History of Psychiatry Podcast Series: Recent Episodes
Professor Rab Houston
Rab Houston was born in Hamilton, Scotland, lived in India and Ghana and was educated at the Edinburgh Academy and St Andrews University before spending six years at Cambridge University as a research student (Peterhouse) and research fellow (Clare College). He has worked at the University of St Andrews since 1983 and is Professor of Modern History, specialising in British social history. He is a fellow of both the Royal Historical Society and the Royal Society of Edinburgh (Scotland’s national academy), and a member of the Academia Europaea. He is married to a senior university manager and lives in Edinburgh. In his spare time he likes any form of active meditation. http://www.st-andrews.ac.uk/history/staff/rabhouston.html https://arts.st-andrews.ac.uk/psychhist/
In this podcast, Professor Houston talks about the psychological impact on those affected by the Aberfan disaster of 1966. The podcast expands on an interview Prof Houston gave to BBC Wales as part of a series of podcasts recently produced about the disaster. It is strongly advised that you listen to podcast 7 of the BBC series prior to listening to this podcast. https://www.bbc.co.uk/sounds/brand/p09z3n7y
Further reading: https://www.nhs.uk/conditions/electroencephalogram/
Iain McLean and Martin Johnes, Aberfan: government and disasters (Cardiff: Welsh Academic Press, 2000), especially chapter 5. Morgan, L., Scourfield, J., Williams, D., Jasper, A., & Lewis, G. (2003). The Aberfan disaster: 33-year follow-up of survivors. British Journal of Psychiatry, 182(6), 532-536. doi:10.1192/bjp.182.6.532
Prof John Crichton - Consultant Forensic Psychiatrist and Chair of the Royal College of Psychiatrists in Scotland.
What is a forensic psychiatrist? Far from the media stereotypes forensic psychiatrists are not so different to other doctors but working at the most extremes of human experience. Any one of us may have a mental health problem. Very rarely that problem may result in an inability to control ones actions and may lead to direful consequences. Forensic psychiatry is all about helping people recover their lives after such life changing events and by placing the care and treatment of patient at the centre ensuring everyone’s safety.
This is a 50 minute audio file of a talk I delivered at the National Records of Scotland on 7 August 2019, in connection with my hugely successful exhibition that they kindly hosted: ‘Prisoners or Patients? Criminal Insanity in Victorian Scotland’. It explains the records I used and the development of the criminal justice system’s attempts to deal with those who had committed serious offences, but were found to be insane and thus not responsible for their actions. The justice system faced the same problems as today and dealt with ‘prisoner-patients’ or ‘state lunatics’ (as they were known) in a remarkably humane fashion, given the constraints of limited resources, basic medicine, and different social attitudes 150 years ago. The talk explains in depth who the offenders were and what they had done, the processes for admission to, and release from the only such specialist facility in Scotland prior to the opening of The State Hospital at Carstairs in 1948, medical and scientific understandings of insanity, and the social context of Victorian Scotland.
Professor Rory O’Connor, Suicidal Behaviour Research Laboratory, University of Glasgow
Suicide and self-harm are major public health concerns with complex aetiologies which encompass a multifaceted array of risk and protective factors. There is growing recognition that we need to move beyond psychiatric categories to further our understanding of the pathways to both. As an individual makes a decision to take their own life, an appreciation of the psychology of the suicidal mind is central to suicide prevention. Another key challenge is that our understanding of the factors that determine behavioural enaction (i.e., which individuals with suicidal thoughts will act on these thoughts) is limited. Although a comprehensive understanding of these determinants of suicidality requires an appreciation of biological, psychological and social perspectives, the focus in this podcast is primarily on the psychosocial determinants of self-harm and suicide. To this end, The Integrated Motivational–Volitional (IMV) Model of Suicidal Behaviour (O’Connor & Kirtley, 2018; O’Connor, 2011) is discussed; it provides a framework in which to understand suicide and self-harm. This tripartite model maps the relationship between background factors and trigger events, and the development of suicidal ideation/intent through to suicidal behaviour.
In this podcast, we talk about a range of different topics including:
• The epidemiological context. Suicide rates. • The myths around suicide and self-harm • The determinants of suicide and self-harm • The IMV model of suicidal behaviour • The implications for the prevention of suicide
References
O'Connor, R.C., Kirtley, O.J. (2018). The Integrated Motivational-Volitional Model of Suicidal Behaviour. Philosophical Transactions of the Royal Society B. 373: 20170268.
Steve Platt's work on inequalities and suicidal behaviour https://onlinelibrary.wiley.com/doi/abs/10.1002/9781118903223.ch15
www.suicideresearch.info
In this podcast Professor Chris Williams, a researcher and teacher in the area of cognitive behavioural therapy (CBT) introduces CBT as a self-help form of therapy. It gives people the tools help themselves. Although correctly described as a form of psychotherapy, another way of conceptualising CBT is as a form of adult learning. That perspective can help make sense of recent advances in CBT where key CBT principles are communicated via CBT books, classes or websites. The key elements are a CBT structure that then builds on the therapeutic relationship and helps people both understand why they feel as they do, and also learn new skills to make changes. CBT provides a structure of how to make these changes in a planned and evidence-based way. However it also requires and effective and supportive therapeutic relationship to encourage people to keep on track as they plan changes in their lives. It is on this balance of structure and relationship that CBT aims to help achieve change.
Chief Inspector Michael Brown: ‘Police, policing, and mental health in the UK’.
Police services all over the world are essential as a de facto mental health service, especially around crisis care. All have struggled with untoward incidents involving the use of force, or deaths following police contact, which have framed – perhaps distorted - discussion. Reviews of these incidents have concluded that police officers are usually working in a context where the professional options available to them are not always adequate and that support after police decision-making is not always available. Reviews have also emphasized the need to improve police training and awareness of mental health, without necessarily specifying what that means and without taking account of contributory problems in healthcare provision by other agencies. Better police training and awareness of the mental health issues they face professionally is essential, but not sufficient. Many of the people the police encounter, where mental health is a factor in the incident, are known to have a history of mental health problems and have often been service users previously. The challenge is twofold – to reduce reliance upon the police service (and criminal justice system, including the prison service) to the extent we can; and to improve the quality of the police response where it is necessary for officers to become involved.
People with learning disability were understood and treated very differently in the past from the present. While attempts were always made to help them, this was against a background of pessimism about their prospects. Much progress has been made in the past half century in positive attitudes towards this group, with closures of the large institutions in which they were often housed and better integration into the community. Nonetheless, challenges remain, including a significantly shorter life expectancy compared with the general population. Dr Fionnuala Williams clarifies misconceptions and enlightens listeners on the definition, causes, and treatments relevant to this diverse population group, where communication is key.
Social workers and care in the community
Social workers have a crucial part to play in improving mental health services and mental health outcomes for citizens. They bring a distinctive social and rights-based perspective to their work. Their advanced relationship-based skills, and their focus on personalisation and recovery, can support people to make positive, self-directed change. Social workers are trained to work in partnership with people using services, their families and carers, to optimise involvement and collaborative solutions. Like community psychiatric nurses, social workers also manage some of the most challenging and complex risks for individuals and society, and take decisions with and on behalf of people within complicated legal frameworks, balancing and protecting the rights of different parties. This includes, but is not limited to, their vital role as the core of the Approved Mental Health Professional (AMHP) workforce. Social workers are central to the holistic, individualised treatment available to sufferers from mental disorders, which epitomises the goals of modern healthcare provision. Dr Ruth Allen, Chief Executive, British Association of Social Workers
In the podcast I talk about my research on the biological basis of schizophrenia using brain imaging and my attempts to understand symptoms such as hallucinations in terms of brain based cognitive processes. I describe what schizophrenia is like from the point of view of clinicians and from the point of view of patients. I suggest that the experiences described by patients in history are very similar to those described today. Finally, I discuss treatments. There has been much improvement since the discovery of drug treatments in the 1950s, but we still have not identified the causes of schizophrenia and, for the majority of patients, life remains very hard.
Chris Frith is Emeritus professor of Neuropsychology and the Wellcome Centre for Human Neuroimaging at UCL and Honorary Research Fellow at the Institute of Philosophy.
Autism is a neuro-developmental disorder with a prevalence of about one in 100 births. Although we assume that this disorder has always been with us, and Rab Houston and I identified a case from the 18th century, it was not given a label until the 1940s. Hans Asperger, a Viennese pediatrician, and Leo Kanner, an American child psychiatrist, both used the label ‘autistic’ to characterise the condition. It took another thirty years until it was understood that it was not rare, but there was a whole spectrum of autistic conditions, all sharing the core symptoms of impaired social communication and repetitive and restricted behaviours. To explain these symptoms I mention two proposals: the ‘Theory of mind’ account, explaining the communication impairment; the ‘Weak central coherence account’, explaining the focus on detail.
