D. Laing: A Divided Self. London: Hodder & Stoughton, 1996, p. 77; Webb, Occult Establishment, La Salle, Ill.: Open Court Publishing, 1976. p. 476; William Stranger (ed.) The Druid of Harley Street: The Spiritual Psychology of Eric Graham Howe. Cobb CA: Dharma Cafe Press, 2012. 104 ‘Motives and Mechanisms of the Mind. XII: Psychopathology in Relation to Treatment’, Lancet (1931), 220, pp. 714–21; Motives and Mechanisms of the Mind: An Introduction to Psychopathology and Applied Psychology, [Post-graduate Medical Series vol. 1]. London: The Lancet, 1931, ch. 12. 105 Jules Romain, Dr Knock translated by Granville Barker. London: Sidgwick and Jackson, 1935. For notes on the reception of this play and the 1926 French film

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107 1 08 109

110

111

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version, see: Wellcome CMAC: FPW/B.211/1-2 Box 102. On Barker’s West End production, see: ‘The Case of Dr Knock’, BMJ (8 May 1928): 841. Daukes published under the pseudonym Sidney Fairway, see his Quacks’ Paradise. London: Stanley Paul, [1937]; The Doctor’s Defence, London: Stanley Paul, [1931]. Private Worlds, London: Bodley Head, 1934; Penguin Books, 1937. See Bottome, Alfred Adler: Apostle of Freedom. London: Faber and Faber, 1939, 3rd edn., 1957. Directed by Gregory La Cava, Paramount Pictures, 1935. W. R. Houston, ‘The Doctor Himself as a Therapeutic Agent’, Annals of Internal Medicine 11 (1938): 1416–25, c.f. M. Foucault, ‘About the Beginning of the Hermeneutics of the Self ’, Political Theory (1993), 21, pp. 203–23; Luther H. Martin et al. (eds) Technologies of the Self. Amherst: University of Massachusetts Press, 1988. David Armstrong, ‘The Doctor-Patient Relationship, 1930–80’, in P. Wright and A. Treacher, The Problem of Medical Knowledge. Edinburgh: Edinburgh University Press, 1982, pp. 109–22. Thomas Osborne, ‘Mobilizing Psychoanalysis: Michael Balint and the General Practitioners’, Social Studies of Science (1993), 23.1, pp. 175–200; Marshall Marinker. ‘What is Wrong’ and ‘How We Know It’: Changing Concepts of Illness in General Practice’ in Irvine Loudon, John Horder and Charles Webster, General Practice under the National Health Service. London: Clarendon Press, 1999, pp. 68–9. It could be argued that the investigations of different rates of prescription and diagnosis, described in the previous chapter, provided an objective measure of the physician’s personality, but most investigators took the more modest course and attributed the differences to belief and style. P. E. Vernon and J. B. Parry, Personnel Selection in the British Forces. London: University of London Press, 1949, ch. 2; For a general background, see: N. Thalassis, ‘The Use of Intelligence Testing for the Recruitment of “Other Ranks” during the Second World War’, History and Philosophy of Psychology 5 (2003): 17–29. [Ministry of Health/Department of Health for Scotland], Report of the Interdepartmental Committee on Medical Schools [Goodenough Report]. London: HMSO, 1944 p. 41, para. 12. [Royal College of Physicians], Report of Planning Committee on Medical Education, London: Royal College of Physicians, 1944, c.f. complaint that ‘too many students have neither the character nor the ability to make good doctors’. The issue has became more vital following post-war oversubscription. D. H. Smyth, ‘Selection of Medical Students’, BMJ (14 September 1946): 357–67, on 361–2; F. C. Bartlett, ‘Selection of Medical Students’, BMJ (2 November 1946): 665–6; [BMA], The Training of a Doctor. London: Butterworths & Co., 1948, paras. 28, 38; Ffrangcon Roberts, Medical Education. London: H. K. Lewis, 1948, pp. 139–41.

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115 A. D. Harris, ‘The Selection of Medical Students’, Lancet (28 August 1948): 317–20; R. Orton and D. R. Martin, ‘Psychiatric Screening of Medical Students’, Lancet (28 August 1948): 321–3; Q. H. Gibson, ‘Intelligence Tests and University Careers of Medical Students’, Lancet (28 August 1948): 323–4; Asenath Petrie, ‘The Selection of Medical Students’, Lancet (28 August 1948): 325–7. 116 W. M. Millar, ‘Personality Studies of Medical Students’, Lancet (28 August 1948): 327–31; Denis Brinton, ‘Selection of Medical Students’, Lancet (8 December 1951): 1047–52. 117 R. W. Parnell, ‘Health Examinations of Students’, Lancet (27 December 1947): 939–40. 118 M. Horder, ‘The Vocation of Medicine’, The Lancet (6 November 1948): 717. 119 ‘In England Now’, Lancet (30 October 1948): 705. 120 Hayward, ‘Pursuit of Serenity’. 121 [Editorial]. ‘General Practitioners and Hospitals’, BMJ 2 (1949): 1031. 122 Honigsbaum, Divison in British Medicine, Horder ‘Rennaissance’. 123 Royal Commission on Doctors’ and Dentists’ Renumeration, Minutes of Evidence 3–4. Evidence of Lord Moran of Manton’. London: HMSO, 1958, p. 193, para. 1020. For discussion of Moran’s remarks see: Julian Tudor Hart, A New Kind of Doctor, pp. 84–5; Clyne dismissed Moran as Lord Moron, tape 2, p. 28. 124 [Sir Henry Cohen], General Practice and the Training of the General Practitioner. The Report of a Committee of the Association. London: BMA, 1950. [Editorial], ‘The Training of the G.P. ’ , BMJ (27 May 1950): 1244–5; ‘General practice: a new perspective’: 1251–5. 125 [Cohen], Training of the General Practitioner, p. 25, para. 43. 126 Ibid., p. 77, para. 167. See also: p. 27, para. 45; General practice: a new perspective’: 1253. Horder, ‘Vocation of medicine’, 715. The emphasis on literary self-cultivation and medical identity was indebted to William Osler, see his ‘Books and men’ (in Aequanimitas, ch. 11) and the commentary on the essay by William K. Beatty in J. P. Mcgovern and C. P. Rowlands (eds) William Osler: The Continuing Education. Springfield, IL: Charles C. Thomas, 1967. 127 T. F. Fox, ‘Professional Freedom II’, Lancet (28 July 1951): 173. For later restatement, see: T. F. Fox, Purposes of Medicine [The Harveian Oration for 1965]. London: Royal College of Physicians, 1965, pp. 14–15. T. H. Pear, English Social Differences. London: George Allen and Unwin, 1955, p. 38. See also A. Fraser Darling, ‘The Art and Science of Prognosis in General Practice’, JCGP 1.2 (1958): 138–9. 128 The potency of the argument was demonstrated when they were rehearsed six years later by the BMA when giving evidence to the Pilkington Committee, see: Royal Commission on Doctors’ and Dentists’ Renumeration, Minutes of Evidence. Minutes of Evidence 5–6. Witnesses: British Medical Association. London: HMSO, 1958, p. 236, paras, 172–3.

