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Centre for the History of Science, Technology and Medicine

Mental illness

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The Mental After Care Association provided an alternative to the asylum, offering convalescent care and employment opportunities to discharged patients. In the 1950s, it pioneered long-term care in homes such as Hill House, Esher.
(Image courtesy of the Wellcome Trust, library ref CMAC SA/MAC/J.3/1/4. Distributed under Creative Commons licence by-nc 2.0)

Studying responses towards those who experienced mental distress in different eras reveals how medical understandings of mental illness and its treatment were shaped by broader social and cultural dimensions. Over the course of the nineteenth century, mental illness became viewed as a public problem rather than a private matter, to be treated by the emergent psychiatric profession within a network of asylums. Historians have explored how diagnosis and treatment were shaped by ideas about social class, gender and ethnicity. They have also turned their attention to the persistence of care and treatment of mental illness beyond the asylum walls and to the role played by patients, their families, nurses and social workers.

During the twentieth century, the 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. New therapies, including psychotherapy, psychosurgery, ECT and drug treatments were developed to cure or alleviate mental illnesses. Psychiatry extended beyond the walls of the asylum into the community, extending its scope to incorporate the nominally healthy people. These developments culminated in the closure of the asylum and the creation of community mental health services.

Research at CHSTM moves away from narratives of the nineteenth-century asylum to explore broader public debates surrounding the nature of mental illness and its treatment, and to analyse local innovations in therapeutic practice in the twentieth century. Michael Brown's work demonstrates that asylum reform in the early nineteenth century was influenced by broader notions of public accountability and political reform. Vicky Long has explored how health care workers, voluntary organisations, patients and the media debated and contested public understanding of the nature of mental illness over the course of the twentieth century; more recently, she has studied  how employment was used as a rehabilitative agent in mental health care. John Pickstone's work on innovations in psychiatric practice in Manchester demonstrates that we must not lose sight of local developments when studying the history of mental illness. Val Harrington's recent PhD explores local variety in care 'outside the asylum' -- and points the way to further histories of mental illness and services in communities.

Recent publications by CHSTM staff and students

Michael Brown. "Rethinking early nineteenth-century asylum reform". Historical Journal, 2006, 49(2): 425-452

Val Harrington. "Innovations in a backwater: the Harpurhey Resettlement Team and the mental health services of North Manchester, 1982-1987". Health and Place, 2009, 15(3): 664-671.

Vicky Long. "'A satisfactory job is the best psychotherapist': employment and mental health, 1939-60". In J Melling and P Dale, eds. Mental illness and learning disability since 1850: finding a place for mental disorder in the United Kingdom. London: Routledge 2006, 179-199.

Chris Philo and John V Pickstone. "Unpromising configurations: towards local historical geographies of psychiatry". Health and Place, 2009, 15(3), 649-656.

John V Pickstone. "Psychiatry in district general hospitals: history, contingency and local innovation in the early years of the National Health Service". In John V Pickstone, ed, Medical Innovations in Historical Perspective. Macmillan 1992, 185-99.

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