Uta Frith is Emeritus Professor of Cognitive Development at UCL’s Institute of Cognitive Neuroscience.
Symptoms of schizophrenia develop in more than 1:200 people, in all cultures, while 2- 4% of the population may experience major depression at some time in their life. Mild and moderate depression are, of course, much more common. Sometimes illnesses run in families and show higher concordance among identical compared to non-identical twins suggesting an important genetic contribution to risk. Molecular genetics now gives us the tools to analyse genetic risk using DNA samples donated by people with schizophrenia, bipolar disorder, depression, autism, attention deficit, obsessive-compulsive disorder, anxiety, anorexia, substance use and post-traumatic stress. These disorders are the focus of ongoing international collaborations performing genome -wide association studies. Results to date are remarkable. Genes have been found that contribute to these illnesses and it is hoped this new knowledge could lead to novel drug targets and new preventative interventions. The use of advanced techniques such as gene editing and improved possibilities for accurate prenatal testing are raising important ethical questions that require informed public discussion and debate.
People in both the developed and the developing world are living longer, and in better health, than in any prior point in history. However, mental health professionals, especially psychologists, need to prepare for this upcoming increase in older persons – whom they will encounter in all areas of practice. There is an urgent need for practitioners to upskill, and students to embrace, key principles from gerontology (the science of aging) to foster greater awareness, understanding, and appreciation of later life experience. The psychological issues faced in clinical practice will evolve along with these demographic changes — for example, intergenerational issues among blended families, anxieties around retirement, and issues particularly pressing for women, such as caregiving, will present themselves more frequently. These issues are important for mental health professionals, concerned with ageing, to recognize and address with sensitivity and respect, with curiosity and a willingness to listen and learn.
Eating Disorders are understandable as a way of coping with uncomfortable feelings. A temporary sense of reward or emotional detachment can occur due to maladaptive eating. The disorders are driven by fears about being unacceptable. Beliefs about people with eating disorders being selfish or overly concerned about beauty, still seem to arise. In reality they tend to have an excessively low opinion of their appearance and are usually kind and generous to a fault. The belief that what is required to cure an eating disorder is to ‘just eat normally’, is still frequently expressed to people with these complex psychological disorders. I also believe the risk of premature death from an eating disorder is commonly exaggerated in public and professional discourse, with potentially unhelpful consequences for treatment. My hope for the future is that overly simplistic theories about and treatment of eating disorders will give way to more complex, integrated, holistic approaches to care.
Bipolar disorder is a complex psychiatric disorder of mood and behaviour that has been recognised for thousands of years. It probably affects about 1 in 50 individuals worldwide and is characterised by episodes of depression alternating with episodes of mania. In this podcast we discuss the presentation, diagnosis and treatment of bipolar disorder. We highlight the strengths and limitations of current diagnostic classifications and we consider the need for a multidisciplinary treatment approach that integrates medications (such as lithium) with psychosocial approaches (such as group psychoeducation). We also consider the intriguing link between bipolar disorder and creativity and we conclude with an optimistic discussion of latest research in the field and how this will ultimately lead to improved diagnosis and new treatments in the future.
In this podcast, Professor Rab Houston speaks to Alexander Baldacchino, Professor of Medicine, Psychiatry and Addictions, University of St Andrews and Clinical Lead and Consultant in Addiction Psychiatry with NHS Fife. This podcast will hopefully provide the right incentive for listeners to understand better the finer details pertinent to the topic of substance misuse disorder and dependence. Listeners will be taken through some of the relevant historical, clinical, epidemiological, humanistic and other cross cutting themes to allow a more positive formulation of what the problems caused or as a consequences of substance misuse can be crystallised without stigmatising the individual or population involved. The interview explores understandings and misunderstandings of substance misuse, and the possibilities for helping misusers against a background of rapid changes in society, medical provision, and the proliferation of substances.
Gerry Hastie trained between 1993-96, when nurse training programmes were changing from being delivered by the Local Health Authority to Higher Education. He has always been a mental health nurse and has worked in care home settings, long term in-patient care settings, acute admissions, addictions and the community.
In this podcast he illustrates his personal journey to doing what he does, and what it takes to be a mental health nurse, focusing on values and personal qualities; skills and different remits and the many roles taken on by nurses with patients, their families and colleagues. Nurses are simultaneously therapists, advocates, teachers and researchers who within their own training and skill set but whose work is essential with other professionals. He offers a perspective on what makes nursing unique and how nurses complement the multi-disciplinary team.
Finally, Gerry tries to step outside and looks into his profession as an observer and use examples from clinical experience and popular culture to imagine what the public think mental health nurses do.
In the first podcast of our new series, Professor Rab Houston is in conversation with Dr Miles Mack, Past chair of RCGP Scotland and a GP partner in Dingwall, Scotland.
General Practice is the backbone of the British NHS and GPs provide a vital role in providing medical health care to patients registered to their practices. They provide continuity of care and a comprehensive approach, both in the first point of care and coordinating ongoing care for long term conditions. This podcast discusses their work in mental health, its relationship to physical well being and how they provide an interface with the hospital and specialist services in the wider health and care services.
I argued in the last podcast that medical theories in colonial Africa had a strong racial element to them, which buttressed colonialism. In this final podcast of my mini-series I’m going to explore how these ideas related to the actual practice of psychiatry in colonial Africa. I broaden my perspective to include not only Malawi, but also Natal and Uganda. I try to nuance some of cruder understandings of colonial psychiatry by suggesting that clinicians could adopt perspectives and treatments that focused on suffering human beings, rather than racial stereotypes. Psychiatry on the ground was different: it always is when interacting with real-life patients. I conclude by looking at the way forward for psychiatry in sub-Saharan Africa.
Image: Nurse and patient, Malawi. Copyright Daniel Maissan www.danielmaissan.nl
If you have listened to my series of podcasts on the history of psychiatry in Britain and Ireland you will know that psychiatric relationships are at least partly about power and about the assumptions medical practitioners made concerning those they treated. In the old world, class and sex were important differentiators. In a colonial setting there was an added dimension. Daniel H. Tuke, a British expert on insanity and visiting medical officer at England’s York Retreat, wrote in the Journal of Mental Science for 1857 that ‘the liability to mental disease is greater (other things being equal) in a civilized and thinking people, than in nomadic tribes’. So madness was the price Europeans paid for living in civilization, but transposed to a colonial setting it was the price Africans paid for encountering civilization. Colonial psychiatrists worked to address fundamental issues of social anthropology: How did race affect mind and behaviour? Was it possible to change peoples and cultures? The answer was sadly predictable and the racist ideas I outline provided a rationale for maintaining colonial dependency because they seemed to prove that Africans were unsuited to governing themselves or interacting with the wider world. Their societies had both too many and too few restraints, making them inherently unstable.
Image: Juba Central Prison, Sudan, copyright PBS (Robin Hammond, Condemned)( www.witnesschange.org )
At the end of the last podcast I explained what was special about colonial psychiatry from the 1880s to the 1960s, compared with mental medicine in the United Kingdom. 1) Continuing medical pluralism 2) Limited institutionalization of patients and professionalization of services 3) Persistently low resources 4) Attempts to introduce European-style practices of care 5) Racism Today I’m going to deal with the first three of these points. An important theme in my podcasts on the history of psychiatry in the United Kingdom is the enduring importance of different ways of dealing with the mad, including religious healing and traditional talking therapies as well as formal or learned medicine. Medical pluralism meant that there was in effect a marketplace for therapies, chosen according to availability of practitioners, the cost of treatment, the nature of the condition, the person experiencing it, and the social context in which the illness had presented itself. Biomedicine gained dominance only in the nineteenth century. I then go on to explain how the care of insane people in institutions came very late to much of colonial Africa and psychiatry as a specialisation later still. Finally, I talk about the experience of white people who went mad, because it is an important counterpoint to race and racism, which will be the subject of next week’s third of the four podcasts in this mini-series.
Image: male patients, Zomba hospital courtyard, copyright Daniel Maissan, www.danielmaissan.nl
I have been asked by the Scotland Malawi Mental Health Project to prepare a short series of podcasts to act as a component of the training programme for psychiatrists at the College of Medicine in Malawi. Like much of the less developed world, Malawi has limited resources for specialist psychiatric care: the ratio of psychiatrists per head of population is less than 1% of that in Western Europe. The two series of podcasts already broadcast have been used to help train clinicians and nurses in Anglophone sub-Saharan Africa, including Malawi. The practice of psychiatry in a colonial setting is surprisingly varied. Even within British colonies around the world, those who received psychiatric care, where they were treated, and to what ends was significantly different. Other European colonies were different again. So colonial psychiatry, as practised between the 18th century and the 1940s, 1950s, and 1960s, is a rich and varied topic. I want to narrow it down. I’m going to stick to Anglophone southern and eastern Africa, between the 1880s and 1960s, because that covers the geographical and cultural area in which Malawi is located. Between 1891 and 1964, when it became independent, Malawi was the British Protectorate of Nyasaland. Up to the middle of the nineteenth century the old world shared many of the characteristics we shall encounter in African colonies between the 1880s and 1960s. I’m going to set out 8 key similarities. I then explain what changed in Britain and Ireland over the last two centuries. Finally, I’ll summarise the distinctive experience of southern Africa under colonization, which I’ll explain in detail next time.