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129 Stephen J. Hadfield, ‘A Field Survey of General Practice’, BMJ (26 September 1953): 683–706. 130 Lindsey W. Batten ‘The Medical Adviser: The James Mackenzie Lecture of the Royal College of General Practitioners for 1960’, Practitioner 186 (1960): 102–12; Cardew. 131 Pinsent, Approach to General Practice, pp. 10–15. 132 John Rickman, ‘Psychology in Medical Education’, BMJ (6 September 1947): 363–6. 133 CMAC GP/29/2/70 Tape 1 Side B, [transcript. p. 27]. 134 M. Balint, ‘Training General Practitioners in Psychotherapy’, BMJ (16 January 1954): 115–20; Idem., ‘Method and Technique in the Teaching of Medical Psychology. II. Training General Practitioners in Psychotherapy’, British Journal of Medical Psychology 27 (1954): 37–41. 135 Bluma Swerdloff, ‘An Interview with Michael Balint [1965]’, The American Journal of Psychoanalysis 62 (2002): 383–413; Phillip Hopkins, ‘Interview with Michael Balint’, London Doctor 2 (1971): 17–18., ‘Balint, Michael Maurice [formerly Mihaly Bergsmann] (1896–1970)’, Oxford Dictionary of National Biography (2004–7); M. M. Ricard, ‘Michael Balint: An Introduction’, American Journal of Psychoanalysis 62 (2002): 17–24. For Balint’s early interest in transference, see: ‘On the transference of emotions’ [1933] in Primary Love and Psycho-analytic Technique, London: Tavistock, 1965. 136 D. Blair, ‘Group Psychotherapy for War Neuroses’, Lancet 244 (13 February 1943): 204–5S. Foulkes, ‘Contribution to a symposium on group therapy’, British Journal of Medical Psychology 25 (1952) 229–34; F. Kräupl Taylor, ‘A History of Group and Administrative Therapy in Great Britain’, British Journal of Medical Psychology 31 (1958): 153–73. For a history of the Northfield experiment, see: N. Thalassis, ‘Soldiers in Psychiatric Therapy: the Case of Northfield Military Psychiatric Hospital’, Social History of Medicine 20 (2007): 351–68. 137 John Horder, ‘The First Balint Group’, British Journal of General Practice 51 (2001): 1038–9. The members of the first session were: Dorothy Arning, George Barasi, Norman Chisholm, Max Clyne, Arthur Hawes, Berthold Herrman, Phillip Hopkins, Horder, Leo Hornung, Aaron Lask, Paul Saville, George Szabo, Jindrich Tinter and Anneliese Zweig. 138 Sigmund Freud, ‘Recommendations for physicians on the psychoanalytic method of treatment’ [1912], in James Strachey et al. (eds) The Complete Standard Edition of the Works of Sigmund Freud. London: Hogarth Press, XII, 109–20. See also Enid Balint, ‘Remarks on Freud’s Metaphors about the “Mirror” and the “Receiver” ’, Comprehensive Psychiatry 9 (1968): 344–8. 139 ‘Analysis terminable and interminable’ SE 23. 140 Sandor Ferenczi, First Contributions to the Theory and Technique of Psychoanalysis, tans, J. Suttie. London: Hogarth Press, 1952, 198. S. Ferenczi and O. Rank, The Development of Psychoanalysis, [1925].

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141 C.f. D. Malan, A Study of Brief Psychotherapy. London: Tavistock Publications, 1963, pp. 7–8, 32–3, 225–31, 279–81. See Balint’s essays, ‘On transference and counter-transference’, [1939] (written with Alice Balint) and ‘Analytic training and the training analysis’ [1953], in Primary Love and Psychoanalytic Technique. London: Tavistock Publications, 1965, pp. 201–8, 275–86. 142 The idea of the analyst’s transformation in therapeutic work had been underlined in British psychoanalysis by James Strachey’s paper, ‘On the Nature of the Therapeutic Action of the Psychoanalysis’, International Journal of Psychoanalysis 15 (1934): 127–59. The renewed interest in counter-transference in post-war work is usually attributed to Paula Heimann, ‘On Counter-transference’, International Journal of Psychoanalysis 31 (1950): 81–4. For an overview see Gregorio Kohon, ‘Countertransference: an Independent view’, in The British School of Psychoanalysis: The Independent Tradition. London: Free Association Books, 1986, pp. 51–73. 143 Balint, The Doctor, His Patient and the Illness. London: Pitman, 1956. p. 1. 144 Ibid., pp. 222f. 145 Ibid., pp. 224–5. 146 Malan, Psychotherapy, pp. 210–11. 147 Balint, ‘The Three Areas of the Mind. Theoretical Considerations’, International Journal of Psychoanalysis, 39 (1956): 328–40; Doctor, Patient, Illness, p. 255. 148 Lyndsey Stonebridge, ‘Anxiety at a Time of Crisis’, History Workshop Journal, 45, (1998): 171–82. 149 Thomas Osborne, ‘Mobilizing Psychoanalysis: Michael Balint and the General Practitioners’, Social Studies of Science 23.1 (1993): 175–200. 150 M. Marinker in Wellcome Witnesses to Twentieth Century Medicine vol 2: Research in General Practice. London: The Wellcome Centre for the History of Medicine, 1998, pp. 125–7; H. R. Playfair, ‘Psychological Medicine in General Practice: a Study of a Training Group Method’, Journal of the College of General Practitioners 5 (1962): 419–42; Ferris, The Doctors, pp. 133–4. 151 Lindsey Batten, ‘Stress in Life and Medical Practice’, Journal of the College of General Practitioners 20 (1964): 320–7. 152 Ibid., p. 235. 153 Ibid., p. 249. 154 Thomas Osborne, ‘Power and Persons: on Ethical Stylisation and Person-centred Medicine’, Sociology of Health and Illness (1994), 16, pp. 515–35. 155 Balint, Doctor, Patient, Illness, p. 281. 156 Max Clyne, Night Calls: A Study in General Practice. London: Tavistock, 1961; M. B. Clyne, A. J. Hawes. A. Lask, and P. R. Saville, ‘The Discontented Patient. Leaving by Notification’, Journal of the College of General Practitioners 6 (1963): 87–102; Michael Balint, John Hunt, D. Joyce, Marshall Marinker and J. Woodcock, Treatment or Diagnosis: A Study of Repeat Prescriptions in General Practice, [Mind and Medicine Monographs 20]. London: Tavistock, 1970.

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Chapter 5 1 This was not the case in New England Medicine where the rise and professional acceptance of the Emmanuel Movement (see Chapter 1) led to a deep interest in placebo and suggestion: Richard Cabot, ‘The Use of Truth and Falsehood in Medicine’, American Medicine 5 (1903): 344–9. 2 Ted Kaptchuk, ‘Intentional Ignorance: a History of Blind Assessment and Placebo Controls in Medicine’, Bulletin of the History of Medicine 72 (1998): 389–433; A. J. M. de Craen, T. J. Kaptchuk, J. G. Tijssen and J. Klejinen, ‘Placebos and Placebo Effects in Medicine: Historical Overview’, JRSM 92 (1999): 511–15; L. Frank, Persuasion and Healing. Baltimore: Johns Hopkins University Press, 1961, ch. 4. 3 W. L. Rees and G. N. King, ‘Desoxycortisone Acetate and Ascorbic Acid Treatment of Schizophrenia’, Journal of Mental Science 97 (1951): 376–80; W. L. Rees and G. N. King, ‘Cortisone in the Treatment of Schizophrenia’, Journal of Mental Science 98 (1952): 408–13; J. Elkes and C. Elkes, ‘Effect of Chlorpromazine on the Behaviour of Chronically Overactive Psychotic Patients’, BMJ (4 September 1954): 550–4; D. Healy and W. L. Rees, ‘The role of clinical trials in the development of psychopharmacology’, History of Psychiatry 8 (1997) 1–20. 4 R. P. C. Handfield Jones, ‘A Bottle of Medicine from the Doctor’, Lancet (17 October 1953): 823–5; [Editorial], ‘The Humble Humbug’, Lancet (16 August 1954): 321; ‘Bottle of medicine’, BMJ (19 January 1952): 149–50. 5 D. M. Dunlop, T. L. Henderson and R, M. Inch, ‘A Survey of 17,301 Prescriptions on Form E.C. 10’, BMJ (9 February 1952): 292–5. 6 D. Craddock, Introduction to General Practice. London: H. K. Lewis, 1953, pp. 506–9; P. Ferris, The Doctors, London: Gollancz, 1955, pp. 108–11; Anne Digby, Evolution of British General Practice, pp. 198–9; 231–2; Ronald Gibson, Family Doctor. London: George Allen and Unwin/Pulse, 1981, p. 82; Christopher M. Callahan and German E. Berrios, Reinventing Depression: A History of the Treatment of Depression in Primary Care, 1940–2004. New York: Oxford University Press, 2005, pp. 18–24. 7 R. E. Hope Simpson, ‘The First Gale Memorial Lecture: Opportunities and Pitfalls of General Practitioner Research’, JCGP 1 (1958): 231. 8 Collings, ‘General practice: a reconnaissance’, p. 583. 9 Balint, Doctor, Patient and Illness, pp. 12, 108, 170, 225–6. 231–3, 277 the ritualised bottle of medicine exchange in the case of Mr Z formed the focus of the Balint’s ‘The Doctor, his Patient and the Illness’, Lancet (2 April 1955): 683–8. 10 Ibid., p. 108. 11 Max Clyne, ‘The Placebo [Letter]’, Lancet (31 October 1953): 939–40. 12 Ibid.

