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'Outside the Walls of the Asylum': Anti-Psychiatry to Care in the Community

The final seminar comes a full circle from earlier sessions, where we looked at the establishment of a major asylum system in Britain, and an era when institutions were represented as the way forward in managing and treating the insane. This began to be questioned in the 20th century (and possibly earlier) in light of changing approaches to treatment and changing ideas about what mental illness was and who might be vulnerable. Anti-psychiatry appears to have represented a major challenge to both mental hospitals and psychiatry, though it may well have been attacking structures and regimes that were already under question from within. The second half of the 20th century saw the dismantling of the asylum system and its substitution by ‘care in the community’. This seminar will look at what this consisted of, and question the motivations behind it, and the results in terms of patient access and care. There are two books of special interest, listed at end of reading list. One is Gittins, Madness in its Place, the other Taylor's The Last Asylum. Both in very different ways discuss and partly regret the demise of the asylum.
Care for the Community poster
  1. How did ideas about vulnerability to mental disorder change in the 20th century?
  2. How influential was anti-psychiatry?
  3. Why was the asylum abandoned in the 20th century?
  4. Abandoning the asylums also meant abandoning the insane. Do you agree?
** Roy Porter, ‘Two Cheers for Psychiatry! The Social History of Mental Disorder in Twentieth Century Britain’, in 150 Years of British Psychiatry II, pp. 383-406. Scanned article (course extracts HI383) and Talis Aspire
** Mark Micale, ‘The Psychiatric Body’, in Roger Cooter and John Pickstone (eds), Medicine in the Twentieth Century (Harwood International, 2000), pp. 323-46. Talis Aspire
** Joan Busfield, ‘Mental Illness’, in Roger Cooter and John Pickstone (eds), Medicine in the Twentieth Century (Harwood International, 2000), pp. 633-51. Talis Aspire
** Barbara Taylor, 'The Demise of the Asylum in Late Twentieth-Century Britain: A Personal History', Transactions of the Royal Historical Society, 21 (2011), 193-215. e-journal
* Special issue of Medical History ‘Social Psychiatry and Psychotherapy in the Twentieth Century’, 48: 4 (October 2004). e-journal
** Vicky Long, Destigmatising Mental illness?: Professional Politics and Public Education in Britain, 1870-1970 (Manchester: Manchester University Press, 2015). e-book
* Ian Dowbiggen, The Quest for Mental Health: A Tale of Science, Medicine, Scandal, Sorrow, and Mass Society (Cambridge University Press, 2011). e-book

* Volker Roelcke, Paul J. Weindling, and Louise Westwood (eds), International Relations in Psychiatry: Britain, Germany, and the United States to World War II (University of Rochester Press, 2010). e-book

** Essays in Marijke Gijswijt-Hofstra and Roy Porter (eds), Cultures of Psychiatry and Mental Health Care in Postwar Britain and the Netherlands (Amsterdam and Atlanta, GA: Rodopi, 1998), esp. chs by Mathew Thomson, Jonathan Andrews, Gemma Blok, Peter Barham, Roy Porter and Colin Jones, ch. 15, Colin Jones, ‘Raising the Anti: Jan Foudraine, Ronald Laing and Anti-Psychiatry’ is e-book and scanned chapter
* Digby Tatham, ‘The Anti-Psychiatry Movement’, in 150 Years of British Psychiatry, 1841-1991.
Residential care home, Anthea Sieveking
* Erving Goffman, Asylums: Essays on the Social Situation of Mental Patients and other Inmates (1961, Pelican edn 1968). e-book and several copies in library
Nick Crossley, 'R.D. Laing and the British Anti-Psychiatry Movement: A Socio-Historical Analysis', Social Science & Medicine, 47 (1998), 877-89. e-journal
Jonathan Toms, 'MIND, Anti-Psychiatry, and the Case of the Mental Hygiene Movement's "Discursive Transformation', Social History of Medicine, 33 (2020), 622-40. e-journal
Andrew Scull, ‘Psychiatry and its Historians’, History of Psychiatry, 2 (1991), 239-50. e-journal
Daniel Burston, The Wing of Madness: The Life and Work of R.D. Laing (Harvard University Press, 1996).
R.D. Laing, The Divided Self (Penguin edn 1990; 1st pub. 1960).
R.D. Laing and A. Esterson, Sanity, Madness and the Family (1970 edn, 1st pub. London: Tavistock, 1964). e-book and multiple copies in libary (Read Laing’s books and commentaries on his work, shelfmark RC514L2.)
* Thomas S. Szasz, The Manufacture of Madness (New York: Dell, 1970).
* Thomas S. Szasz, The Myth of Mental Illness: Foundations of a Theory of Personal Conduct (New York: Paladin, 1961; revised edn New York: Harper and Row, 1974).
Thomas S. Szasz, The Age of Madness: The History of Involuntary Mental Hospitalization Presented in Selected Texts (London: Routledge and Kegan Paul, 1975).
* Ken Kesey, One Flew over the Cuckoo's Nest (1962, numerous edns). Film also available in Short loan collection
** Andrew Scull, Madness in Civilization (London: Thames & Hudson, 2015), ch. 12 'A Psychiatric Revolution?' e-book
** Despo Kritsotaki, Vicky Long and Matthew Smith (eds), Deinstitutionalisation and After: Post-War Psychiatry in the Western World (Cham: Palgrave Macmillan, 2016). e-book
** Outside the Walls of the Asylum, all the essays are useful, but see esp. chs 10, 11 and 12. e-book and several copies in library
*Faber Book of Madness, ch. 13 ‘What Should be Done with the Asylums?’
** Peter Barham, Closing the Asylum: The Mental Patient in Modern Society (2nd edn, Penguin, 1997).
* Louise Westwood, ‘Care in the Community of the Mentally Disordered: The Case of the Guardianship Society, 1900- 1939’, Social History of Medicine, 20 (2007), 57-72. e-journal
Nurses, Justine Desmond
* Hugh Freeman (ed.), A Century of Psychiatry (London: Mosby, 1999).
* David Healy, The Anti-Depressant Era (Harvard, Mass: Harvard University Press, 1997).
* Joan Busfield, ‘Restructuring Mental Health Services in Twentieth-Century Britain’, in Marijke Gijswijt-Hofstra and Roy Porter (eds), Cultures of Psychiatry (Amsterdam and Atlanta, GA: Rodopi, 1998), pp. 9-28. e-book
* Liam Clarke, ‘The Opening of Doors in British Mental Hospitals in the 1950s’, History of Psychiatry, 4 (1993), 527-51. ​e-journal
* Andrew Scull, Decarceration: Community Treatment and the Deviant (London: Prentice Hall, 1977; Cambridge: Polity, 1984).
* Diana Gittins, Madness in its Place: Narratives of Severalls Hospitals, 1913-1997 (Routledge: London, 1998). e-book
** Barbara Taylor, The Last Asylum: A Memoir of Madness in our Time (London: Hamish Hamilton, 2014).