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Week 11: Mental Health: Despair and Desperate Remedies

Lecturer: Hilary Marland

By the late nineteenth century the optimism associated with the early and mid-19th-century asylum had been largely lost, the period of reform over, though psychiatry struggled to preserve the principles and practices of moral management as asylums increased in number and in size, confronted with a seemingly inexhaustible number of mentally ill patients. This lecture explores a period in psychiatry marked by pessimism and questions how far theories and concerns about degeneracy shaped psychiatric practice in the late nineteenth century. Compared with other branches of medicine, with their new discoveries and innovations, psychiatry appeared to be falling behind and by the end of the century desperately sought new and more effective therapeutic approaches. Moving into the twentieth century, the lecture explores in particular the adoption of new somatic therapies, including ECT, contrasting these with the psychoanalytic turn, which emerged in the late 19th century and was strongly associated with Freud's work. The lecture also briefly summarises changes in policy and approaches to the provision of psychiatric services as the asylum was abandoned in the mid-twentieth century.

Discussion/Essay Questions:

1. How far did asylums become places of therapeutic despair by the late 19th century?

2. In what ways did theories of degeneration influence psychiatric practice?

3. What factors drove new and often radical approaches to the treatment of mental illness in the early and mid 20th century?

Required Readings:

Andrew Scull, The Most Solitary of Afflictions: Madness and Society in Britain, 1700-1900 (1993), 'Chapter 7: The Social Production of Insanity', 334-74.

Patricia E. Prestwich, ‘Drinkers, Drunkards, and Degenerates: The Alcoholic Population of a Parisian Asylum’, Histoire Sociale/Social History, 27 (nos. 53-4) (1994), 321-35. e-journal

Roy Porter (ed.), Faber Book of Madness (1991), 'Ch. 12: Treatments’, pp. 279-349 (dip into the relevant extracts).

Further Readings:

Joel T. Braslow, Mental Ills and Bodily Cures: Psychiatric Treatment in the First Half of the Twentieth Century (1997).

Joel T. Braslow, 'The Influence of a Biological Therapy on Physicians’ Narratives and Interrogations: The Case of General Paralysis of the Insane and Malaria Fever Therapy, 1910-1950', Bulletin of History of Medicine, 70 (1996), 577-608. e-journal

Joan Busfield, ‘Mental Illness’, in Roger Cooter and John Pickstone (eds), Medicine in the Twentieth Century (2000), 633-51.

Ian Dowbiggin, Inheriting Madness: Professionalization and Psychiatric Knowledge in Nineteenth-Century France (1991).

Ian Dowbiggin, Keeping America Sane: Psychiatry and Eugenics in the United States and Canada, 1880-1940 (1997).

Hugh Freeman, 'Psychiatry in Britain, c.1900', History of Psychiatry, 21 (2010), 312-24. e-journal

Peter Gay, Freud for Historians (1985). e-book

Gerald N. Grob, Mental Institutions and American Society: 1875-1940 (1983). e-book

Edgar Jones and Shahina Rahman, ‘Framing Mental Illness, 1923-1939: The Maudsley Hospital and its Patients’, Social History of Medicine, 21 (2008), 107-25. e-journal

Joseph Melling and Bill Forsythe (eds), The Politics of Madness: The State, Insanity and Society in England, 1845-1914 (2006). e-book

Mark Micale, ‘The Psychiatric Body’, in Roger Cooter and John Pickstone (eds), Medicine in the Twentieth Century (2000), 323-46.

Roy Porter (ed.), Faber Book of Madness (1991), chs 15 ‘Freud’ and 16 ‘Psychoanalysis’.

Roy Porter, A Social History of Madness: Stories of the Insane (1987), chs 5 and 8.

Roy Porter, ‘Two Cheers for Psychiatry! The Social History of Mental Disorder in Twentieth Century Britain’, in Hugh Freeman and German E. Berrios. 150 Years of British Psychiatry II, The Aftermath, pp. 383-406.

Dean Rapp, ‘The Early Discovery of Freud by the British General Public, 1912- 1919’, Social History of Medicine, 3 (1990), 217-43. e-journal

Laurence J. Ray, ‘Models of Madness in Victorian Asylum Practice’, Archives of European Sociology, 22 (1981), 229-64. e-journal

Andrew Scull, The Insanity of Place, The Place of Insanity: Essays on the History of Psychiatry (2006), esp. chs 9 and 10. e-book

Andrew Scull, Madness in Civilization (2015), ch. 8 'Degeneration and Despair' and ch 10 ‘Desperate Remedies’.

Edward Shorter, A History of Psychiatry: From the Era of the Asylum to the Age of Prozac (1997), esp. chs 5, 6, 7 and 8. e-book

Barbara Taylor, The Last Asylum: A Memoir of Madness in our Times (2014).

E. Fuller Torrey and Judy Miller, The Invisible Plague: The Rise of Mental Illness from 1750 to the Present (2001), esp. ch. 11. e-book

David Wright, ‘Getting out of the Asylum: Understanding the Confinement of the Insane in the Nineteenth Century’, Social History of Medicine, 10 (1997), 137-55. e-journal

Jonathan Miller's film, in the BBC series 'Madness' (episode ‘Brainwaves), BBC MCMXCI is a useful resource, on You Tube