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13 Two years later his ideas would be underlined by Henry Beecher’s seminal paper. ‘The Powerful Placebo’, Journal of the American Medical Association 159 (1955): 1602–6. 14 D. W. Abse, ‘Rationale of Convulsive Therapy’, British Journal of Medical Psychology 19 (1942): 262–70. L. Bruce Boyer, ‘Fantasies concerning Convulsion Therapy’, Psychoanalytic Review 39 (1952), pp. 252–70; A. B. J. Plaut, ‘Some Psychological Observations on E.C.T’, British Journal of Medical Psychology 21 (1947): 263–7. 15 Enid and Michael Balint, Psychotherapeutic Techniques in Medicine. London: Tavistock, 1961, pp. 118–19. 16 Ibid., p. 120. 17 Wenegrat, pp. 102–3. 18 Balint, Doctor, Patient and Illness, pp. 253, 257, 189. 19 Ibod., pp. 276–81. 20 See Chapter 1. 21 On Pinel and his ‘pious frauds’, see: Jan Goldstein, Console and Classify: The French Psychiatric Profession in the Nineteenth Century. Cambridge: Cambridge University Press, 1987, pp. 83–94. 22 See his, Battle for the Mind. London: William Heinemann, 1957, ch. 3 and 4. For a patient’s perspective: D. Dunhill, ‘Will Power – but not that Sort’ BMJ (16 September 1989): 747. 23 Francis Pilkington and William Sargant, ‘The Use and Abuse of Drugs in Psychological Medicine’, The Practitioner CXVIII (1937): 503. 24 W. Sargant, ‘Eight Years Psychiatric Work in England’, Journal of Nervous and Mental Disease 107 (1948): 501–16. E. Slater and W. Sargant, An Introduction to Physical Methods of Treatment in Psychiatry (Edinburgh: E. & S. Livingstone, [1944], 2nd edn. 1948. 25 J. R. Edkins, ‘Further developments in abreaction’, in Noel Harris (ed.) Modern Trends in Psychological Medicine. London: Butterworth and Co. 1948, pp. 265–86; J. Stephen Horsley, ‘Narco-analysis’, Lancet 1 (4 January 1936): 55–6; ‘Narcoanalysis’, Medical Press and Circular 194 (April 1937); Idem., ‘Narco-analysis’, Journal of Mental Science 82 (1936): 416–22; Idem., ‘Narco-analysis’, British Medical Journal 2 (22 August 1942): 230; Idem., Narco-analysis: A New Technique in Short Cut Psychotherapy. London: Humphrey Milford, 1943; Harold Palmer, ‘Abreactive Techniques’, Journal of the Royal Army Medical Corps 84 (1945): 86–90; Idem., ‘Military Psychiatric Casualties’, Lancet (13 October 1945): 434–7 and Lancet (20 October 1945): 492–4; Idem., ‘Recent technique of physical treatment and its results’, in Noel G. Harris (ed.) Modern Trends in Psychological Medicine. London: Butterworth, 1948, pp. 237–64. 26 William Sargant and H. J. Shorvon, ‘Acute War Neurosis; Special Reference to Pavlov’s Experimental Observations and the Mechanism of Abreaction’, Archives of Neurology and Psychiatry 54 (1945): 231–40; William Sargant and H. J. Shorvon,

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35

36

37 38 39

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‘Excitatory Abreaction: with Special Reference to its Mechanism and the Use of Ether’, Journal of Mental Science 93 (1947): 709–32. William Sargant & E. Slater, An Introduction to Physical Methods of Treatment in Psychiatry. Edinburgh: E. & S. Livingstone, 1948, p. 138. Ibid., p. 139. Alison Winter, ‘Film and the Construction of Memory in Psychoanalysis, 1940–60’. Science in Context 19.1 (2006): 111–36. A. Owen Flood, ‘Hypno-narcosis with Radio’, Medical World (9 August 1946): 810–12; Edkins, ‘Abreactive techniques’. p. 273. William Sargant, Battle for the Mind [1957]. London: Pan Books, 1964, pp. 60–1. See Chapter 2. F. L. Golla, ‘Croonian Lecture: The Objective Study of Neurosis’, Lancet (20 August 1921): 376. F. L. Golla and S. Antonovitch, ‘The Respiratory Rhythm and its Relation to the Mechanism of Thought’, Brain 52 (1929): 491–510; Idem., ‘The Relation of the Muscular Tonus and the Patellar Reflex to Mental Work’, Journal of Mental Science 75 (1929): 234–41. F. L. Golla, E. L. Hutton, W. G. Walter, ‘The Objective Study of Mental Imagery. I. Physiological Concomitants’, Journal of Mental Science 89 (1943): 216–22; Rhodri Hayward, ‘The Tortoise and the Love-Machine: Grey Walter and the Politics of Electro-encephalography’, Science in Context 14.4 (2001): 615–41. Stephen Taylor gave a clear statement of this model, see his ‘Mental illness as a clue to normality’, Lancet (13, 20 April 1940), 677–80; 730–4. See also: Henry Devine, Recent Advances in Psychiatry. London: J. & A. Churchill, 1929, p. 86; E. Mapother and A. Lewis, ‘Psychological Medicine’ in F. W. Price (ed.) A Textbook of the Practice of Medicine 5th edn. (London: Oxford University Press, 1937), pp. 1870–4; D. K. Henderson and R. D. Gillespie, A Textbook of Psychiatry [1927]. Cambridge: Cambridge University Press, 1956, pp. 154–5. Taylor, ‘Mental illness’, 734; E. Guttman and W. Sargant, ‘Observations on Benzedrine’, BMJ (15 May 1937): 1013–15; W. R. Bett, ‘Benzedrine Sulphate in Clinical Medicine: A Survey of the Literature’, Post-Graduate Medical Journal 22 (1946): 205–18. See Chapter 2. William Sargant, The Unquiet Mind [1967]. London: Pan Books, 1971, p. 68. Edward Mapother, ‘Tough or Tender. A Plea for Nominalism in Psychiatry’ [RSM Psychiatry Section – President’s Address], Proc. RSM 27 (1930): 1687–1712. See also F. L. Golla, ‘The Eighteenth Maudsley Lecture: Science and Psychiatry’, Journal of Mental Science 84 (1938): 4–20. James, The Will to Believe and Other Essays in Popular Philosophy. [1897]. New York: Dover Publications, 1962.

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41 M. Foucault, ‘Truth and Power’ in C. Gordon (ed.) Power/Knowledge. Brighton: Harvester Wheatsheaf, 1977. 42 A good example of this ambivalence can be seen in the works of Christopher Lasch, The Culture of Narcissism [1977]. London: Picador, 1985 and his Minimal Self: Psychic Survival in Troubled Times, [1984]. London: Picador, 1985. Books which epitomize the opposing position from the post-war period include Colin Wilson, The Outsider, [1959]. London: Pan Books, 1968; Nigel Dennis, Cards of Identity [1955]. Harmondsworth: Penguin, 1966. 43 Anthony Hordern, ‘Psychopharmacology: Some historical considerations’ in C. R. B. Joyce (ed.) Psychopharmacology: Dimensions and Perspectives. London: Tavistock Publications, 1972, pp. 119–20. 44 Peter Tyrer, ‘The Benzodiazepine Bonanza’, Lancet (21 September 1974): 509. 45 Edward Shorter, Before Prozac: The Troubled History of Mood Disorder. Oxford: Oxford University Press, 2008. 46 Berrios and Callahan, Reinventing Depression, p. 101. 47 Callahan and Berrios, Reinventing Depression, pp. 106–15. See also the findings of Dunlop, Henderson and Inch, op. cit. 48 On patients demands and the rising costs of prescriptions, see: H. C. Reports [1955–6] XX: 833 [C. W. Guillebaud], Report of the Committee of Enquiry into the cost of the National Health Service (Cmd. 9663), p. 21, Table 19. 49 For the relation between class and consumer consciousness, see: J. P. Martin, Social Aspects of Prescribing. London: Heinemann, 1957, pp. 94–9, 107–10. For a psychologized model, see K. Dunnell and A. Cartwright, Medicine Takers, Prescribers and Hoarders. London: RKP, 1972, ch. 9; Jasper Woodcock, ‘Differences in Doctor’s Prescribing Habits’ in M. Balint et al., Treatment of Diagnosis: A Study of Repeat Prescriptions in General Practice. London: Tavistock Publications, 1970, ch. 3. 50 HC Deb 13 November 1962 vol 667, 40W; ‘In Parliament’, Lancet (1 December 1962) 1176. For UK problems with meprobamate, see: Edward Shorter, Before Prozac: The Troubled History of Mood Disorders. Oxford: Oxford University Press, 2009, pp. 120–2. 51 Peter Parish, ‘The Prescribing of Psychotropic Drugs in General Practice’, Journal of the Royal College of General Practitioners [Supplement 4] 21 (1971): Tables 1 and 2, pp. 1, 4–5, 67. 52 Andrea Tone, The Age of Anxiety: A History of America’s Turbulent Affair with Tranquilizers. New York: Basic Books, 2009; Elizabeth Ettore, Elianne Riska, Gendered Moods: Psychotropics and Society. London: Routledge, 1995; Alison Haggett, ‘Housewives, neuroses and the domestic environment in Britain, 1945–70, in M. Jackson (ed.) Health and the Modern Home. London: Routledge, 2007; Idem., Women, Housewives and the Domestic Environment (London: Pickering and Chatto, 2012), ch. 4.