Image: Eket, Nigeria. Copyright Robin Hammond, Condemned, ( http://www.witnesschange.org )
We are now acutely aware of the effect which viewing or participating in traumatic events can have on people. This last ‘document’ (actually a set of film clips) is about such outcomes. It has no words by the mentally troubled, but it does have the other components that lay and professional alike use to identify mental state: body language, appearance, and behaviour. The symptoms of what First Wold War soldiers called ‘shell shock’ included fatigue, tremor, limb paralysis, pain, breathing problems, nausea, muteness, confusion, nightmares, and impaired sight and hearing. Paralysis and sensory impediments with no apparent biological basis or necessary connection to a specific event were central to the diagnosis.
SOURCE: War Neuroses: Netley Hospital, 1917. Segment 1: film of victims of shell shock. Wellcome Library, London, b1667864
IMAGE: Wellcome Library, London, L0003888. The Nursing Sisters of the Royal Victoria Hospital, Netley. From: The Navy and Army Illustrated vol. 4, 33 (1897), p. 215. Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 http://creativecommons.org/licenses/by/4.0/
This extract accompanies Podcast 21 - Living With Madness 2: An Insane Murderer
IMAGE: Wellcome Library, London, L0040923. John Totterdale throwing his wife down stairs. Copperplate, 18th Century. From: The new and complete Newgate calendar; or, villany displayed in all its branches ... Containing ... narratives ... of the various executions and other exemplary punishments ... in England, Wales, Scotland and Ireland, from the year 1700 to the present time, vol. 2, By: William Jackson (London: Alexander Hogg, 1795), opposite p. 275. Collection: Rare Books, EPB 30093/B. Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 http://creativecommons.org/licenses/by/4.0/
Voice Credit: Sebastian Bridges
We encountered a coroner’s inquest a few weeks back, presiding over the tragic suicide of an anonymous man. An inquest could deliver a verdict on the cause of death and, if they named a third party, their verdict could serve as an indictment at an assize court. The Old Bailey was the assize for the City of London. This document illustrates how insanity was taken into account in criminal trials, even when a formal insanity defence was not pleaded. It vividly shows how the perpetrator behaved and how others interacted with him, not only family and neighbours, but also strangers he encountered in court. This extract gives a vivid sense of day-to-day interactions with sane and insane people alike, and the sorts of decisions that ordinary people had to make about assessing mental capacity in ordinary and extraordinary circumstances alike.
IMAGE: Wellcome Library, London, L0040923. John Totterdale throwing his wife down stairs. Copperplate, 18th Century. From: The new and complete Newgate calendar; or, villany displayed in all its branches ... Containing ... narratives ... of the various executions and other exemplary punishments ... in England, Wales, Scotland and Ireland, from the year 1700 to the present time, vol. 2, By: William Jackson (London: Alexander Hogg, 1795), opposite p. 275. Collection: Rare Books, EPB 30093/B. Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 http://creativecommons.org/licenses/by/4.0/
This extract accompanies Podcast 20 - Living with madness 1: an apprentice in danger, 1738
IMAGE: ‘Fashion Before Ease, or A Good Constitution Sacrificed for a Fantastic Form', pub. by Hannah Humphrey, 1793. Credit: George Moutard Woodward / Bridgeman Art Library / Universal Images Group, Rights Managed / For Education Use Only
NOTE: The young man in this extract was apprenticed to a London stay or corset maker.
SOURCE: Westminster Sessions: Sessions Papers - Justices' Working Documents. London Lives, LMWJPS654130018. Find out more at http://www.londonlives.org/
Voice Credit: Sebastian Bridges
Most people with mental disorders are more of a liability to themselves than to others. The same cannot be said of this podcast and the next one, where the threat or reality of physical harm at the hands of a mad person seems to have been very real. Early modern apprentices were different from modern ones because they lived as well as worked with their master in a sort of family arrangement. One unlucky apprentice petitioned London magistrates to allow him to leave the service of an employer who seems to have been erratic, controlling, threatening, and violent. The case shows how lay public opinion in the past could be just as important as professional medical certification, in identifying mental disorder.
IMAGE: ‘Fashion Before Ease, or A Good Constitution Sacrificed for a Fantastic Form', pub. by Hannah Humphrey, 1793. Credit: George Moutard Woodward / Bridgeman Art Library / Universal Images Group, Rights Managed / For Education Use Only
This extract accompanies Podcast 19 - Fighting back. A ballad about William Frederick Windham, 1862.
IMAGE: Broadsheet Ballad: ‘Poor Windham’. Bodleian Library, Oxford. Harding B 11(3115).
SOURCE: Bodleian Library, Oxford. Harding B 11(3115).
Voice Credit: Oli Savage
This series is entitled ‘the voice of the mad’, but sometimes mentally disordered people needed advocates to speak up for them. Normally that would mean a family member or someone in authority such as a local clergyman or Justice of the Peace. You might remember the young Derbyshire woman, Alice Hill, from an earlier podcast. But sometimes those alleged to be mad attracted support from a wider public, who became their voice. William Windham is an example, where crowds rallied around his cause – just as they sometimes did to frustrate what they saw as wrongful confinement. William Frederick Windham was a young man of considerable wealth and unorthodox behaviour, whose relatives tried to use the law to stop him squandering his estate on the grounds that he was mentally incapable of making his own decisions. They failed.
IMAGE: Broadsheet Ballad: ‘Poor Windham’. Bodleian Library, Oxford. Harding B 11(3115).
This extract accompanies Podcast 18 - Being an asylum patient 4: Christian Watt at Aberdeen Royal Mental Asylum, 1877
SOURCE: The Christian Watt papers. Edited with an introduction by David Fraser (Edinburgh, 1983), 106-8. A newer, corrected edition is published by Birlinn. http://www.birlinn.co.uk/The-Christian-Watt-Papers-9781780270722.html
Voice Credit: Oli Savage
As I showed last week, Herman Charles Merivale’s time at Ticehurst was a bit like being in a nice hotel, though he did not like the other ‘guests’. Someone who seems to have settled rather better into an institutional environment was a working class Aberdeenshire woman, who also wrote a retrospective account of her time in a public asylum. She wrote with frankness and sensitivity, about both herself and her fellow patients, making the best of her prolonged stay, which lasted 45 years. However, it is also clear that she re-wrote much of what happened, including the frightening circumstances of delusion and arson, which had caused her to be admitted in the first place.
This extract accompanies Podcast 17 - Being an asylum patient 3b: Herman Charles Merivale at Ticehurst, 1875
IMAGE: Wellcome Library, London. Ticehurst Case Records, 1875-9, pp. 15-16. Credit: Wellcome Library, London, Creative Commons Attribution NonCommercial license
Voice Credit: Jem Tatar
Last week’s extract and podcast allowed us to see what others thought of the lawyer Herman Charles Merivale, when he was committed to a private asylum. The document from which it came exists in abundance for 19th century asylums. Insight into how patients saw the experience of incarceration are much rarer, though I shall give examples this week and next. Merivale is unusual because he wrote his own account of entering and living in an up-market private madhouse. Public asylums were crowded with paupers. Understaffed and with only basic facilities, they were probably difficult environments for most patients. Merivale’s experience was very different, though he does not seem to have enjoyed it.
IMAGE: Herman Charles Merivale. Photograph by Elliott & Fry. From the frontispiece to H. C. Merivale, Bar, Stage & Platform (London: Chatto & Windus, 1902).
This extract accompanies Podcast 16 - Being an asylum patient 3a: Herman Charles Merivale admitted to Ticehurst, 1875
IMAGE: Wellcome Library, London. Ticehurst Case Records, 1875-9, pp. 15-16. Credit: Wellcome Library, London, Creative Commons Attribution NonCommercial license
SPOKEN VERSION: Jem Tatar
The most abundant sources for understanding the history of psychiatry are medical case notes, kept by asylum staff. In addition, petitions for admission gave accounts of behaviour that precipitated the committal of a person to an institution. In this case he was a well-off London lawyer and the asylum was an up-market private one in the Home Counties of England. In drawing up the certification necessary for compulsory committal, the medical men relied much more on accounts given by servants and family, than they did on the rather uncommunicative object of their consultation.
