The history of psychiatry and institutional mental asylums has attracted considerable attention during recent decades from both social historians and psychiatrists. Each group has contributed to the narrative of the rise of the lunatic asylum and the professionalisation of “psychiatry.” The historical inquiries and the methodological approaches adopted by the two fields have led to interpretations that often question, and conflict with, each other. Social historians have emphasised the need to place “alienists” and the asylum in their social context. This enables changes in social structures and relationships to be determined and their influence on professional interests to be assessed. Psychiatrists, or amateur historians as they are sometimes labelled, have tended to construct their work within a medical model that attempts to legitimise the activities of present day psychiatry.
Psychiatric history written from this perspective is consequently dogged by questions of partiality and concerns that the narrative may be compromised and distorted. Despite these potential shortcomings, psychiatrists possess an important attribute that can strengthen their historical writing. The medical knowledge they hold means they tend to understand mental illness and its treatment in greater depth than social historians. John Cramer describes Andrew T. Scull’s application of the terms madness, insanity and mental illness, in his sociological account of institutionalisation, as “confused.” Andrew T. Scull’s confusion about the difference between law, legal and medical concepts is attributed to his “little or no first-hand experience of people regarded as mad or insane, and how their behaviour impinges on others.”
- At the Mountains of Madness
- H. P. Lovecraft
- Publisher: Lulu.com
- Hardcover: 100 pages
The assumption that psychiatrists were amateur historians was challenged by the groundbreaking work of Richard Hunter and Ida Macalpine in the 1960s and 1970s. ‘Three Hundred Years of Psychiatry and Psychiatry for the Poor,’ published in 1970, broke decisively with the uncritical “whig” accounts that had preceded them. The whiggish interpretation suggests psychiatric history was a story of morality in which reform was inevitably victorious. The history of psychiatry is presented as a march of progress from savagery and ignorance to institutional humanitarianism and medical science. It is argued that progress towards humane treatment resulted from “the steady application of rational-scientific principles by people of good will.” “Whig” interpretations aggrandise the contribution of nineteenth-century reformers, like John Conolly and Samuel Tuke, in order to denigrate much of what had gone before and contrast the dark days with the progress made since.
Richard Hunter and Ida Macalpine’s work did not rely upon the established texts of major theorists. Instead, they delved into source material that had previously been overlooked or hardly used. Although their assessment of the development of psychiatry still retained elements of the “whig” approach, their contribution to the advancement and reshaping of psychiatry’s historiography should not be doubted. Richard Hunter and Ida Macalpine’s work strengthened the historical narrative of psychiatrists because their “scholarship is fully contextualised, remarkably nonjudgmental, and extraordinarily free of psychiatric triumphalism.” Despite the different perspectives held by psychiatrists and social historians, the work of both disciplines has cultivated a diverse and rich body of literature that has stimulated continued and extensive research on the subject of mental health provision.
The emphasis Kathleen Jones places on the inevitability of progress could compromise her work as it leads to the mistaken belief that the progressive sequence of events she charts becomes the sole line of causation for reform. Kathleen Jones’ work has obvious limitations, especially when compared to the later work of revisionist historians.
Andrew T. Scull ‘Museums of Madness,’ published in 1979, challenged the traditional “whiggish” interpretation of the rise and development of the asylum system and generated new debates among medical and social historians. The uncritical account of reform offered by the “whig” histories of Kathleen Jones and Richard Hunter and Ida Macalpine were displaced by a sociological paradigm that examined the impact of economics and a shifting social order. Kathleen Jones’ work is primarily concerned with lunacy reform on a parliamentary and legislative level. Her account is constrained by the exclusion of a sociological analysis of the rise of the public asylum. Kathleen Jones does draw attention to the principal reformists of the period and their humanitarian motivations. Unfortunately, she does not take sufficient account of the cultural and economic forces that operated in society and facilitated an important change in what Andrew T. Scull terms “a profound shift in the cultural understanding of madness.” The loosening of kinship ties, growing public tolerance and emerging professional interests are overlooked as catalysts for reform. Kathleen Jones presents a narrative of humanitarianism that was stimulated and fuelled by revelations of abuse in the private and public asylums of the late eighteenth and early nineteenth-centuries. She describes the 1845 Lunatics Act as “the culmination of a slow process of social revolution,” which infers that progress towards enlightenment was a straightforward task.
- Andrew T. Scull
- Publisher: Viking
- Edition no. 0 (03/29/1979)
- Hardcover: 276 pages
However, if her work is to be judged fairly it should be placed in historiographical context and understood within the tradition of the “liberal fifties” and not the “strident seventies.” Importantly, Kathleen Jones did at least open up the subject of the social and political history of provision for the insane. Her books, ‘Lunacy, Law and Conscience, 1744-1845: The Social History of the Care of the Insane’ and ‘Mental Health and Social Policy’ were written in 1955 and 1960 respectively, which was a very different era for social history. Kathleen Jones’ adherence to the chronological approach of social history was reflective of the practices of the time. Social history was still dominated by the legacy of the Tim Webb, whose approach to charting the progress of reform was not dissimilar to that of Kathleen Jones. Radical historians, particularly Andrew T. Scull, criticise Kathleen Jones but they do so from the sanctity of their own, distinctly different, historiographical context. As a sociologist who “developed his trade” in the seventies, Andrew T. Scull writes in a different tradition and has been able to look “over many of the same sources, but of course, he has access to more up-to-date ones as well.”
The simplistic view that reform was an inevitable consequence of growing humanitarianism, scientific advances and government inspection was in time disputed by radical and revisionist historians. Revisionist studies presented a more nuanced portrait of the patient experience and the cultural and professional context of psychiatric treatment. Discourse began to focus on the societal forces that created changes in the intellectual and social structure of English society in the early nineteenth-century. The context for reform was widened to include economic, political and social factors. Consequently, the emergence and growth of public asylums in the nineteenth-century has been defined and discussed in relation to deviance, segregation, social control, and the rise of the medical profession. Revisionist studies have acknowledged that boundaries, definitions and meanings of madness are influenced by social structures and fluctuate over periods of time as social responses to the insane change. Social organisation of deviant groups and a clearer distinction between the criminal, poor, socially disruptive and insane members of the community have become the focus, so that madness can be placed and understood within the social order of nineteenth-century society.