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53 A total of 16.5 million prescriptions for barbituates and 5.5 million prescriptions for non-barbituate hypnotics such as Mandax were issued in 1968. K. Dunlop, ‘The Use and Abuse of Psychotropic Drugs’, Proc. RSM 63 (1970): 1279–82, on 1280. 54 On the role of the placebo effect in antidepressant medication, see: Max Clyne, P. Freeling, and S. Ginsborg, A Comparative Trial between Two Tranquillizers’, Practitioner 203 (1968): 496–8; M. Shepherd, ‘Resperine: Problems Associated with the Use of a so Called “Tranquillizing Agent”’ Proc. RSM [Section of Psychiatry] (1956): 849–52: J. Moncrieff, S. Wessely and R. Hardy, ‘Meta-analysis of Trails Comparing Antidepressants with Active Placebos’, British Journal of Psychiatry 172 (1998): 227–31. On under medication, see: D. Wheatley, ‘Evolution of Psychotropic Drugs in General Practice’, Proc. RSM 65 (1972): 317–20. 55 [College of General Practitioners], Present State and Future Needs of General Practice. London: College of General Practitioners, 1965, p. 19. 56 C. R. B. Joyce, ‘Quantitative estimates of dependence on the symbolic function of drugs’, in H. Steinberg (ed.) Scientific Basis of Drug Dependence. London: J. & A. Churchill, 1969, p. 277, Table 4. 57 G. Barber reported in: ‘Reports of Societies: Medication in General Practice’, BMJ (1 December 1951): 133.6. 58 Clyne, ‘The Placebo’: 940. 59 Parish, ‘Prescribing’, 33–6; J. Johnson, A. D. Clift, ‘Dependence on Hypnotic Drugs in General Practice’, BMJ (7 December 1968): 613–17; Jasper Woodcock, ‘Long term consumers of psychotropic drugs’, in M. Balint et al., Treatment or Diagnosis. London: Tavistock Publications, pp. 147–76. 60 H. L. Lennard et al., Mystification and Drug Misuse (San Francisco, 1971) quoted in Parish, ‘What influences have led to the increased prescribing of psychotropic drugs’, JRCGP. 61 Trethowan ‘Pills for Personal Problems’, BMJ (27 September 1975): 759. See also his updated report in Guy Edwards (ed.) Psychiatry and General Practice. Southampton: University of Southampton, 1981, pp. 58–73. 62 Parish, ‘Prescribing’, 33–6; J. Johnson, A. D. Clift, ‘Dependence on Hypnotic Drugs in General Practice’, BMJ (7 December 1968): 613–17; Jasper Woodcock, ‘Long term consumers of psychotropic drugs’, in M. Balint et al., Treatment or Diagnosis. London: Tavistock Publications, pp. 147–76. 63 Malleson, Need Your Doctor be so Useless, pp. 67–9. 64 P. E. Vernon, Personality Tests and Assessments. London: Methuen, 1953; R. M. Mowbray and T. F. Rodger, Psychology in Relation to Medicine. Edinburgh: E. & S. Livingstone, 1963, pp. 352–7; Alistair Heron, ‘Three Approaches to the Study of Personality’, British Journal of Industrial Medicine 11 (1954): 159–60. 65 The idea of the clinical iceberg was developed by Jerry Morris and J. M. Last at the MRC Social Medicine Unit, see: Jerry Morris, The Uses of Epidemiology. Edinburgh: E. & S. Livingstone, 1957, pp. 44–8 and J. M. Last,

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66 67 68 69 70

71 72 73 74

75

76 77

78

79

Notes ‘The Iceberg: “Completing the Clinical Picture” in General Practice’, Lancet (6 July 1963): 28–31. On the sheer weight of pharmaceutical advertisement in the United Kingdom, see: Malleson, Need your Doctor be so Useless, pp. 67–9. Frank Ayd, Recognising the Depressed Patient. London: Grune and Stratton, 1961. [Anon], A Guide to Depressive Illness. Dagenham: May and Baker, 1968, Appendices A and B (55–67). M. Derksen, ‘Discipline, Subjectivity and Personality: an Analysis of the Manuals of Four Psychological Tests’, History of the Human Sciences 14 (2001): 25–47. H. Eysenck, ‘The Effects of Psychotherapy’, Journal of Consulting Psychology 16 (1952): 319–24. See also. H. J. Eysenck and S. Rachman, The Causes and Cures of Neurosis. London: Routledge and Kegan Paul, 1965, pp. 268–72. For background, see: Rod Buchanan, Playing with Fire: The Controversial Career of Hans Eysenck. Oxford: Oxford University Press, 2010, pp. 191–6. On their relationship see Buchanan, Playing with Fire, pp. 205–12. H. L. Freeman and D. C. Kendrick, ‘A Case of Cat Phobia: Treatment by a Method Derived from Experimental Psychology’, Lancet (13 August 1960): 497–502. See M. G. Gelder, ‘Behavior therapy’, in J. L Crammer (ed.) Practical Treatment in Psychiatry. Oxford: Blackwell Scientific Publications, 1969, p. 44. H. J. Eysenck, ‘Learning theory and behaviour therapy’ [1959] in Behaviour Therapy and the Neuroses. Oxford: Pergamon, 1960, pp. 8–9. The inset quotation is from R. L Munroe, Schools of Psychoanalytic Thought, (1955). On the slow uptake of clinical psychological expertise in primary care, see: J. A. Kincey, ‘General Practice and Clinical Psychology – Some Arguments for a Closer Liason’, JRCGP 24 (1974): 882–8; A. Gatherer, ‘Present and possible contributions to mental health by local authorities’, in G. O’Gorman (ed.) Modern Trends in Mental Health and Subnormality 1. London: Butterworth, 1968, ch. 9. Kevin Browne, ‘Behaviour Therapy in Relation to Contemporary Psychotherapy’, JRCGP 13.3 (May 1967): 325, 329. Isaac Marks and Michael Gelder, ‘Common Ground between Behaviour Therapy and Psychodynamic Techniques’, British Journal of Psychiatry 111 (1961): 561–73; H. Gwynne Jones, ‘New Horizons in Behaviour Therapy’ in L. E. Burns and J. L. Worsley (eds) Behaviour Therapy in the 1970s, Bristol:John Wright and Sons, 1970, pp. 98–9. As argued, for example, by Paul Halmos, The Faith of the Counselors. London: Constable, 1978; Maurice North, The Secular Priests. London: George Allen and Unwin, 1972. On this shift, see: Peter Kramer, Listening to Prozac. London: Penguin Books, 1994.

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80 For an overview, see: Dylan Evans, Placebo: Mind over Matter in Modern Medicine. London: Harper Collins, 2004. For thoughts on the historiographical importance of the placebo effect, see David Harley, ‘Rhetoric and the Social Construction of Illness and Healing’, Social History of Medicine 12 (1999): 407–35. For the impact of new illness categories on lived experience and social organisation, see: Allan Young, The Harmony of Illusions: Inventing Post-Traumatic Stress Disorder. Princeton NJ: Princeton University, 1995.

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Unpublished theses and dissertations Brown, Steven D., ‘The Life of Stress: Seeing and Saying Dysphoria’, University of Reading, Ph.D. thesis, 1997. Ellesley, Sandra, Psychoanalysis in Early Twentieth-century England: A Study in the Popularization of Ideas. University of Essex, Ph.D., 1995. Morrice, A. A. G., ‘Honours and Interests’: Medical Ethics in Britain and the Work of the British Medical Association Central Ethical Committee, 1902–1939. University of London, MD., 1999. North, D. L., Middle Class Suburban Lifestyles and Culture in England. University of Oxford: D.Phil, 1989. Osborne, Thomas, The Doctor’s View: Clinical and Governmental Rationality in Twentieth-Century Medical Practice. Brunel University: Ph.D., 1991. Root, Sheryl, Healing, Touch and Medicine, c. 1890–1950. University of Warwick, Ph.D., 2006.