IMAGE: Wellcome Library, London. Ticehurst Case Records, 1875-9, pp. 15-16. Credit: Wellcome Library, London, Creative Commons Attribution NonCommercial license
This extract accompanies Podcast 15 Being an asylum patient 2: Letters from the Royal Edinburgh Hospital, late 19th century.
IMAGE: Lothian Health Board Archive, University of Edinburgh, LHB7/51/54, p. 314. James P. to Dr Thomas Clouston 28 April, 1891. Credit: Courtesy of Lothian Health Services Archive, Edinburgh University Library.
Last week I looked at some regulations from Cardiff District Asylum at the start of the twentieth century. One of their main functions was to restrict communication between patients and the outside world, but it is often difficult to see how patients experienced their lives within institutions. The most abundant records are of what doctors and their staff did to patients. Yet patient letters to the staff or ones they tried to get to outsiders give unique insights into the spectrum of heartfelt attitudes from gratitude to anger and dislike, shown by patients. The uses and abuses of power in the narrow compass of a mental hospital come through very clearly.
IMAGE: Wellcome Library, London V0012576. Edinburgh Lunatic Asylum, Scotland. Line engraving by R. Scott after R. Reid. Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 http://creativecommons.org/licenses/by/4.0/
This extract accompanies Podcast 14 Being an asylum patient 1: Cardiff Asylum regulations, 1919
Voice credit: Rosie Beech
IMAGE: Psychiatric patient, 19th century. Credit: KING'S COLLEGE LONDON/SCIENCE PHOTO LIBRARY / UIG, Rights Managed / For Educational Use Only
In this podcast and the next four, I’m going to look at what patients made of entering and being in what we call mental hospitals and what were known until 1930 as lunatic asylums. The podcasts are about life in the institutions which dominated care of the insane and mentally impaired from the mid-nineteenth to the late twentieth century. The first extract shows why we seldom hear the voice of those who were institutionalised: asylums were highly regulated and authoritarian, not only for patients, but also for staff. The regulations show how closed many public asylums were. This was the day-to-day existence of about 100,000 asylum inmates in a British population of 36 million; by 1900 there were over 100 asylums whose average size was nearly 1,000. The average length of stay ran to several years because asylums increasingly filled up with chronic cases.
IMAGE: Psychiatric patient, 19th century. Credit: KING'S COLLEGE LONDON/SCIENCE PHOTO LIBRARY / UIG, Rights Managed / For Educational Use Only
Eighteenth and nineteenth century English coroners’ inquests investigated roughly one death in every twenty. Their main task was to discover if someone else might have been involved or if a crime might have been committed. Suicide was one of those cases because it was a crime until 1961. The truly poignant part of this verdict is that nobody knew the name of the man who had hanged himself. Juries were always comprised of men from the locality where the body was found. That means the suicide must have been an outsider, perhaps a vagrant or even a suspected criminal as he seems to have been locked in a room or cage with iron bars. Still, the jury was prepared to give him the benefit of the doubt and say that he was insane when he killed himself. Increasingly common during the 18th century, this verdict may indicate the emergence of an attitude which automatically linked self-murder with mental illness.
This extract accompanies Podcast 13 - Suicide 2. A London coroner's inquest verdict.
Voice Credit: Rosie Beech
This voice extract accompanies Podcast 12 - Suicide 1. Letters, diaries, and notes in the National Archives of Scotland Read by: Sebastian Bridges, Caroline McWilliams, Hannah Raymond Cox
This voice extract accompanies Podcast 12 - Suicide 1. Letters, diaries, and notes in the National Archives of Scotland Read by: Sebastian Bridges, Caroline McWilliams, Hannah Raymond Cox
This voice extract accompanies Podcast 12 - Suicide 1. Letters, diaries, and notes in the National Archives of Scotland Read by: Sebastian Bridges, Caroline McWilliams, Hannah Raymond Cox
This voice extract accompanies Podcast 12 - Suicide 1. Letters, diaries, and notes in the National Archives of Scotland Read by: Sebastian Bridges, Caroline McWilliams, Hannah Raymond Cox
This voice extract accompanies Podcast 12 - Suicide 1. Letters, diaries, and notes in the National Archives of Scotland Read by: Sebastian Bridges, Caroline McWilliams, Hannah Raymond Cox
This voice extract accompanies Podcast 12 - Suicide 1. Letters, diaries, and notes in the National Archives of Scotland Read by: Sebastian Bridges, Caroline McWilliams, Hannah Raymond Cox
This voice extract accompanies Podcast 12 - Suicide 1. Letters, diaries, and notes in the National Archives of Scotland Read by: Sebastian Bridges, Caroline McWilliams, Hannah Raymond Cox
This voice extract accompanies Podcast 12 - Suicide 1. Letters, diaries, and notes in the National Archives of Scotland Read by: Sebastian Bridges, Caroline McWilliams, Hannah Raymond Cox
This voice extract accompanies Podcast 12 - Suicide 1. Letters, diaries, and notes in the National Archives of Scotland Read by: Sebastian Bridges, Caroline McWilliams, Hannah Raymond Cox
These nine examples of letters, diaries, and notes build up to what I think is a compelling picture of the despair and powerlessness felt by suicides. Some were left by those who had killed themselves, but most were written by survivors. We can sum up suicide quite simply as a search by those who felt trapped, for an end to unbearable mental anguish. Desperation, darkness, and depth of suffering depressed their minds as they struggled with feelings of being worthless, alone, and pointless. But the extracts also show the range of emotions felt by survivors, from bewilderment and awful comprehension to blame and stigma.
IMAGE: French Artist – Bibliotheque des Arts Decoratifs, Paris, France, engraving. Credit: Bridgeman Art Library / Universal Images Group, Rights Managed / For Education Use Only
This is the first of three podcasts that give different accounts of suicide. We first came across William Cowper a few weeks back, having an anxiety attack that left him mentally disabled for some months. This episode is a ‘prequel’, dealing with attempted suicide, a topic that it is difficult to examine in the past. While a law student, Cowper first began to be troubled by low self-opinion, anxiety, and depression, culminating in a failed attempt to hang himself. Both his determination to end his own life and his subsequent guilt come through clearly in his writing.
IMAGE: William Cowper by Lemuel Francis Abbott, 1792, painting, oil on canvas. Credit: National Portrait Gallery, London / Universal Images Group, Rights Managed / For Education Use Only
This voice extract accompanies podcast 11 - William Cowper - Attempted Suicide SPOKEN VERSION: Henry Roberts IMAGE: [William Cowper 2] William Cowper by Lemuel Francis Abbott, 1792, painting, oil on canvas. Credit: National Portrait Gallery, London / Universal Images Group, Rights Managed / For Education Use Only
This extract accompanies Podcast 10 A ‘silent madness’. Hugh Blair (1747)
IMAGE: James Robertson of Kincraigie; John Dhu (Dow, MacDonald); Jamie Duff by John Kay. Credit: National Portrait Gallery / Universal Images Group, Rights Managed / For Education Use Only
Voice credits: Matthew Lansdell (Intro: Oli Savage, Questions: Sebastian Bridges)
Last week’s extract was a series of diary entries showing how a clergyman sought to help a young woman with learning disabilities. Hearing the voice of the intellectually impaired can be hard for historians, but this week’s podcast does just that. Alice Hill was prevented from marrying, but we know about the case of Hugh Blair because he was married. His brother wanted the marriage annulled on the grounds that Hugh was an ‘idiot’ who did not understand the union he had entered into. An enigmatic figure, I explain how Hugh was in fact autistic: one of the clearest and earliest cases for modern psychologists.
IMAGE: James Robertson of Kincraigie; John Dhu (Dow, MacDonald); Jamie Duff by John Kay. Credit: National Portrait Gallery / Universal Images Group, Rights Managed / For Education Use Only
Voice Credit: Hannah Raymond Cox
IMAGE: Wellcome Library, London, V0030051. Young girl with Down's syndrome, sitting, wearing striped socks. Photograph. By: Joseph Arthur Baldry after: George Edward Shuttleworth. Collection: Iconographic Collections. Library reference no.: ICV No 30534. Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 http://creativecommons.org/licenses/by/4.0/
NOTE: We do not know if Alice Hill had Down’s syndrome, but appearance was an important indicator of mental capacity in early modern times and she may well have looked distinctive.
