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University of Warwick Institutional Repository: a Thesis Submitted for the Degree of Phd at The University of Warwick institutional repository: http://go.warwick.ac.uk/wrap A Thesis Submitted for the Degree of PhD at the University of Warwick http://go.warwick.ac.uk/wrap/1217 This thesis is made available online and is protected by original copyright. Please scroll down to view the document itself. Please refer to the repository record for this item for information to help you to cite it. Our policy information is available from the repository home page. Changing Public Representations of Mental Illness in Britain 1870 - 1970 by Vicky Long A thesis submitted in fulfillment of the requirements for the degree of Doctor of Philosophy in History University of Warwick, Department of History, Centre for the History of Medicine January 2004 Table of Contents Title Page I Table of Contents II List of Figures vii Acknowledgments and Declaration of Material Included From a Prior Thesis VII' Abstract x Abbreviations XI Introduction 1 1: The Public Sphere, Professionalisation and Mental Health Groups 1 2: Government Inquiries into Mental Illness 7 3: Representation and Mental Disorder 12 3.1: Representing Public Representations of Mental illness? 15 4: Mental Illness and Society, 1870-1970 17 5: Organisation and Objectives 23 Chapter One: Psychiatry and the Medico-Psychological Association 29 1: Introduction 29 2: A Brief History of Psychiatric Organisations in Britain 31 11 3: Mental Illness, Stigma and the Public 37 4: Monitoring Media Representations: The Royal Edinburgh Asylum Press Cuttings Books 45 4.1: Areas of General Concern to Psychiatrists 46 4.2: Articles Reflecting the Personal Interests and Concerns of Clouston and Robertson 51 5: Writing for the Public: Popular Psychiatry Books, 192 1-70 54 6: Conclusion 71 Chapter Two: The National Asylum Workers' Union 75 1: A Brief History of the NAWU 76 2: Using the Journal as a Source 79 3: Patients Viewed from Male Nurses' Perspective 83 4: Representing the Interests of Staff or Representing Patient Interests? 98 4.1: Representing Mental Deficiency 98 4.2: The Emergence of the Patient Voice 108 5: Towards a Model of General Nursing and a Patient-Centred View 110 6: Professional Crisis and a New Stigmatisation of the Psychiatric Patient 122 7: Conclusion 128 111 Chapter Three: Psychiatric Social Workers 131 1: Who PSWs Were: Background Information and Professional Ideals 132 1.1: History of Psychiatric Social Work 132 1.2: The Work of PSWs and their Professional Identity 136 2: Internal Debate: From Representing the Mentally Ill as Maladjusted Individuals to a Social View of Mental Illness 140 2.1: Forums for Internal Debate 140 2.2: Maladjusted Individuals 142 2.3: A Social View of Mental Illness and Psychiatric Treatment 144 2.4: Psychiatric Social Treatment 148 2.5: Using Casework to Treat Sick Middle-Class Families 155 2.6: Adaptation, Individual and Society 157 3: External Representations 160 3.1: The PSW as a Representative of Mental Health in the Community 160 3.2: The Public Relations Sub-Committee 161 3.3: Ignorance of the Press and Public 164 3.4: Selling Psychiatric Social Work 166 3.5: Debating with or Informing the Public? 172 4: Conclusion 173 lv Chapter Four: The Mental After Care Association 178 1: History of the MACA 179 2: Creating and Publicising a 'Suitable Case' for Aid in the Late Nineteenth and Early Twentieth Centuries 185 3: State Intervention and its Impact on Voluntary Organisations 192 4: A 'Social' / Community Approach 206 5: Not 'Educating the Public' 215 6: Conclusion 227 Chapter Five: Patients and the Representation of Mental Illness 233 1: Introduction: Mental Illness, Texts, Reality and Representation 233 2: Internal Debate 241 2.1: Background Research on the Morningside Mirror 241 2.2: Purposes of the Mirror: A Place in Which to Vent Grievances 243 2.3: A Forum in Which to Fashion an Alternative Identity 248 2.4: The Secret Society of Certified Lunatics 252 3: Patient Narratives not Intended for a Public Audience 261 3.1: Letters Written by Patients at the REA 261 3.2: John R.'s Letter, 1915 267 V 4: Public Narratives: Using Narratives to Rework Identity 271 4.1: Narratives Written to Attack the Asylum System 273 4.2: Using Narratives to Describe Experiences of Mental Illness as a Product of Life 276 5: Conclusion: Dialogues and Silences 286 Chapter Six: Representations of Mental Illness in the General Media: The BBC 296 1: Introduction: Is the Media an Expression of or Hindrance to the Public Sphere? 296 2: The BBC: Representing Mental Illness and Educating the Public 1950-1970 305 2.1: Purposes of Mental Health Broadcasting 311 2.2: Interactions of the BBC and Mental Health Organisations/ Professions 314 2.3: The Hurt Mind 323 3: Conclusion 344 Conclusion 349 1: Sub-Public Spheres and Democratic Representation 349 2: Representing the Public 356 3: Changing Representations of Mental Illness 358 vi Bibliography 364 vii List of Figures Figure 1: Barlow, 'The Shadow Over England and Wales', MHI WU Journal, 24 (July, 1935), P. 9. 