258

Index Abraham, Karl  53 Abse, D. W.  206n. 14 Adams, W. Eric  188n. 148 Adler, Alfred  167n. 113, 169n. 128 Adlerian method  50–2 Adrian, E. D.  187n. 133 Allbutt, Clifford  146n. 86, 199n. 88 Allen, Clifford  9, 99, 142n. 48, 195n. 51 Ambrose, Gordon  196n. 59 animal magnetism  10, 12, 21 Antonovitch, S.  207n. 34 anxiety  xiii, 5, 23, 32, 46, 61–2, 74, 76–8, 80–3, 89, 92, 101, 115, 128, 130, 189n. 164 Arac, Jonathan  192n. 23 Armstrong, David  39, 156n. 19, 160n. 50, 180n. 49, 191n. 2, 201n. 110 Ash, Edwin  24–5, 98–9, 153nn. 151–2, 197n. 65 Ashley, Mike  151n. 137, 151n. 140 Attfield, J.  188n. 152 Auden, W. H.  175nn. 1, 3, 5 The Arts Today  61 Ayd, Frank  211n. 66 Recognising the Depressed Patient  128 Babinski, Henri  19, 149n. 117 Babinski, Joseph  97, 194n. 36 Backett, E. Maurice  190n. 178 Baldwin, James Mark  93, 191n. 15 Balint, Enid  203n. 137 Balint, Michael  xiii, 108, 112–15, 203nn. 134–5, 204nn. 143, 147, 155–6, 205n. 9, 206n. 18 Ball, John  10 Banister, H. C.  101, 197n. 68 Barber, G.  209n. 57 barbiturate hypnotics  124–5 Barker, Granville  107

Barnes, Barry  139n. 24, 192nn. 18, 21 Barrett, W. F.  193n. 25 Bartlett, F. C.  201n. 114 Bartrip, P.  157n. 27 basic fault  114 Batten, Lindsey W.  203n. 130, 204n. 151 Baynes, Godwin  55 Beck Depression Inventory  128 Begbie, Harold  155n. 175 Bell, Charles  13 Bell, John  143n. 55 Bell, Mary C.  104, 199n. 86 The Doctor, His Patient and the Illness  118 Bennett, Arnold  31, 156n. 11 Hilda Lessways  31 How to Live on Ten Minutes a Day  32 Mental Efficiency  32 Riceyman Steps  32 Bennett, R. Allan  195n. 57 benzodiazepines  125 Bernard, Luther Lee  167n. 109 Bernheim, Hippolyte  16, 97, 191n. 16 Berrios, German E.  205n. 6, 208nn. 46–7 Bett, W. R.  207n. 36 Bevan, Aneurin  81, 187n. 129 In Place of Fear  82 Bevan-Brown, C. M.  200n. 101 Bierer, Joshua  112 Billig, Clinton Ambrose  152n. 141 Bion, Wilfred  185n. 112 Blacker, Carlos Paton  70, 179n. 40, 187n. 132 Blackwood, Algernon  22, 151nn. 138–9 Blair, D.  203n. 136 Boardman, Phillip  181n. 64 Bond, C. H.  179n. 39 Bonduelle, Michel  193nn. 30, 34 Booth, Christopher  143n. 62, 144n. 67 Boris, Sidis  191n. 16 bottle of medicine  56, 62, 117–18, 125

260

Index

Bottome, Phyllis  167n. 114 Private Worlds  107 Bourneville, Desiree  17 Bowlby, John  77 Box, Kathleen  186n. 123 Boyer, L. Bruce  206n. 14 Brackenbury, Henry  104, 199n. 83 Braid, James  12, 15, 145nn. 70–1, 73 Braiker, Harriet  x, 135n. 3 Braine, John  199n. 81 Bramwell, Edwin  173n. 169 Bramwell, James  26, 28 Bramwell, John Milne  155n. 174 Briggs, Julia  151n. 136 Brinton, Denis  202n. 116 British Medical Association (BMA)  3, 105, 110 British Psychoanalytical Society  48, 53 British Psychological Society Medical Section  48 Brock, A. J.  27, 67, 154n. 166 Brodie, Benjamin  12–13 Brook, W. H.  158n. 33 Brookes, Barbara  72, 181n. 66 Brotherston, J. H. F.  189n. 159 Brown, C. M. Bevan  106 Brown, Edward M.  146n. 87 Brown, Hayden  99, 195nn. 49, 52 Brown, J. A. C.  56, 173n. 170 Brown, Langdon  52, 169n. 127, 178n. 32 Brown, P. S.  154n. 157 Brown, Steven D.  191n. 7 Brown, Walter Langdon  67, 102, 198n. 72 Brown, William  38, 43, 46–8, 50, 55, 65, 98–9, 159n. 40, 163n. 75, 165n. 96, 166n. 105, 195n. 56 Browne, Kevin  130, 210n. 76 Bruce, W. S.  192n. 24 Brunswick Square Clinic  54 Bryan, Douglas  52 Bryce, W. H.  48, 167n. 108 Buchanan, Rod  210nn. 70–1 Buranelli, Vincent  9, 142n. 50 Buzzard, Farquhar  36 Cabot, Richard  205n. 1 Callahan, Christopher M.  205n. 6, 208nn. 46–7 Campbell, Harry  106, 200n. 97 On Treatment  105

Campbell, Macfie  69, 181n. 54 Canguilhem, Georges  94, 192n. 18 Cantor, David  200n. 94 Caplan, Eric  146n. 85, 150n. 128 Carlyle, Thomas  95 Carpenter, Edward  45, 66, 177n. 27 Carpenter, William  13, 16, 146nn. 80, 83 Carr, David  191n. 12 Cartwright, Anne  208n. 49 Carver, A. E.  179n. 36 Cassel, Ernest  67–8 Cassidy, Maurice  68, 180n. 50 Casson, F. R.  191n. 5 catharsis  xii, 4, 99, 120–1, 174n. 179 Chapman, Guy  65, 177n. 21 Charcot, Jean-Martin  16–18, 20, 97 Chardle, Casimir  144n. 68 Charles, E.  184n. 99 Charon, Rita  135n. 6 Chave, Sidney  85–6, 189nn. 153, 155–7, 159 Chertok, Leon  193n. 30 Chesterton, Gilbert K.  171n. 152 Chettiar, Teri  150n. 119 Cheyne, George  65 Christian Science  20–2 Church, R. W.  192n. 24 Clark, R. W.  189n. 165 Clay, John  200n. 103 Clift, A. D.  209nn. 59, 62 clinical polygraph  42 Clyne, Max  91, 112, 131, 191nn. 4, 6, 8, 11, 204n. 156, 205n. 11, 209n. 54 Cohen, Henry  110–11 College of General Practitioners  57, 83, 88, 117 Collie, John  36 Collings, Joseph  87, 118, 189n. 166, 205n. 8 Collini, Stefan  193n. 24 Collins, Harry  6 Collins, Wilkie  143n. 61 The Moonstone  10, 143n. 61 Colquhoun, John Campbell  11 Colquhoun, Ithel  152n. 144 Connerton, Paul  161n. 54 Conrad, P.  135n. 1 Cooter, Roger  94–5, 158n. 29, 159n. 41, 192nn. 18, 20 Corelli, Marie  22, 151n. 134

Index Cornell Medical Index  127 cosmetic psychiatry  xiv, 130 Coulehan, J. L.  191n. 3 Crabtree, Adam  139n. 20, 193n. 31 Craddock, D.  205n. 6 Crammer, John L.  180n. 47 Crew, F. A. E.  84, 188n. 147 Crichton-Miller, Hugh  104, 153n. 154, 165n. 92 Crocker, Lucy  182nn. 73, 76–7, 79 Experiment in Living  73 Crookes, William  27 Crookshank, Francis Graham  50–1, 66, 74, 122, 168nn. 117, 120, 123, 169n. 129–30, 178n. 30, 200n. 101 Diagnosis and Spiritual Healing  106 The Mongol in our Midst  49 Crossman, Richard  81 Culpin, Millais  75, 98, 165n. 100, 194n. 39 Cumberland, Stuart  193n. 29 Curran, Desmond  70 Cushion, A.  189n. 158 Danckwerts, Justice  111 Danziger, Kurt  140n. 25 Darling, A. Fraser  202n. 127 Daukes, Sidney  107 de Craen, A. J. M.  205n. 2 de Fleury, Maurice  105, 199n. 91 Dearden, Harold  195n. 57 Dejerine, Joseph  19, 97, 149n. 117 Derksen, Maarten  128, 210n. 68 Devine, Henry  4, 53, 139n. 16, 207n. 35 Dicks, H. V.  180n. 45 Digby, Anne  205n. 6 Dixon, W. E.  197n. 65 doctor-patient relationship  104, 112–14 Donkin, H. Bryan  48, 166n. 106 Douglas-Fairhurst, Robert  192n. 23 Doyle, Conan  22, 151n. 135 dream analysis  28, 57 Dresser, Horatio  151n. 132 Drury, Mark  190n. 169 du Maurier, George Trilby  10, 143n. 61, 196n. 60 Dubois, Paul  19, 195n. 58