People with learning disabilities were often slow to acquire the ability to read and write – which were not normal skills for many people until the 19th century. We know little of their mental worlds. Those who cared for the intellectually and socially impaired, on the other hand, did record the decisions made on their behalf, both to enable and prevent them acting in ways that might not be in their best interests. The case of Alice Hill, where the issue was whether she should be allowed to marry, shows the fine line between protecting and inhibiting people with learning disabilities, which those close to them have walked over the centuries
IMAGE: Wellcome Library, London, V0030051. Young girl with Down's syndrome, sitting, wearing striped socks. Photograph. By: Joseph Arthur Baldry after: George Edward Shuttleworth. Collection: Iconographic Collections. Library reference no.: ICV No 30534. Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 http://creativecommons.org/licenses/by/4.0/
NOTE: We do not know if Alice Hill had Down’s syndrome, but appearance was an important indicator of mental capacity in early modern times and she may well have looked distinctive.
IMAGE: The House of Lethen, Auldearn: the family home of Miss Anne Brodie, daughter of Alexander Brodie and Henrietta Grant (Mrs Brodie). Canmore 15594, a/N/81.
IMAGE: Wellcome Library, London, L0080105. ‘Madeleine Smith at the bar of the Justiciary, Edinburgh’. Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 http://creativecommons.org/licenses/by/4.0/
NOTE: This is an image from the nineteenth century, but John Philip would have stood in the same place as the accused young woman, before a bench of judges and a jury of 15 men.
This week, we continue the story of John Philip, a humble legal clerk who lived in a world of fantasy, delusion, and obsession. This week, we try to understand his thought processes, and what those around him made of them.
IMAGE: Portrait of Robert Fergusson (1750-1774). Painting by Alexander Runciman (1736-1785). Credit: De Agostini Picture Library / Universal Images Group, Rights Managed / For Educational Use Only
Voice credit: Henry Roberts
IMAGE: William Cowper by George Romney, pastel, 1792. Credit: National Portrait Gallery, London / Universal Images Group, Rights Managed / For Education Use Only
Like many of those who had the time to write about their mental state prior to modern times, William Cowper came from a privileged background. Early in the reign of George III he had a breakdown while faced with an examination for a job, becoming crippled by anxiety. Admitting his mental problems, as had George Trosse, he wrote in depth about his experience of treatment, and of the process of recovery under the care of a specialist ‘mad doctor’ or early psychiatrist. Cowper experienced several serious bouts of depression during his long life, but went on to be a famous literary figure.
IMAGE: William Cowper by George Romney, 1792, drawing, pastel. Credit: National Portrait Gallery, London / Universal Images Group, Rights Managed / For Education Use Only
IMAGE: Head of Military Man by Giovanni Battista Piazzetta, 1682-1754, oil on canvas. Credit: SuperStock/ Universal Images Group, Rights Managed / For Education Use Only
Voice credit: L. P. Catliff
Among those we have encountered so far in this series, only Alexander Cruden seems to have frightened those around him. Most sufferers from mental disorders were vulnerable people, perplexed by what was happening to their minds. John Philip was quite different. A humble legal clerk, he lived in a world of fantasy, delusion, and obsession, which caused him to instil fear in others and brought him to the edge of murder. In four episodes, based around a single, very long statement he made to magistrates, I explain what started as a simple infatuation with a young woman of high rank in Georgian Edinburgh. Then I move on to trying to understand his thought processes, and what those around him made of them. In the third episode I explore his trial for harassment and assault – what we might call stalking – and the nature of insanity defences in the historic past. Finally, I look at what became of him and the object of his obsession.
IMAGE: Head of Military Man by Giovanni Battista Piazzetta, 1682-1754, oil on canvas. Credit: SuperStock/ Universal Images Group, Rights Managed / For Education Use Only
Both Fitzherbert and Allen, whose accounts formed the basis of earlier podcasts in this series, saw their mental condition as a burden to themselves and others. During the Renaissance in the century before they lived, some scholars instead revived the classical Greek idea that there could be a connection between madness and genius. This became a prominent feature of the eighteenth-century intellectual movement called the Enlightenment. One of its best-known and most prolific exponents was Scots-born the lawyer James Boswell, a friend of Samuel Johnson and a fellow sufferer from depression or melancholia. In the extract Boswell toys with the idea that what we might describe as manic depressives had special intellectual abilities, setting the tone for many subsequent attempts to link madness and creativity.
IMAGE: JAMES BOSWELL (1740-1795). Caricature etching, 1786, by Thomas Rowlandson. Credit: The Granger Collection / Universal Images Group, Rights Managed / For Education Use Only
IMAGE: JAMES BOSWELL (1740-1795). Caricature etching, 1786, by Thomas Rowlandson. Credit: The Granger Collection / Universal Images Group, Rights Managed / For Education Use Only
Voice credit: Oli Savage
This audio file is intended up be listened to in conjunction with Series 2, Podcast 5, Religious lunacy. Dionys Fitzherbert (1610). https://soundcloud.com/user-516743905/5-religious-lunacy-dionys-fitzherbert-1610
SOURCE: Women, Madness and Sin in Early Modern England: The Autobiographical Writings of Dionys Fitzherbert. Edited by Katharine Hodgkin (Farnham, 2010), 185, 187, 189.
VOICE CREDIT: Rosie Beech
IMAGE: [Unknown lady 2] PORTRAIT OF AN UNKNOWN LADY, of the English School 1660-1670 at Lyme Park, Stockport, Cheshire. Credit: Universal Images Group, Rights Managed / For Education Use Only
NOTE: We do not know what Dionys Fitzherbert looked like, but this portrait may well represent the style of dress in the aristocratic circles in which she moved.
Alexander Cruden, the author of last week’s document, wholly disowned the label of madness. Dionys Fitzherbert also refused to be called insane, arguing in a lengthy account that she was simply experiencing religious turmoil, as did many of the more radical or ‘Puritan’ Protestants of post-Reformation England; she interpreted her experience as a spiritual battle for her soul. A gentlewoman from a privileged background, she (like Hannah Allen) was cared from in domestic settings using medical, spiritual, and psychological methods. In her narrative, physical, mental, and spiritual health were entwined and inseparable: truly holistic.
IMAGE: PORTRAIT OF AN UNKNOWN LADY, of the English School 1660-1670 at Lyme Park, Stockport, Cheshire. Credit: Universal Images Group, Rights Managed / For Education Use Only
This audio file is intended up be listened to in conjunction with Series 2, Podcast 4, Obsession - Alexander Cruden (1739). https://soundcloud.com/user-516743905/4-cruden
Voice Credit: Oli Savage
IMAGE: Alexander Cruden, 1700-1770. Credit: Design Pics Historical Collection / Universal Images Group. Rights Managed / For Education Use Only
Hannah Allen, the author of last week’s document, knew she suffered from melancholy. An altogether less sympathetic figure, Alexander Cruden vigorously denied having any psychopathology, though those he encountered found him obsessive and disproportionate, insisting he was the victim of malice and stupidity. His writings show the contested boundaries of madness, as experienced and observed. A Scot by birth, Cruden lived in early Georgian London and had experience of being placed in private madhouses, which provided much of the care for the mentally disordered prior to the 19th century.
IMAGE: Alexander Cruden, 1700-1770. Credit: Design Pics Historical Collection / Universal Images Group. Rights Managed / For Education Use Only
As a young woman in 17th century London, Hannah Allen suffered from severe depression or what was then known as melancholy. She wrote about the pain and despair she experienced. The way she wrote, retrospective but incorporating written fragments from the time of her collapse, and the nature of the temptations to which she was subject, as well as the cures proposed by relations, indicate a narrative of madness and depression as well as bringing out the pervasive religious belief of the age. Concentrated and painful, her frank account accepted that she had been mentally and physically ill; she wrote simply to explain what it had been like. Her writings are a vivid personal account, but they also show a poignant awareness of how her condition affected those around her.
IMAGE: [Unknown lady 2] PORTRAIT OF AN UNKNOWN LADY, of the English School 1660-1670 at Lyme Park, Stockport, Cheshire. Credit: Universal Images Group, Rights Managed / For Education Use Only
This audio file is intended up be listened to in conjunction with Series 2, Podcast 3, Depression - Hannah Allen. https://soundcloud.com/user-516743905/3-depression-hannah-allen
Voice Credit: Caroline McWilliams
IMAGE: [Unknown lady 2] PORTRAIT OF AN UNKNOWN LADY, of the English School 1660-1670 at Lyme Park, Stockport, Cheshire. Credit: Universal Images Group, Rights Managed / For Education Use Only
We begin our exploration of the voices of the mad with the story of the Rev. George Trosse, an English nonconformist minister, who wrote about his experience of mental illness in his autobiography in the 1650s. Although he realised he was ill, he saw his experiences as a supernatural struggle.
Please read or listen to the extracts before listening to the podcast. You will find the written text on the website, or you can listen to them on our soundcloud stream by clicking on the links below.
