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Warwick WRAP 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/54604 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. Rest and Restitution: Convalescence and the Public Mental Hospital in England, 1919–39 by Stephen Soanes A thesis submitted in fulfilment 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 2011 Table of Contents Title Page p. i Table of Contents p. ii List of Figures p. iv Declaration p. vi Acknowledgements p. vii Abstract p. viii Abbreviations p. ix Introduction p. 1 1. Definitions p. 3 2. Convalescence in Historical and Historiographical Context p. 11 3. Methodology and Sources p. 31 Chapter One: The Development of Accommodation for Convalescents in Asylums and Mental Hospitals, c.1780–1939 1. Introduction p. 44 2. Moral Architecture and Convalescence, c.1780–1853 p. 47 3. Contested Sites of Convalescence and the “Barrack” Asylum, 1853–1898 p. 62 4. An Emerging Consensus? The Admission Hospital and Convalescent Villa, 1898–1939 p. 83 5. Conclusion p. 105 Chapter Two: The Mental Hospital Convalescent Villa, 1919–39 1. Introduction p. 111 2. Official Policy and the Emergence of the Convalescent Villa 2.1. The Powers and Influence of the Lunacy Commission (1845–1913) and Board of Control (1913–39) p. 117 ii 2.2. Official Interest in Asylum Convalescence, 1845–1913 p. 125 2.3. The Convalescent Villa within Official Policy, 1913–39 p. 129 2.4. Site and Design as Aspects of Recovery in the „Modern‟ Halfway Home, 1919–39 p. 147 3. Local Authorities and the Emergence of the Convalescent Villa: The Case of the London County Council, 1902–39 p. 172 4. Conclusion p. 186 Chapter Three: The Voluntary Cottage Home, 1919–39 1. Introduction p. 193 2. Origins and New Directions: Voluntary Aftercare, 1871–1939 p. 196 3. Cottage Homes: Familial and Familiar Spaces for Healthcare? p. 221 4. Local and National Growth in Voluntary Provision for Convalescence p. 242 5. Metropolitan Aftercare: The Mental After-Care Association and the London County Council p. 266 6. Conclusion p. 280 Chapter Four: Patient Responses to Convalescence, 1919–39 1. Introduction p. 286 2. Marginal Voices: Evidential and Methodology Issues p. 290 3. Identity and Remembrance: Patient Representations of Convalescence p. 304 4. Escape and Belonging: Patient Agency and Recovery p. 329 5. Conclusion p. 358 Conclusion p. 364 Bibliography p. 379 Appendices p. 406 iii List of Figures Figure 1: Detail of Copy Plan of Colney Hatch Asylum, showing Convalescent Home, c.1900 p. 76 Figure 2: Age of Mental Hospital, and the Prevalence of Board of Control Appeals for Convalescent Villa Construction, 1923–30, 1934–37 p. 134 Figure 3: Convalescent Accommodation across English and Welsh Mental Hospitals, circa February 1925 p. 137 Figure 4: West Park Mental Hospital, Epsom (LCC), Process Print, 1926 p. 155 Figure 5: Plan of Proposed Middlesex Asylum [Claybury] by G.T. Hine, 1887 p. 159 Figure 6: Proposed Site of Admission Hospital, Rainhill Mental Hospital, 25 January 1937 p. 160 Figure 7: Plan of proposed Shenley Mental Hospital, 1934 p. 162 Figure 8: Plan of Proposed Reception Hospital, Winwick Mental Hospital, 1937 p. 165 Figure 9: Interior of Day Room, Male Convalescent Villa („Willow‟), Ewell Mental Hospital, December 1936 p. 168 iv Figure 10: Interior of Day Room, Admission Hospital, Ewell Mental Hospital, December 1936 p. 169 Figure 11: Types of Cases „Convalesced‟ in the MACA‟s Cottage Homes, 1936–39 p. 214 Figures 12 and 13: Publicity images of unnamed MACA cottage homes, from Monthly Pictorial, December 1934 p. 239 Figure 14: Cases Handled by the Mental After-Care Association [MACA], 1887–1939 p. 244 Figure 15: Mental After-Care Association, Sources of Income, 1913–17, 1925–29, 1931–39 p. 252 v Declaration I hereby declare that this thesis has not been submitted, either in the same or different form, to this or any other University for a degree. Signature: vi Acknowledgements I owe a great deal of thanks to my two supervisors, Mathew Thomson and Hilary Marland, for their warm encouragement, and for the time they have generously provided me in the oversight of my research. Their knowledge, thoughtfulness, enthusiasm for historical enquiry, and friendship has guided me throughout the preparation and production of this thesis. The Wellcome Trust have made this thesis possible through their financial support, for which I am most grateful. Many others have subsequently helped me develop as a historian through participation in the various facets of academic life. Notable mention in this respect must be made to the Centre for the