261

Duckworth, Dyce  105, 200n. 95 Duff, Charles  177n. 22 Dunbar, Flanders  198n. 70 Dunhill, D.  206n. 22 Dunlop, D. M.  125, 117, 205n. 5 Dunlop, K.  209n. 53 Dunnell, K.  208n. 49 Earlforward, Henry  32 Eddy, Mary Baker  21, 150n. 129 Eder, M. David  1, 4, 28–9, 46, 52, 136n. 2, 165n. 95 Eder, Norman  157n. 28, 160n. 45 Edkins, J. R.  206n. 25 Edmonds, Enid  112 Einthoven, Willem  42 electro-convulsive therapy  118 electrophysiology  41 Elkes, Charmian  117, 205n. 3 Elkes, Joel  205n. 3 Ellenberger, Henri  4, 154n. 171, 193n. 31 Elliott, Carl  136n. 19 Ellis, Havelock  66 empathy  109, 113, 198n. 74 English Society for Individual Psychology  66 Erskine, Alex  196n. 59 Ettore, Elizabeth  208n. 52 Evans, Dylan  211n. 80 Evans, J. C. G.  190n. 178 Evans, Margiad The Wooden Doctor  103 Evans, Warren Felt  21, 151n. 130 expectations  13–14, 21, 33, 55, 91, 96–7, 107 Eysenck, H. J.  109, 128–30, 210nn. 69–70, 74 Falconer, William  11, 119 family physician  33–4 mental health  57 personality  xiii prescriptions  117 Fara, Patricia  143n. 54 faradization  17 Felkin, Robert  23, 152n. 145 Ferenczi, Sandor  112–13, 203n. 140 Ferrier, David  25 Ferris, P.  204n. 150, 205n. 6 Figlio, Karl  xi

262

Index

Flood, A. Owen  207n. 30 Flower, J. C.  194n. 43 Forrester, John  151n. 137, 196n. 59 Forsyth, David  52, 66 Foucault, Michel  123, 201n. 109, 208n. 41 Foulkes, S. H.  112 Fox, Theodore  202n. 127 ‘professional freedom’  111 Frank, L.  205n. 2 Frank, Robert  162n. 64 free association  1–2, 28, 112, 137n. 4 Freeling, P.  209n. 54 Freeman, Hugh  129, 210n. 72 Freud, Sigmund  xi, 1–2, 61, 135n. 11, 138nn. 11, 13, 139n. 23, 178n. 28, 193n. 32, 203n. 137 Froment, J.  149n. 117, 194n. 36 frustration  xii, 33, 50, 56, 65, 67, 74, 77–8, 107 Fry, John  83, 187n. 139 Future Organisation of the Psychiatric Services  82 Galison, Peter  141n. 37 Galsworthy, John  31, 33 Gatherer, A.  210n. 75 Gauld, Alan  9, 143n. 53 Geddes, Patrick  71 Gelder, Michael  181n. 55, 210nn. 73, 77 Gelfand, Toby  193nn. 30, 34 general practitioner  xii diagnostic powers  36 ethical self-cultivation  111 exemplary force  105–6 legislative initiatives  35 medically unexplained syndromes  xiv NHS  87 organ jargon  51 personality  109–11 prescriptions  124–6 professional ethics  101–2 psychiatric knowledge  57 psychological distress, symptomatic understanding of  127 public image  111 role  34 training course  55 tranquilizers  124–7 Gerhardie, William  172n. 154 Know Yourself as You Really Are  54

Gibberd, Frederick  84, 188n. 149 Gibson, Q. H.  202n. 115 Gibson, Ronald  205n. 6 Gigerenzer, Gerd  141n. 35 Gilbert, R. A.  151n. 141 Gillespie, Robert Dick  69, 173n. 172, 207n. 35 Mind in Daily Life  63 Ginsborg, S.  209n. 54 Ginzburg, Carlo  151n. 137 Glaucker, E.  149n. 117 Glover, Edward  79, 185nn. 114–15 Glover, James  53–5 Godlee, Rickman  46, 165n. 97 Goetz, Christopher  193nn. 30, 34 Goldsmith, Margaret  9, 142n. 49 Goldstein, Jan  156n. 7, 206n. 21 Golla, F. L.  43, 98, 162n. 74, 194n. 40, 197n. 70, 207nn. 33–4, 39 Good, Byron J.  191n. 3 Good, Mary-Jo DelVecchio  191n. 3 Good, T. S.  68, 180n. 44 Gooding, D. C.  141n. 32 Graham, William  139n. 18 Gray, Frank  170n. 133 Greenwood, M.  183nn. 87–8 Epidemiology and Crowd Diseases  75 Groddeck, George  75, 169n. 125 Gross, William Mayer  70 Gurney, Edmund  15–16, 19, 193n. 25 Guttman, E.  207n. 36 Hacking, Ian  141n. 31 Hadfield, J. A.  196n. 58, 197n. 70, 198n. 73 Hadfield, Stephen  87, 111, 189n. 168, 203n. 129 Haggett, Ali  125, 208n. 52 Hall, Barton  197n. 70 Hall, Trevor  193n. 25 Hallam, Arthur  25, 152n. 141 Haller, Edward  13 Halliday, James  xiii, 75–7, 80, 183n. 93, 184nn. 94, 96–8 Halmos, Paul  210n. 78 Hambling, John  198n. 70 Hamer, William  50, 74, 182n. 81 Hamilton Rating Scale  128 Hardy, Richmond  56, 209n. 54 Harley, David  211n. 80

Index Harlow Development Corporation  84 Harris, A. D.  202n. 115 Harris, Ruth  148n. 105 Harrisson, Tom  79 Hart, Bernard  8 Hart, Ernest  21, 150n. 127 Hartmann, Franz  151n. 135 Hawes, A. J.  204n. 156 Hay, Louise  x Haygarth, James  11, 119 Haygarth, John  144n. 64 Hayward, Charles  195n. 57, 199nn. 87, 89, 202n. 120 Hayward, Rhodri  194n. 40, 198n. 74, 207n. 34 Head, Henry  31, 45 Heady, J. A.  190n. 178 health insurance  35–6 Healy, D.  205n. 3 Heimann, Paula  204n. 142 Henderson, D. K.  69, 207n. 35 Henderson, T. L.  205n. 5 Hepworth, Barbara  85 Heron, Alistair  209n. 64 hidden potentials  5, 21, 23, 38, 84, 89, 114, 122 Hill, A. B.  183n. 87 Hinshelwood, R. D.  170n. 138 Holland, Henry  12–13, 45, 145nn. 72, 74 Hollander, Bernard  197n. 63 Honigsbaum, F.  202n. 122 Hooker, J. Stenson  25 Hopeallianz  xi Hopkins, Phillip  203n. 135 Horder, John  111, 202n. 122, 203n. 137 Horder, M.  202n. 118 Hordern, Anthony  208n. 43 Horney, Karen  66 Horsley, J. Stephen  120, 206n. 25 Houston, W. R.  201n. 109 Howe, Eric Graham  55, 106, 172n. 163 Hughes, F. L.  160n. 49 human character  2, 29, 31 Hunt, John  88, 190n. 175, 204n. 156 Hunter, K. M.  191n. 3 Hunter, Richard  29, 137n. 5 Hurst, Arthur  97, 193n. 35, 195n. 53 Hutchison, Robert  52, 63, 175n. 10 Hutton, E. L.  207n. 34 Huxley, Julian  80, 186n. 117

263

hypnotic somnambulism  18 hypnotism  12, 15–16, 196n. 59 hysteria malingering  36 pithiatism  97 ideo-motor action  13 Illingworth, John Richardson  192n. 24 illness  80 artistic creation  119 hysterical distress  xi identity  92 insurance  37 stress  xi Inch, R. M.  205n. 5 Inchbald, Elizabeth  143n. 59 Animal Magnetism (farce)  10 influence  93 models  95 psychological suggestion  94 Inman, William  75 Interdepartmental Commission on Health Insurance Records  39 Jackson, Hughlings  45 Jackson, Mark  188n. 144 Jackson, Stanley  4 Jago, William  103, 198n. 79 James, William  16, 41, 148n. 101, 207n. 40 The Will to Believe  123 Jameson, Frederic  191n. 13 Janet, Pierre  16, 17–20, 47, 149nn. 109–10, 114 L’ Automatisme Psychologique  18 Johnson, J.  209nn. 58–9, 62 Jolly, Sheridan  151n. 135 Jolly, Stratford John Silence  22–3, 151n. 138, 151n. 139 Jones, Ernest  52–4, 170nn. 136–7, 173n. 164 Jones, H. Gwynne  210n. 77 Jones, R. P. C. Handfield  88, 190n. 174, 205n. 4 Jones, Robert Armstrong  99, 194nn. 42, 46 Jones, William Parry  150n. 120 Jouve, Nicole Ward  155n. 5 Joyce, C. R. B.  209n. 56