101 Figure 2: Craig Dunain Hospital, Health Services Journal, 14 (September—October, 1961), pp. 12-13. 121 Figure 3: Distribution of PSWs in Three Main Fields of Work, 1937-69. Figures for the years 1937, 1955 and 1961 are drawn from data in N. Timms, Psychiatric Social Work in Great Britain (1939-1962) (London, 1962), pp. 69-70. The figures for the year 1969 are drawn from 'The APSW Annual Report 1969', p. 17, MSS.378/APSW/2/1/35. 135 vii' Acknowledgements The ideas for this thesis began while I was studying for an MA in the Social History of Medicine at Warwick University, and I would like to thank Hilary Marland and Mathew Thomson, who supervised both my MA and my PhD theses for their encouragement and support. I also wish to thank the Arts and Humanities Research Board for providing the financial support that enabled me undertake the research both for my MA and for this thesis. A Warwick Humanities Research Centre Doctoral Fellowship also contributed towards my research costs. My research has been assisted by the helpful archivists and librarians at the University of Warwick Library, the Modem Records Centre at the University of Warwick, the BBC Written Archives Centre at Caversham, the Contemporary Medical Archives Centre at the Welicome Library for the History of Medicine in London, the British Library, Birmingham Central and University Libraries and the Lothian Health Service Archives in Edinburgh. The Research Forum for postgraduate students has offered support over the last few years, and I'd like to thank Sheryl Root, Brooke Whitelaw and Dan O'Connor for their encouragement. My friends and family have also offered help and assistance over the past few years, and I'd like to specially thank Andy for help with my aged computer, my Dad for financial assistance and Harry for the necessary encouragement and support that enabled me to finish my thesis. Any errors that remain in the work are my own. ix Declaration of Material Included From a Prior Thesis Chapters Four and Five of this thesis incorporate small sections of my MA dissertation. These inclusions have been indicated in the footnotes where they occur. This thesis is my own work and has not been submitted for a degree at another university. x Abstract This thesis uses Haberrnas' arguments concerning the public sphere and Nancy Fraser's concept of counter-public spheres as a framework to explore how changes in the representation of mental illness occurred between 1870 and 1970. Within this period, the nineteenth-century polarisation of sanity and madness that had led to the segregation of the mentally ill within the asylum gave way to the belief that mental health and illness formed a continuum. Psychiatry extended beyond the walls of the asylum into the community, expanding its scope to incorporate the nominally healthy. These developments, which culminated in the creation of community mental health services and the closure of the asylums, suggest that mental disturbance was no longer seen solely as the problem of sick individuals but of the public at large, and points to a potential destigmatisation of mental illness. To examine if the representation of mental illness matched these developments in practice and to explain why, this thesis studies how groups directly connected to the mentally ill, conceptualised as sub-public groups, sought to represent mental illness. The groups studied are the Medico-Psychological Association in Chapter One, the National Asylum Workers' Union in Chapter Two, The Association of Psychiatric Social Workers in Chapter Three and a charity, the Mental After Care Association, in Chapter Four. The fifth chapter explores patients and the representation of mental illness. It is argued that such sub-public groups helped initiate a debate about mental illness and enabled a broader spectrum of people to participate in the debate. However, it is suggested that private and professional motivations impinged upon how groups chose to represent the mentally ill. The thesis argues that the difficulties groups experienced balancing the representation of their own interests with those of the mentally ill, combined with the negative perceptions some sub-public groups held regarding the general public's capacity to participate in a debate on mental illness, obstructed their efforts to communicate with the public and to represent the interests of the mentally ill. Finally, the thesis uses the case study of the BBC to explore the factors that influenced the media to cover the issue of mental health and illness. This final chapter illustrates the
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