Extract 1 - https://soundcloud.com/user-516743905/george-trosse-extract-1 Extract 2 - https://soundcloud.com/user-516743905/george-trosse-extract-2
This audio file is intended up be listened to in conjunction with Series 2, Podcast 2, Becoming Insane - George Trosse. https://soundcloud.com/user-516743905/2-george-trosse
Voice Credit: Felix Langley
This audio file is intended up be listened to in conjunction with Series 2, Podcast 2, Becoming Insane - George Trosse. https://soundcloud.com/user-516743905/2-george-trosse
Voice Credit: Felix Langley
You might recognise my voice from listening to some or all of my previous set of 44 podcasts about the history of psychiatry in Britain since 1500. That series was mostly a medical history, explaining who cared for the mad, where, and how. I talked about asylums, care in the community, medical and lay understandings of the causes of mental problems, changing therapies, and the kinds of mental conditions that existed in the past. Put simply, the series was about what lay and professional people did to help the mad over the last five centuries. But along the way I also tried to bring out what madness was like for sufferers and those around them, explaining the social, economic, scientific, cultural, and political context of welfare provision.
The series is still available in its entirety and will be for some time to come. You’ll find a link to it on the main web page.
What I’m trying to do with the current series of 26 podcasts is offer a counterpoint, by giving a sense of the lived experience of madness. I want to explore the thoughts and feelings of those who knew they had mental problems, or who others thought disordered, using mainly their own words or, sometimes, descriptions that followed closely what they said and did.
In this special podcast, Professor Rab Houston discusses some of the interesting questions that have been raised by listeners during the first series. He explains how he undertakes his research into the history of psychiatry and the types of sources he uses before looking at some of the areas that still need to be explored and how this will influence the future direction of his research.
The second series of podcasts entitled 'The Voice of the Mad' will be launching on June 27th and Professor Houston tells us more about this exciting new series.
There's still time to send us your feedback from series one. If you'd like to take part in our feedback survey please go to https://standrews.onlinesurveys.ac.uk/2017podcast-survey
Understanding the history of psychiatry can help to preserve a sense of perspective, humanity, and humility, by setting out just how unusual and diverse the past is and how people coped with mental ailments under very different material, social, and cultural circumstances. My suggestion, in this final podcast, about how better to care for people is to spend time caring about people, by supporting the large and important voluntary sector that helps those with mental problems. Science has made great strides in understanding and treating mental disorders. The state continues to work towards a financially viable system of mental healthcare provision. But the members of civil societies can themselves help sufferers by reaching out to them.
Amazon vouchers to be won!
This podcast is the last in a series of 44 podcasts on the History of Psychiatry since 1500. Whether you have listened to the whole series, or just a few episodes, we would love to hear from you and to find out what you have gained from listening to the series.
We would be very grateful if you would take the time to fill in a short survey about the series. The survey will only take a few minutes to complete, and there is a prize of an Amazon voucher worth £50 for the first response drawn at random, with two runner-up prizes of a voucher worth £25.
Please click on the link below to access the questionnaire.
https://standrews.onlinesurveys.ac.uk/2017podcast-survey
Thank you!
Image of the week: Mental Aftercare Association poster, 1889 Full Bibliographic Record: Wellcome Library Catalogue L0031850 Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 creativecommons.org/licenses/by/4.0/
History shows us where we have been. Yet the lessons it offers are not simply examples of what to emulate and what to avoid. Some time back, the archivist of Bethlem Hospital wrote that there are few ideas in psychiatry that have not been round at least once before during the last 500 years. This podcast shows what understanding historic change can do to help those who frame modern welfare policy: history can help illuminate opportunities and constraints by exploring differences and similarities.
Image of the week: Asylum for Imbecile Poor, proposed for Leavesden Woodside, near Watford, Hertfordshire, 1868 Full Bibliographic Record: Wellcome Library Catalogue V0014594 Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 creativecommons.org/licenses/by/4.0/
When we talk about psychiatry and its history we delve deeply into all aspects of human life: mind and body, emotions and experiences, thoughts and moods, the self and others, lay and expert opinion, health and illness, science and society, normal and abnormal, liberty and compulsion. In this last set of three podcasts I want to explain why I think that knowing about the history of psychiatry matters to modern mental health specialists. And to all of us. This podcast looks at the fertile exchanges that can take place between medical researchers and historians.
Image of the week: Professor Uta Frith [copyright Uta Frith; from RAH]
Diagnoses such as autism are less than a century old. Other conditions, now central to our concerns about mental wellbeing, were hidden in the past, though this time because the demographic parameters were so markedly different. I’m going to look at two examples, which show how changing longevity and lifestyles may increase the observed incidence of mental disorders: dementia and substance abuse. I argue that changing demographics and different thresholds of what individuals tolerate in themselves and others are a better explanation of rising diagnoses, than are changing incidences of underlying pathologies.
Image of the week: ‘Insanity supervening on habits of intemperance’, The Medical Times and Gazette, vol. 38 (1858) Full Bibliographic Record: Wellcome Library Catalogue L0028554 Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 creativecommons.org/licenses/by/4.0/
The last podcast argued that apparent changes in the diagnosis of mental disorders probably had more to do with developments in science and society, than with shifts in the incidence of underlying pathologies. I’ll pursue this argument further today by looking at three conditions: hysteria, autism, and (briefly) eating disorders. The podcast ponders changing diagnostic categories and fashions over time.
Mental ailments are presently the fastest growing diagnostic category in world medicine, particularly anxiety, depression, and the damaging effects of abusing alcohol and recreational drugs. Intuitively, we tend to associate this with the accelerating stresses of modern living. This podcast tries to test this assumption by looking at the history of changes in the incidence of certain mental pathologies such as schizophrenia. It explores whether they actually took place, and asks if changes are the result of different perceptions or thresholds, or of changing illness patterns.
Image of the week: Emil Kraepelin, 1856-1926 Full Bibliographic Record: Wellcome Library Catalogue L0030730 Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 creativecommons.org/licenses/by/4.0/
I conclude this block of podcasts by showing what insights can be gained into the mind of the suicide, using historical evidence. The podcast sets out how survivors struggled to understand why someone had killed themselves and asks if we can build a picture of how suicides felt. The podcast returns to the selective and stigmatising portrayal of suicide in historic newspapers. It concludes by looking at some attempts to adopt a more pro-active approach to preventing suicide in Victorian and Edwardian times.
Image of the week: Voluntary Euthanasia Society Poster, 1930s Full Bibliographic Record: Wellcome Library Catalogue L0028037 Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 creativecommons.org/licenses/by/4.0/
In this podcast I outline historic patterns of suicide and I’ll explore attitudes towards it. Historic suicide resembles modern in important regards such as the predominance of males among those who kill themselves. The most distinctive feature is the very high proportion of suicides in past centuries, who were children or young adults. The podcast tries to explain this disturbing historic pattern.
Image of the week: restraint blanket, Brighton Mental Hospital, early twentieth century Full Bibliographic Record: Wellcome Library Catalogue L0066388 Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 creativecommons.org/licenses/by/4.0/
Suicide is the most private of acts. It leaves surviving relatives and friends with more profound puzzlement, guilt, and shame than any other kind of death. It is the cause of bereavement most likely to make the living experience mental problems. Even now, when the subject is discussed more openly in mass media, we often speak of it in hushed terms. This is the legacy of centuries of horror and condemnation, which I want to look at in this block of three podcasts. Today, I’ll explain how we know about suicide in the past, because it is far from straightforward to get evidence.
Image of the week: suicide from a bridge. From George Cruikshank, The Drunkard’s Children (1848). Full Bibliographic Record: Wellcome Library Catalogue L0007446 Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 creativecommons.org/licenses/by/4.0/
In the previous three podcasts in this section I have talked about the portrayal of madness in media, though at the end of the last one I touched on how sufferers represent themselves. Today I want to do something slightly different, by looking at the creative artistic products of those who suffer from mental disorders. This podcast looks at the assumption that manic depression and genius are linked, charting its fluctuating popularity over time and assessing its validity.
Modern understandings of asylums, mental disorder, and psychiatry are strongly influenced by the medicalised identities portrayed in film. This podcast sets out some examples of the interaction between sociology, psychiatry, and social comment, and between medicine and history, to show how film representations shape understandings – and how they are often a product of their own time. It concludes by looking at more modern documentaries produced by sufferers.
Image of the week: George III in his final illness, c. 1820 Full Bibliographic Record: Wellcome Library Catalogue L0000507 Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 creativecommons.org/licenses/by/4.0/
For the last three centuries newspapers have been the main organ by which the British general public has been informed about events outside their immediate knowledge. Though they deal in facts, the representations newspapers offer are mixed with literary elements because they are designed to entertain, provoke, and change, as well as simply to inform. This podcast looks at historic and modern representations and misrepresentations of mental disorder, especially in the periodical press.