264

Index

Kaptchuk, Ted  205n. 2 Keating, Peter  151n. 136 Kendrick, David  129, 210n. 72 Kermode, Frank  167n. 110 Kessel, W. J. N.  83, 188n. 142 Kincey, J. A.  210n. 75 King, G. N.  205n. 3 Kingsbury, George C.  152n. 148 Klejinen, J.  205n. 2 Kohon, Gregorio  204n. 142 Kramer, Peter  210n. 79 Kuriyama, Shigehisa  141n. 38

Logan, W. P. D.  160n. 48, 189n. 158 London Psychoanalytic Circle  52–3 London School of Hygiene and Tropical Medicine (LSHTM)  85 Long, Constance  52 Loudon, Irvine  190n. 169 Lovie, A. D.  195n. 55 Lovie, P.  195n. 55 Low, Barbara  54, 171n. 150 Lowenstein, Leopold  172n. 154 Know Yourself as You Really Are  54 Luckhurst, Roger  193n. 29 Lumsden, Thomas  36, 158n. 34 Lutz, Tom  177n. 25 Luys, Joseph  27

Laddell, MacDonald  106 Laing, Adrian  200n. 103 Langdon-Brown, Walter  50, 106, 165n. 94 Langworthy, Charles Cunningham  11 Laplanche, J.  198n. 74 Lasch, Christopher  208n. 42 Lask, A.  204n. 156 Last, J. M.  210n. 65 Law, John  192n. 21 Lawrence, Christopher  105, 199nn. 87, 92, 200n. 94 Lawrence, D. H.  66, 178n. 29 Laycock, Thomas  13 Leahy, M. P.  195n. 57 Lee, Nick  191n. 7 Lee, Paula Young  191n. 13 Leighton, M. E.  150n. 126 Lennard, Henry  126, 209n. 59 Lenoir, Timothy  141n. 32, 161n. 61 Lewis, Aubrey  57, 69, 70–1, 82, 122, 173n. 171, 181nn. 60–1, 207n. 35 Lewis, Ioan  xi, 135n. 8 Lewis, Jane  72, 181n. 66, 182n. 67 Librium  124, 127 Liébault, J. A.  16, 97 lifestyle  xii Littlemore Clinic for Nervous Disorders  68 Lloyd, B. Layton  196n. 59 Lockhart, L. P.  76 Lodge, Oliver  27

M’Kendrick, Archibald  36, 158n. 31 MacAlpine, Ida  29, 137n. 5, 155n. 178 MacDonald, Ramsay  66 MacIntyre, Alasdair  143n. 60 MacKeith, Frances Millais  194n. 39 Mackenzie, James  34, 40, 42, 76, 157nn. 21–2, 160n. 47 MacNeice, Louis Blacklegs  78 Magonnet, A. Philllip  196n. 59 Main, T. F.  180n. 43 Malan, D.  204nn. 141, 146 Mapother, Edward  69–70, 122, 181n. 58, 207nn. 35, 39 Marey, Étienne-Jules  41 Marinker, Marshall  201n. 111, 204nn. 150, 156 Marks, Isaac  210n. 77 Martin, D. R.  202n. 115 Martin, J. P.  208n. 49 Martin, Luther H.  201n. 109 Martin, T. Muirhead  159n. 36 Martineau, Harriet  56, 173n. 167 Matless, D.  176n. 19 Maudsley Personality Inventory  128 Mayer, Anna-Katherina  200n. 94 McDougall, William  47–8, 68, 80, 98–9, 195n. 54, 198n. 76 McFadyean, Norman  67 McLaine, Ian  185n. 110 McMahon, C. E.  144n. 66 Medical Planning Research  79

Joyce, Dick  126, 204n. 156 Jung, Carl Gustav  1–2, 137n. 4

Index Medical Society for Individual Psychology  48–9, 51, 74, 76 Medico-Psychological Association  55, 81 Mental Treatment Act, 1930  68 Meprobamate  124 Mercier, Charles  28, 155n. 172 Mesmer, Franz Anton  8 Meyer, Adolf  69–70, 83 Micale, Mark S.  148n. 102, 148n. 103, 193n. 33 Mill Hill Inventory for neuroticism  109 Millar, W. M.  202n. 116 Miller, Hugh Crichton  24–5, 55, 102, 198n. 73, 199n. 84 Miller, Jonathan  142n. 44, 192n. 24 Millingen, John  12 Miltown  124 Mitchell, Thomas Walker  52, 100, 196n. 61 Mitrinovic, Dimitri  49 Moll, Albert  192n. 16 Moncrieff, J.  209n. 54 Moodie, William  196n. 59 Moore, Henry  85 Morant, Robert  39 Morland, Egbert  78 Morris, Jerry  210n. 65 Morrison, Herbert  81 Mosso, Angelo  41, 162n. 62 Mott, F. W.  162n. 73, 164n. 90 Mowbray, R. M.  209n. 64 Moxon, Charles  197n. 64 Muirhead, J. H.  47 Murray, Jessie  53 Muthu, C. K.  27, 154n. 166 Myers, A. T.  149n. 118, 150nn. 119, 121 Myers, Arthur  19–20 Myers, C. S.  164n. 85 Myers, F. W. H.  15–16, 19–20, 150nn. 122–4, 193n. 25 National Health Insurance Act of 1911  35 National Health Insurance scheme  xiii, 36, 40 National Health Service (NHS)  39, 57, 81 National Survey of Sickness  80 neuroinduction  99 New Thought  21–2 New Towns Act of 1946  84

265

Newbold, George  196n. 59 Noble, Ralph  101, 197n. 69 North, Maurice  210n. 78 Nuffield Provincial Hospitals Trust  88 O’Neill, Desmond  83 occultist practice  22–4 Oglivie, Heneage  83 Oppenheim, Janet  3, 138n. 12, 193n. 25 Order of the Golden Dawn  23–4 orthopsychics  53 Orton, J. Louis  196n. 59 Orton, R.  202n. 115 Orwell  177n. 23 Coming Up for Air  65, 177n. 23 Osborne, Thomas  114, 186n. 121, 201n. 111, 204nn. 149, 154 Osler, William  137n. 3, 191n. 3 outpatient clinic  67–8 Overy, Richard  175n. 4 Owen, Alex  151n. 141 Page, Herbert  13–14, 146n. 88, 147n. 89 Paicheler, Genevieve  191n. 14, 192n. 17 Palmer, Harold  120, 206n. 25 Parish, Peter  126, 208n. 51, 209nn. 59, 62 Parnell, R. W.  109, 202n. 117 Parry, J. B.  201n. 113 Parry, L. A.  172n. 157 Parsons, John Herbert  44–5, 164n. 86 Passerini, Luisa  167n. 112 Paullett, J. D.  83, 188n. 140 Pearse, Innes  71–2, 181n. 65, 182nn. 69, 73, 75–7, 79 Experiment in Living  73 Pearse, James  156n. 18 Pearson, D. Bruce  69, 180n. 52 Pear, T. H.  180n. 41, 202n. 127 Peckham Experiment  71–3 Peck, M. Scott  x Pennington, Hugh  168n. 118 Penry, Jacques  54, 172n. 155 Perkins, Benjamin  144n. 63 Perkins Patent Tractors  11 Perkins, William  11 Peterson, Frederick  42, 162n. 71 Petrie, Asenath  202n. 115 Pfüngst, Oskar  96, 193n. 27

266

Index

Phantasms of the Living  15 physical illness  xi, 102, 114, 120, 123 unconscious  130 physical weaknesses  51 physician’s personality  108–9 moral power  105–6, 108 Pick, Daniel  192n. 22 Pickering, Andy  141n. 36 Pierce, Arthur  147n. 99 Pignarre, P.  136n. 15 Pilkington, Francis  120, 206n. 23 Pinch, Trevor  6 Pinel, Phillippe  119 Pines, Malcolm  200n. 100 Pinsent, R. J. F. H.  88, 112, 190n. 170, 203n. 131 placebo effect antidepressant medication  123–5, 127–8, 209n. 54 pharmacological description  118 scientific trials  117 truth and fantasy  121–3 Plaut, A. B. J.  206n. 14 Playfair, H. R.  204n. 150 Podmore, Frank  21, 147n. 99, 151n. 131 Pontalis, J.-B.  198n. 74 Popper, Karl  141n. 28 Porter, Roy  155n. 177 Potts, W. A.  180n. 42 Powell, Enoch  125 preventative psychiatry  xiii, 59, 82, 187n. 135 Priestley, J. B.  64 psychoanalysis, establishment  31 psychodynamic psychiatry  77, 83, 137n. 8 Psycho-Medical Society  27 psychosomatic medicine  xi, xiii, 9, 75–7, 100, 112, 114 psycho-therapeusis  24 psychotherapeutic confession  120 Psycho-Therapeutic Society  25–6 psychotherapy  24 British military  50 eclecticism  47–9 general practitioner  xiii, 108, 112 modern  4, 9 Victorian  24–6 psychotropics  125–6