History of Medicine and Department of History at the University of Warwick, Voluntary Action History Society, History Lab, and all those who have provided training, or opportunities to present and discuss research. Thanks to those archivists and librarians at the Wellcome Collections, London Metropolitan Archives, National Archives, British Library, Modern Records Centre at Warwick, and records offices at Bristol, Devon, Norfolk, East Sussex, Manchester and Durham for their helpfulness, especially in cases where I have needed to look at many separate files. Finally, I would like to thank my family, Sarah, George, and other friends and colleagues who have shown interest in my work, and supported me over the last three years. vii Abstract Previous histories have tended to look beyond the asylum for innovations in early twentieth-century mental healthcare. In contrast, this thesis appraises the mental hospital as the nexus for a new approach to convalescent care and makes the case for a more integrated conception of institutional and community care in the interwar period. Despite a concentration of convalescent facilities in certain areas, this study argues that the period between 1919 and 1939 witnessed the emergence of a more standardised and coordinated model of care that traversed institutional boundaries. Consequently, it challenges a prevailing view that sees asylum care as separate from developments in borderline care in this period. It is demonstrated that public mental hospitals after 1919 widely added new convalescent villas within their grounds, whilst voluntary organisations diversified and extended their community-based cottage homes. This thesis explores the reasons for this expansion and seeks to explain the functions it served those who planned, managed and utilised mental convalescent homes. It is argued that those with professional interests in the mental hospital focused on the „modern‟ convalescent villa partly as a strategic response to the low status of mental hospitals in the 1920s, as well as to alleviate overcrowding, and oversee recovery in managed and healthful environments. The spatial and rhetorical connection between the admission hospital and the convalescent villa allowed these interests to claim they formed part of a broader movement of mental hygiene and early treatment. In contrast, patient representations of cottage homes offer an alternative perspective of convalescence as a holiday and break from social demands. Particular attention is paid to the case of the London County Council. The analysis focuses on descriptions of convalescent homes found in organisational records. These are compared with plans and photographs to make sense of the uses such homes served. viii Abbreviations BBMHS Bath and Bristol Mental Health Society BoC Board of Control BRO Bristol Record Office CAMW Central Association for Mental Welfare DRO Devon Record Office ESRO East Sussex Record Office LCC London County Council JMS Journal of Mental Science LAB Lancashire Asylums Board (later Lancashire Mental Hospitals Board) LMA London Metropolitan Archives MACA Mental After-Care Association MoH Ministry of Health MoP Ministry of Pensions MRC Modern Records Centre NCMH National Council for Mental Hygiene NRO Norfolk Record Office QAF Queen Adelaide Fund (R)MPA (Royal) Medico-Psychological Association TNA The National Archives WLHUM Wellcome Library for the History and Understanding of Medicine ix Introduction The problems „convalescence‟ historically addressed remain highly pertinent to current practice in mental health care, even though the term itself has a relatively peripheral place in contemporary psychiatry. Issues of stigmatisation, social isolation and behavioural nonconformity amongst the recovering mentally ill have historically raised questions over their place between the twin poles of institution and society. These issues were at the heart of mental convalescence, as a practice that in the early twentieth century provided a „half-way home‟ for patients, strategically and variably situated between mental hospital and home. Unlike convalescence in many cases of somatic disorder, therefore, mental convalescence extended beyond the consolidation of biological recovery and addressed fundamental issues about recovering patients‟ identity and belonging. Ongoing debates over the respective role of community care and institutionalisation in mental health indicate that those interested in psychiatry continue to disagree over the best place for mental treatment.1 This thesis explores comparable
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