Image of the week: Anorexia Nervosa. By William Withey Gull, M.D., published in Transactions of the Clinical Society of London (1873). Full Bibliographic Record: Wellcome Library Catalogue L0073689 Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 creativecommons.org/licenses/by/4.0/
Perceptions of madness and those who care for it have always been shaped by representations in mass media. Nowadays we have radio and television as well as the internet and for the whole of the twentieth century film shaped understandings. Prior to this there was literature, newspapers, drama, and art. This block of podcasts provides examples to show how representations past and present create understandings of what mental disorder is and of the alleged threat to liberty or personal freedom, posed by being labelled insane.
Image of the week: female maniac, late nineteenth century Full Bibliographic Record: Wellcome Library Catalogue L0026690 Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 creativecommons.org/licenses/by/4.0/
The last two podcasts have shown how mad people are different before the law. Psychiatry has certain legal privileges in how it handles patients. The implications of these two facts have stimulated debate for at least the last three centuries. I’d like to confront them this week and discuss the charge that psychiatry and the law conspire to oppress certain sections of the population. The podcast revisits some of the themes of anti-psychiatry and shows how they influence modern perceptions of the practice of mental medicine.
Image of the week: man in restraint chair, West Riding Lunatic Asylum, Wakefield, Yorkshire, c. 1869 Full Bibliographic Record: Wellcome Library Catalogue L0019069 Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 creativecommons.org/licenses/by/4.0/
All parts of Britain and Ireland had laws to safeguard the physical welfare and supervise the management of the finances, of adults with a mental illness or impairment. These laws remained more or less unchanged from the Middle Ages until the twentieth century and the essential principles are still enshrined in very recent legislation. This podcast looks at the legal procedures necessary to prove that a person could not manage their own affairs and at the place of medical certification in admission to an asylum.
Image of the week: old man suffering from senile dementia, c. 1890 Full Bibliographic Record: Wellcome Library Catalogue L0026689 Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 creativecommons.org/licenses/by/4.0/
For centuries the development of psychiatry was shaped by social norms, political climates, and legal frameworks. In this block of podcasts I want to talk about psychiatry’s relationship with the law, both from a sufferer’s point of view and a medical practitioner’s. I’m going to discuss the boundary between mental capacity and incapacity before the civil and criminal law, bringing out how the mentally impaired were protected from blame or exploitation. In this podcast I look at insanity defences and the criminal law, and particularly at who decided whether an alleged criminal was insane in the past.
Image of the week: Daniel M’Naughten, 1843 Full Bibliographic Record: Wellcome Library Catalogue L0000720 Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 creativecommons.org/licenses/by/4.0/
Only a small proportion of modern physicians are psychiatrists and they are far outnumbered by nurses and social workers in care systems. The imbalance was even greater in the past, when specialisation of any kind was limited. This podcast looks at who nursed the mentally disordered in the past and how they too became more specialised in the twentieth century. It sets out the qualifications and roles of those who attended the mentally ill or impaired.
Image of the week: Nursing Staff. Royal Western Counties Institution, [Idiot Asylum] Star Cross, Devon, late nineteenth century Full Bibliographic Record: Wellcome Library Catalogue L0000665 Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 creativecommons.org/licenses/by/4.0/
A landmark in the formation of psychiatry came in the middle of the twentieth century. After centuries of sometimes heated disagreements between practitioners, professional associations and non-governmental bodies developed criterion-based system of classifying mental disorders: DSM and ICD. The podcast suggests that their creation and implementation was the decisive moment in creating a coherent discipline of psychiatry. I conclude by contrasting once again modern practice with historic.
Image of the week: Cover of ICD-10 [copyright World Health Organization; from RAH]
This podcast returns to mental medicine. It sets out the forces behind the emergence of psychiatry: the rise of asylums, professional associations, research publications, and specialist training. These concentrated in Victorians times, but psychiatry did not become a fully fledged speciality until the mid-twentieth century.
Image of the week: Thomas Smith Clouston, 1840-1915 Full Bibliographic Record: Wellcome Library Catalogue V0028676 Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 creativecommons.org/licenses/by/4.0/
The structure of mental health medicine I outlined last time is a late twentieth century innovation. Until the mid-nineteenth century it is probably better to talk, not of a stratified medical profession based on a clear division of training, expertise, labour, and association, but of a complex hierarchy or pyramid of medical practice based on status and function. This podcast sets out the many kinds of practitioners of medicine that existed and their widely differing claims to expertise. It concludes by exploring the distinctive relationship between patients and practitioners, which existed in the past.
Image of the week: phlebotomy (blood-letting), 17th century Full Bibliographic Record: Wellcome Library Catalogue L0041074 Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 creativecommons.org/licenses/by/4.0/
Modern psychiatric care is structured into a system of provision which mainly provides care in the community. Understanding the neat modern categories throws into relief the complex, multi-layered medical marketplace of the past. The contrast allows us to see how generalist provision developed, during the nineteenth and twentieth century, into a psychiatric profession.
Psychiatry has always been influenced by perspectives from non-medical disciplines and these have in turn changed how the wider society looks at mental medicine. This podcast examines critical perspectives associated with a philosopher whose name is almost synonymous with madness. It concludes by discussing the contribution of sociology to questioning the benign model of medical progress, which had been central to the history of psychiatry since the start of the nineteenth century.
Image of the week: lobotomy instruments, c. 1950 Full Bibliographic Record: Wellcome Library Catalogue L0026980 Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 creativecommons.org/licenses/by/4.0/
The great age of the asylum was between 1850 and 1950, yet even then there were voices raised to question the role and effectiveness of large-scale instititions. This podcasts asks what asylums were about and why there was a rising tide of criticism of them between the 1920s and 1960s, both from within and outside the medical world, which led to the replacement of institutional provision with ‘care in the community’.
Image of the week: a long corridor in the West Riding Pauper Lunatic Asylum, Menston, Yorkshire Full Bibliographic Record: Wellcome Library Catalogue L0038337 Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 creativecommons.org/licenses/by/4.0/
This podcast looks at the roots of asylums in hospitals or infirmaries as well as private madhouses, but it focuses on workhouses to illustrate that historic provision was much less indiscriminate than is usually believed. It concludes by exploring the political imperatives behind institutionalization
Image of the week: replica of a nineteenth century restraint collar Full Bibliographic Record: Wellcome Library Catalogue L0065156 Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 creativecommons.org/licenses/by/4.0/
When we think about the history of psychiatry we probably envisage large institutional buildings that can look like military barracks or even prisons, their names locally synonymous with madness. Yet the great age of public asylums came quite late, between about 1830 and 1980. This podcast provides statistics on the rise and fall of institutional provision in different parts of Britain and Ireland, between 1800 and the present day.
Image of the week: man in restraint chair, West Riding Lunatic Asylum, Wakefield, Yorkshire, c. 1869 Full Bibliographic Record: Wellcome Library Catalogue L0019069 Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 creativecommons.org/licenses/by/4.0/
This podcast carries on from last week’s, asking: Were Bethlem’s staff negligent and cruel? Did it do little to cure its inmates? The conclusion is that Bethlem was for centuries a troubled institution dominated by recurring scandals. It was a Bedlam in all senses of the word, potentially ‘brutal, cold, dark, and dirty’. Yet this needs to be balanced with a strong imperative to help sufferers and a more recent history, since the mid-nineteenth century, which was a model of good psychiatric practice.
Image of the week: William Norris, 1815 Full Bibliographic Record: Wellcome Library Catalogue L0011319 Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 creativecommons.org/licenses/by/4.0/
This is the first of two podcasts about the only public lunatic asylum in England for centuries: St Mary of Bethlehem Hospital in London, usually known as Bethlem. It symbolises the history of psychiatry. I want to look at the sort of image this institution had (and still has in the modern mind) and to assess if it is justified. I’ll explore what was special about Bethlem, whether it was typical of developing institutional provision, and what it really tells us about the way insanity was cared for in the past. This podcast asks: Was Bethlem a freak show? Was its administration chronically corrupt?
Image of the week: Cibber’s statues at Bethlem Hospital, 1680 Full Bibliographic Record: Wellcome Library Catalogue L0011832 Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 creativecommons.org/licenses/by/4.0/
Given the preference for extra-mural care shown in some parts of Britain in the nineteenth and early twentieth century, this podcast asks whether what we now call (with caution) ‘care in the community’ worked because the people of the past were more tolerant towards aberrant words and behaviour. It concludes that madness was simply more familiar to historic populations than it is in the modern world, and the cultural values of the people of the past were subtly different to our own.