Quimby, Phineas  21 Rachman, S.  210n. 70 railway spine  13 Ralph, Joseph  171n. 153 Raven, Charles  165n. 99 Raven, Martin  103, 199n. 82 Rawson, Frederick  22, 151n. 133 Read, Charles Stanford  53, 101, 197n. 66 reciprocal inhibition  129–30 red cards  39 Rees, Linford  117, 205n. 3 Reeve, A. B.  162n. 70 Reports, H. C.  208n. 48 repression  xii, 28, 45, 66, 76, 83, 130 Reynolds, John Russell  105, 199nn. 88, 93 rheumatism  1, 29, 32, 56, 76 Ricard, M. M.  203n. 135 Rickman, John  112, 203n. 132 Ricoeur, Paul  2, 137n. 7 Riska, Elianne  125, 208n. 52 Rivers  165n. 101 Rivers, W. H. R.  45, 47–8, 65, 79, 98, 104, 164nn. 83, 91 Riviere, Joan Civilisation and its Discontents  66 Robb, Maurice  51, 169n. 131 Robertson, George  106, 150n. 120, 200n. 100 Rodger, T. F.  209n. 64 Rolleston, H.  150n. 120 Romain, Jules  107, 200n. 105 Rorie, James  154n. 167 Rose, Nikolas  186n. 121 Rosen, George  177n. 24 Rosenberg, Carol Smith  xi Ross, Thomas  55, 63, 68, 98, 102–3, 180n. 51, 194n. 38, 198n. 78 Rouse, Joseph  7, 141n. 34 Rows, R. G.  68, 179n. 37 Royal Army Medical Corps  98 Royal College of General Practitioners  viii, 126 Royal College of Physicians  82, 105 Royal Medico-Psychological Association  81–2 Russell, David  12, 145n. 77 Ryle, Anthony  83, 188n. 141 Ryle, John  80, 186n. 119

Index Sachs, Hans  112 Sadoff, Deborah  148n. 107 Sakula, Alex  193n. 34 Sargant, William  70, 120–1, 131, 192n. 24, 206nn. 23–4, 26, 207nn. 27, 31, 36, 38 Physical Methods of Treatment  121 Savage, George Henry  28, 31, 152n. 148, 155n. 173 Savage, O. D.  151n. 133 Saville, P. R.  204n. 156 Schaffer, Simon  163n. 79, 190n. 179 Schofield, Arthur Taylor  109, 199nn. 88–9 Schwartz, Joseph  198n. 75 Selye, Hans  83 Shamdasani, Sonu  4, 152n. 143 Shand, Alexander  47 Shapin, Steven  140n. 27 Shapiro, Monte  128–9 Shaw, Thomas Claye  26–7, 154nn. 163–4 Shearer, Charles  69, 180n. 53 shell shock  46 suggestion  98 Shepherd, Michael  127, 209n. 54 shock  38 psychodynamic theories of  46 Showalter, Elaine  xi, 135n. 7 Shorter, Edward  208nn. 45, 50 Shorvon, H. J.  206n. 26 Sidgwick, Henry  15 Simpson, R. E. Hope  117, 205n. 7 Sinclair, May  53 The Helpmate  33 The Life and Death of Harriet Frean  33 Skinner, Quentin  94, 192nn. 18–19 Skottowe, Ian  180n. 46 Slater, E.  206n. 24, 207n. 27 Smith, J. Barker  154n. 165 Smith, May  75 Smith, R. P.  150n. 119 Smith, Roger  142nn. 41–2 Smith, W. Whately  163n. 76 Smyth, D. H.  201n. 114 social medicine  84 Society for Psychical Research (SPR)  14–15 Society for the Study of Suggestive Therapeutics  26 Soffer, R. N.  194n. 44

267

Southard, E. E.  165n. 98 Souttar, Henry  79 Spencer, Herbert  95 Spriggs, George  25 Stansky, Peter  137n. 8 Stapledon, Olaf  80, 186n. 118 Stengers, Isabelle  193n. 30 Stewart, Dugald  11, 145n. 69 Stewart, J. Purves  159n. 38 Stoddart, W. B.  163n. 81 Stonebridge, Lyndsey  204n. 148 Stranger, William  200n. 103 string galvanometer  42–3 Stroud, William  12, 145n. 78, 146n. 79 Stumpf, Carl  96 subclinical iceberg  128, 209n. 65 subliminal communication  96–7 subliminal self  20 suburban neurosis  72, 86 effective prevention  78 suggestive therapeutics  xii, 27, 98–9, 191n. 16 disciplinary implications  100 popularity and problems  100 Summerfield, Penny  185n. 111 surveillance medicine  67–8, 71, 182n. 74 Sutherland, J. D.  195n. 55 Suttie, Ian  66, 106 svengalism  95 Swerdloff, Bluma  203n. 135 systematic desensitization  129 Taplin, Alfred Betts  25, 99, 195n. 50 Taves, Ann  150n. 128 Tavistock Clinic  68 Taylor, F. Kräupl  203n. 136 Taylor, Stephen  62–72, 77–89, 122, 175n. 8, 176nn. 15, 18, 177n. 26, 180n. 48, 181n. 62, 184nn. 104, 107, 186n. 125–6, 188n. 150, 190n. 171, 207nn. 35–6 The Battle for Heath  80–1 The Wonders and Mysteries of Animal Magnetism  10 Thalassis, N.  201n. 113, 203n. 136 Thomas, Geoffrey  186n. 123 Thomson, Mathew  3, 25, 47, 136n. 1, 137n. 10, 152n. 141, 153n. 153, 154n. 158, 194nn. 44, 47

268 Thorburn, William  14, 37, 147n. 90, 159n. 37 Tijssen, J. G.  205n. 2 Titmuss, Richard  185n. 113 Todhunter, John  23 Togel, Christfried  171n. 145–6 Tone, Andrea  125, 208n. 52 Topley, W. W. C.  183n. 87 tranquilizers  124–7, 198n. 74 transference  xii, 103, 113, 115, 118, 129 Trethowan, William  127 Trombley, Stephen  156n. 6 Trotter, Wilfred  47, 67, 82, 166n. 103, 178n. 31 Troward, Thomas  22 Tuckey, Charles Lloyd  23, 150n. 120, 152n. 143 Treatment by Hypnotism and Suggestion  26 Turner, Julia  53 Tyrer, Peter  208n. 44 unconscious  xi–xii co-constitution  7 electrical healing  11 imagination  11–13 insurance claims  38 magnetic healing  8 patient records  39 physical illness  130 social construction  6 Valium  124 van Pelt, S. J.  196n. 59 Vernon, P. E.  201n. 113, 209n. 64 Vincent, Ralph Henry  152n. 148 Waite, A. E.  24, 152n. 146 Waller, Augustus  42, 162n. 69 Walter, W. G.  207n. 34 Walters, Cuming  199n. 88 War Officer Selection Boards (WOSBs)  108 Ward, G. E. S.  99 Watts, B. M.  174n. 176, 174nn. 177, 179

Index Watts, C. A. H.  57–9, 82–3, 161n. 55, 174nn. 176–7, 179, 187n. 137 Webb, Beatrice  157n. 25, 200n. 103 Wells, H. G.  31, 33, 156n. 8, 173n. 167 The New Machiavelli  32 The Secret Places of the Heart  56 The Shape of Things to Come  79 Wessely, S.  209n. 54 Westcott, William Wynn  23, 152n. 142 Wheatley, D.  209n. 54 Wheen, Francis  196n. 60 White, William Hale  150n. 120 Whyte, Lancelot Law  4, 139n. 20 Williams, Leonard  154n. 165 Williams, Raymond  32, 156n. 10 Williams-Ellis, Clough  64 Williamson, George Scott  71–2, 181n. 65, 182n. 75 Wilson, Colin  208n. 42 Wilson, J.  183n. 87 Wiltshire, Harold  164n. 89 Winslow, Forbes  25, 27, 154n. 169 Winter, Alison  121, 207n. 29 Winter, George  10, 143n. 57 Wittenberger, Gerhard  171nn. 145–6 Wolpe, Joseph  129 Woodcock, Jasper  204n. 156, 208n. 49, 209nn. 59, 62 Woodman, W. R.  23 Woods, James  24–5 Woods, John F.  152n. 149 Woolf, Virginia  2, 31–3, 55–6, 137nn. 6, 9, 155nn. 1–4, 173n. 166 Workmen’s Compensation Acts  35, 37 Worsley, Peter  135n. 5 Wright, Maurice  31 Wyld, George  25 Yellowlees, Henry  102, 106, 198n. 77, 200n. 102 Young, Michael  81 Young, Allan  211n. 80 Zweig, Stefan  142n. 45

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