Psychiatry and modern Britain, past and present

Session Abstract : How have the institutions and ideas of psychiatry responded to life in post-war Britain, and what can we learn by thinking historically about these aspects of the recent past? This panel will examine how ideas about mental illness, marginalised groups, and the role of institutions in their assessment and management have reflected and shaped British society from the 1950s to the present day, and how analysis and awareness can inform contemporary debate.

Histories of psychiatry have exposed modes of thought and methods of work within medicine that now strike us alien, but have also drawn attention to that which seems more familiar, such as the low prestige of psychiatry and debates over diagnosis and classification. Such histories highlight the contingent nature of medical knowledge, and the socio-political forces that enable diagnoses and official structures to take root. They have the potential to encourage critical reflection upon the beliefs and assumptions that underpin our present, but we are often tempted to both distance ourselves from the dismal, and to find inevitability in that which remains constant.

These papers will attempt to overcome this by looking at three strands of psychiatry’s recent history, each of which has strong connections to present day issues. Addressing mental disorder and the penal system, the contested diagnosis of Borderline Personality Disorder, and institutional abuse in turn, they examine ideas and beliefs about vulnerability, abnormality, risk, and gender, and the roles of social and institutional priorities and demands. This historical approach to contemporary psychiatry helps to reveal some of the fundamental tensions at the heart of therapeutic endeavours, and indicates possible focal points for critical thought and challenge for the future.

Session Chair: Janet Weston, LSHTM

Paper 1 Abstract :The unruly and depraved: managing deviance and disturbance at Cumberlow Lodge Remand Home for Girls, 1949-1965′

Fiachra Byrne, University College Dublin

The inter-war period in England has been hailed as a time when the ‘mentally disordered offender’ became paradigmatic for all offenders. But for the juvenile offender, it was only in the post-war period that some flesh was put on the bones of this conceptual and policy shift as psychiatric assessment and services were extended. Remand homes became a central node in the juvenile justice system for the preliminary evaluation and disposal of the most disturbed delinquents, and functioned increasingly as diagnostic centres for study rather than instruments of custody.

This paper will use a case-study approach, exploiting the extant records of Cumberlow Lodge Remand Home in Croydon, London. This institution was established in 1949 as a form of secure provision for girls of less than seventeen years of age who, because of ‘unruly behaviour or depravity’, would otherwise have to be remanded in prison. Post-war psychiatric research typically found that delinquent girls constituted a more abnormal cohort than their male equivalents, and their numbers seemed to be increasing. The most disturbed, it was argued, presented ‘insurmountable problems’ of management that contributed to a decline in staff morale, leading to calls for those girls suffering from mental, psychopathic and antisocial disorders to be removed to specialist facilities. Framing Cumberlow Lodge as an influential model for the secure units which succeeded it in the early 1970s, this paper will explore how disciplinary regimes, treatment and management practices at Cumberlow enacted and policed the deviant and disturbed female offender. It argues that, ultimately, much of the impetus for such gendered pathologisation was driven by the needs of the often crisis-ridden child custodial institutions rather than developments within formal psychiatric epistemology.

Paper 2 Abstract:  ‘Pathologising the personality: the case of Borderline Personality Disorder’

Hazel Croft, Birkbeck, University of London

How did Borderline Personality Disorder (BPD) become one of the major psychiatric diagnoses of our times? This paper focuses on BPD as a lens through which to consider how psychiatric diagnoses have been constituted, reconstituted and contested over the last fifty years. It begins by tracing the history of the idea of a disordered personality, as it shifted from a cause and consequence of mental disorder to become a pathological condition in itself. Exploring sociologist Nick Manning’s contention that BPD gained credence due to the flourishing of interest in ‘identity’ in the late 1960s, it examines the particular historical and cultural conjuncture in which the notion of a borderline personality began to elicit interest and agreement among psychiatrists and clinicians. It questions whether BPD can be linked to a particular historical and cultural moment in neoliberal capitalism, and whether it represents an inevitable outcome of the current happiness and wellbeing agenda.

After examining controversies over the diagnosis among both clinicians and service-users, the paper concludes with a discussion about the ways in which BPD is a gendered diagnosis, applied mainly to young women, and often linked to childhood physical and sexual abuse. Are the symptoms of BPD more likely to manifest in women because of the levels of sexual abuse and emotional trauma that women face in their lives, or is the condition over-diagnosed due to gendered judgements about women’s emotional instability?

Paper 3 Abstract : ‘Hiding in plain sight: cultures of harm in long-stay psychiatric hospitals’

Louise Hide, Birkbeck, University of London

During the 1970s and early ‘80s, a number of major investigations were conducted into abuse and neglect in long-stay psychiatric hospitals in Britain. These inquiries focused primarily on administrative and management failures, giving little attention to the underlying values and belief systems – staff attitudes to pain, suffering, institutionalisation and care – that contributed to abusive practices, or to the language and behaviours that perpetuated them.

This paper will consider what value there might be in examining past inquiries into institutional abuse. By returning to the extensive documentation that such inquiries have generated, focusing primarily on written submissions of evidence, we may be able to ask new and different questions about the underlying factors that gave rise to institutional abuse in the past. Thinking historically about such institutions at moments of crisis, and the ways in which these crises have been navigated, can generate deeper insights into the structural and attitudinal forces at work. It can also provide current inquiries, policy-makers, health workers and clinicians, and social scientists with valuable historical context around abuse, in the hope that past oversights and assumptions will not be repeated.