Image of the week: male patient of West Riding Lunatic Asylum, Wakefield, York, suffering from ‘Mono-mania of pride’, c. 1869 Full Bibliographic Record: Wellcome Library Catalogue L0041119 Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 creativecommons.org/licenses/by/4.0/
Differences in rates of institutionalization between England on the one hand and Scotland, Wales, and Ireland on the other are at the heart of this podcast. Its aim is to explain why societies in some parts of Britain leant more towards institutional solutions than others, as late as 1900. The podcast brings out the importance of social, demographic, political and economic contexts, to choices about the provision of care in the past.
Image of the week: insane woman drawn by Charles Darwin, 1872 Full Bibliographic Record: Wellcome Library Catalogue L0049513 Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 creativecommons.org/licenses/by/4.0/
Public madhouses did not become common until the mid-nineteenth century. Most institutional provision in what were called ‘madhouses’ was private and designed mainly for the better-off. Run as commercial enterprises, they resembled modern nursing homes for the well-heeled elderly, providing mainly personal care and medical interventions when necessary, to a small number of paying patients. The podcast explores this ‘trade in lunacy’. It brings in comparisons between England and the other parts of Britain and Ireland.
Image of the week: view of Ticehurst private madhouse, c. 1829 Full Bibliographic Record: Wellcome Library Catalogue L0032450 Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 creativecommons.org/licenses/by/4.0/
When we think about modern mental healthcare we probably think of clinics and hospitals funded by the state. But at the start of the eighteenth century there was a single public lunatic asylum in England and none elsewhere in Britain and Ireland. Virtually all care was provided in some sort of domestic setting and that remained true until after 1800. The podcast discusses how families coped and what help was available from public welfare provision.
Image of the week: alms boxes from Bethlem Hospital, c. 1700 Full Bibliographic Record: Wellcome Library Catalogue L0065138 Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 creativecommons.org/licenses/by/4.0/
Drugs are central to the ways modern clinicians handle mental disorders. But more or less consistently effective medicines for specific conditions are a very recent innovation. The new drugs of the 1950s and beyond promised to work on the underlying physical bases of specific disorders. The podcast looks at the emergence and use of anti-psychotic, anti-depressant, and mood-stabilising drugs. It ends by assessing the effectiveness of modern pharmacological treatments.
The nineteenth century saw a mixture of traditional remedies and the selective application of some of the methods associated with moral therapy. The first half of the twentieth century was characterised by some experiments with psycho-surgery and some early pharmacological developments, as most clinicians sought physical rather than psychotherapeutic solutions to the problems posed by mental disorders, especially in asylums. The podcast ends by discussing the effectiveness of historic therapies.
Image of the week: Electro-Convulsive Therapy machine, 1954 Full Bibliographic Record: Wellcome Library Catalogue L0065853 Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 creativecommons.org/licenses/by/4.0/
Physical treatments dominated sixteenth and seventeenth century mental healthcare. One important change was a greater role for psychological treatments or ‘moral therapy’ in the eighteenth-century. Moral therapy drew on the associational theory of the physician and philosopher John Locke, who argued that people were the product of their environment and upbringing. This profoundly optimistic approach to psychology meant that the mad, who had mis-associated ideas, could be brought back to sanity by a carefully constructed programme of re-education in an appropriate setting: what we now call psychotherapy.
Image of the week: William Hallaran’s spinning chair, 1810 Full Bibliographic Record: Wellcome Library Catalogue L0001487 Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 creativecommons.org/licenses/by/4.0/
How have therapies for mental ailments changed over time?
Today’s treatments for mental illness revolve around drugs and psychological therapy. For centuries, medical practitioners relied mainly on treating physical symptoms, while recognising that mind and body were connected. Where possible, they offered some kind of counselling. This next section of podcasts looks at what therapies were available, and highlights continuities and change over five centuries.
Image of the week: St Fillan’s bell Courtesy of Wellcome Images. Full Bibliographic Record: Wellcome Library Catalogue M0014430 Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 http://creativecommons.org/licenses/by/4.0/
If the nineteenth century had been mostly about physiology and somatogenic interpretations of mental problems, the early twentieth century was the golden age of psychodynamic psychiatry. Vienna-based physician Franz Anton Mesmer is usually credited with being the first to unlock the secrets of the psyche at the end of the eighteenth century. Mesmer’s successors included Jean-Martin Charcot, who famously hypnotised hysterics at the Salpêtrière asylum in late nineteenth-century Paris, and early in his career Sigmund Freud worked with Charcot. Freud’s influence has been enormous, though more in the German lands and the United States than elsewhere. Psychoanalysis was shunned in France and never widely accepted in Britain or Ireland, though Freud lived in London for a short time towards the end of his life. He died in 1939 and his family home in Hampstead, north London is now a museum, complete with his famous consulting couch.
Image of the week: Freud’s consulting couch [copyright Freud Museum London]
The nineteenth century in Britain belongs to materialist or somatogenic interpretations of the causes of mental problems, founded on scientific advances in physiology. Rather than mind and body, medical writers focused on the brain as the organ of the mind. British specialists such as W. A. F. Browne, physician at Crichton Royal Institution, Dumfries, built on emerging pathological anatomy, to argue that mental problems were basically organic in origin. Some doctors claimed to be able to read skulls for tell-tale signs of the physical degeneration that accompanied behavioural abnormalities, and proposed that heredity, cerebral deformation, and bad upbringing created degenerates and defectives who were a menace to society.
Image of the week: Down syndrome child. Girl aged 3 months. 1898 Courtesy of Wellcome Images. Full Bibliographic Record: Wellcome Library Catalogue L0003077EB Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 http://creativecommons.org/licenses/by/4.0/
The theme for this section of podcasts is the shifting balance between organic or somatic causes and mental or psychological ones. As new discoveries were made, physicians, scientists, and others did not simply abandon existing theory, but looked for ways to reconcile innovations with what they already knew. Today’s podcast explores the processes behind a move away from a humoral balance theory of health towards nervous and neurological interpretations.
Image of the week: Mania: from Sir Charles Bell’s The anatomy and philosophy of expression as connected with the fine arts (1804) Full Bibliographic Record: Wellcome Library Catalogue L0031760 Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 http://creativecommons.org/licenses/by/4.0/
Early modern Europe saw an unprecedented craze for hunting, prosecuting, and executing witches, tens of thousands of whom were burned. It was widely believed witches could manipulate evil forces to do harm to people and property. Were the witches of the sixteenth and seventeenth century the mad people of the nineteenth and twentieth century?
Image of the week: James VI, Daemonologie (1603 edition) Full Bibliographic Record: Wellcome Library Catalogue L0078964 Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 http://creativecommons.org/licenses/by/4.0/
This week's podcast explores the ways in which mental illness has been identified and described. The popular, vernacular, or 'street' vocabulary of mental dysfunction has always been remarkably rich, perhaps more so than the technical one prior to the twentieth century, including some words and phrases we may still recognize today.
Image of the week: Two photographs of an idiot, St Bartholomew’s Hospital, c. 1895 Full Bibliographic Record: Wellcome Library Catalogue L0067002 Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 http://creativecommons.org/licenses/by/4.0/
One of the themes of these podcasts is that the boundaries between medicine and other disciplines in the past were much less clear cut than nowadays and the way knowledge was organised was also quite different. One of the most famous contributors is the seventeenth century French philosopher Renée Descartes and in today’s podcast I want to explain briefly his theory that the mind (what he called the ‘rational soul’) was distinct from the body.
In this block of podcasts I’m going to look again at the language used to describe mental problems, the ways lay and professional people identified them in the past, and the possible confusions that lie in wait for us in history, when both culture and the material world were very different from the present day. Nowadays we are faced with a sometimes bewildering array of mental conditions and syndromes. By contrast, medical classifications in the past were often remarkably basic. The spectrum of mental illness could be encompassed by just two words: mania and melancholy.
This podcast is about what historians do and what they can bring to an understanding of mental medicine. I talk a little about myself, set out what you might expect from the series, and explain why I did these podcasts and for whom they are intended. The series is not just for historians or healthcare professionals, but for anyone interested in our minds, what can go wrong with them, and how we can help sufferers and those around them. Madness is fascinating because it takes us to the heart of being human and because it tells us much about both medicine and wider social attitudes.
Today’s podcast outlines what makes psychiatry a distinctive medical discipline with a special image, primarily because it deals with something we cannot see - the mind. Its history too is distinctive and a combination of history and psychiatry allows us to delve deeply into all aspects of human life: mind and body, emotions and experiences, thoughts and moods, the self and others, lay and expert opinion, health and illness, science and society, normal and abnormal, liberty and compulsion. The podcast also offers some basic modern and historic definitions of mental disorders: conditions that for centuries were known generically as ‘madness’.
Image: Cover page of William Battie's Treatise on Madness. Courtesy of Wellcome Images. Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 http://creativecommons.org/licenses/by/4.0/