Secrecy and Denial in Matters of Life and Death: A Critical Analysis of Deaths in Psychiatric Detention, 1845-2018 By Carly Jane Speed A Thesis Submitted in Partial Fulfilment of the Requirements of Liverpool John Moores University for the Degree of Doctor of Philosophy December 2018 1 Abstract Each year detained patients die in psychiatric detention in England and Wales in contentious circumstances. Despite the fact that deaths in psychiatric detention is not a new phenomenon, minimal critical research exists which analyses this problem. Underpinned by a critical criminological framework focusing on power, marginalisation and resistance, the thesis undertakes a critical analysis of deaths in psychiatric detention in both a historical and contemporary context. This is achieved through combining primary archival research with interviews and questionnaires undertaken with a number of individuals directly involved with this issue. In addition, the thesis utilises and analyses family campaign websites that were set up following the death of their detained relative. In order to understand the response to patients in death, a critical understanding of the response to them during their lives is also developed, both historically and contemporaneously. Further areas of focus include the official response to patients and their families, inquest and investigation procedures, the issue of accountability and the challenging of dominant discourses surrounding psychiatric detention. Based upon the findings of the thesis, a number of radical alternatives are outlined. These alternatives would address the issue of deaths in psychiatric detention and transform the current failing systems for the benefit of some of the most vulnerable members of society. 2 Acknowledgements First, thank you to all of the participants who took the time to share your experiences with me. Without you willing to talk in such depth, this research would not have been possible. Second, thank you to the staff at The National Archives in London for your assistance. The stories and experiences hidden within these files have formed an integral part of this thesis. Thank you also to the team at INQUEST for taking the time to meet with me at the beginning of the research and sharing your expertise with me. Thank you to the Criminology team at Liverpool John Moores University, particularly Janet Jamieson, for your support since I joined in 2009. It has been a brilliant experience, hence why I have never left! Thanks also to Steve Lawler for always being on hand to assist with all my IT queries, along with the IT technicians for your patience in loaning me laptops when mine repeatedly broke. Thank you also to Lindsey Metcalf for facilitating numerous writers group sessions which proved particularly helpful. Having presented a number of papers at conferences during the duration of my doctoral studies, I also wish to thank the conference organisers for facilitating my presentations. Speaking at these conferences has provided me with very helpful feedback. Thank you also to the editors at Sage, Policy Press, the European Group for the Study of Deviance and Social Control and the Centre for the Study of Crime, Criminalisation and Social Exclusion for allowing material first published by them to be reproduced within this thesis1. Thank you to Dr Victoria Cooper for your support and a memorable trip to the cathedral cafe. Thank you also to Dr David Scott for your support, encouragement 1 See Appendix A. 3 and for all your Take That emails, I will ‘never forget’ them. To my Director of Studies, Professor Joe Sim, you have been integral in making my entire university experience what it has been. Thank you for always being there to listen, advise and encourage me. You have gone above and beyond time and time again. A ‘thank you’ does not seem enough, so a Take That CD may have to do sometime. To my family who have passed away, particularly my Granddad, I know you would have been proud to see me progress through university. To Ollie, thank you for always being there and thank you to Gran for all of your support and encouragement. Finally, to my best friend, Mum. Thank you for always believing in me and encouraging me to pursue my dreams. Thank you for everything. 4 Contents Abstract ........................................................................................................................................... 2 Acknowledgements ........................................................................................................................ 3 Introduction .................................................................................................................................... 8 The Problems Being Examined ........................................................................................................ 9 The Deaths of Detained Patients ..................................................................................................... 9 The Question of Accountability ..................................................................................................... 12 Research Aims ............................................................................................................................... 15 The Structure of the Thesis ........................................................................................................... 16 Chapter One: ‘A Social, Mental and Metaphysical Death’: Theorising Life and Death in Psychiatric Detention ................................................................................................................. 22 The Pathologisation and Criminalisation of Mental Health Problems .......................................... 22 Conceptualising the Rise and Role of Asylums and Psychiatric Hospitals as ‘Total Institutions’ .. 27 Theorising the Role of the Medical Profession and Psychiatrists as ‘Judges of Normality’ .......... 35 ‘Confined’ and ‘Controlled’: The Experiences of Females ........................................................... 45 Subjugating and Denying the Patients’ Experiences ..................................................................... 48 Conclusion ..................................................................................................................................... 57 Chapter Two: Methodology and Methods .................................................................................. 59 Critical Research and the Critical Researcher ................................................................................ 59 Methodology: Approaching the Research .................................................................................... 67 Gathering the Historical Data ........................................................................................................ 70 Archival Research as a Genealogy ................................................................................................. 79 Gathering the Contemporary Data ............................................................................................... 83 Sampling in Interviews and Questionnaires .................................................................................. 83 Undertaking Interviews and Questionnaires ................................................................................. 87 Examining Family Campaign Websites ......................................................................................... 91 Data Analysis: Reliability, Validity and Credibility ......................................................................... 94 Ethical Issues ................................................................................................................................. 97 Conclusion ................................................................................................................................... 100 Chapter Three: ‘An Outrage so Gross and Barefaced’: A Revisionist History of Life and Death in Psychiatric Detention in England and Wales, 1845-1959 .......................................................... 103 Psychiatric Detention: The Emergence of Challenge and Complaint .......................................... 105 The Alleged Lunatics’ Friend Society ........................................................................................... 107 5 Issues and Failings ....................................................................................................................... 112 ‘Hushing up What Looks Like a Very Black Affair’: Contentious Deaths and Their Investigation 117 ‘Secrets of the Prison House of Lunacy’: Accusations, Dismissals and Denials ........................... 123 ‘Sheer Wanton Cruelty’: Into the Twentieth Century ................................................................. 128 Confessions of an Asylum Doctor ................................................................................................ 131 Further Deaths and Failings ........................................................................................................ 134 The Introduction of the National Health Service and Beyond .................................................... 139 Conclusion ................................................................................................................................... 147 Chapter Four: ‘We Are Waving, Yet We Are Still Drowning’: Detained Patients in Life and Death, 1960-2018 ..................................................................................................................................