States of Mind: Conference in Newcastle

Last month, Northumbria University held a conference around the theme of Situating and Interpreting States of Mind: 1700 – 2000. This interdisciplinary conference emerged from a research group, whose work explores how the space, place and historical context in which mental states are experienced has shaped the narratives produced by individuals. The conference was wide-ranging, with papers reflecting on historical themes, literature, art and clinical practice in the field of mental health. The varied perspectives of the key-note speakers indicates the breadth of the approach. Joel Peter Eigen began the event with a lecture on the history of psychiatry, focusing on the dynamics of diagnosis in late Victorian forensic psychiatry. Within this field, the diagnosis of homicidal mania was widely adopted by psychiatrists and prison orderlies alike, but remained nonetheless problematic: a label in which a criminal act was regarded to be the first symptom of illness. Speaking from a broader historical perspective, English Literature scholar Melinda Rabb explored the history of cognition in relation to ideas of size and scale, presenting a fascinating account of the Georgian interest in miniatures, from art to “baby houses” (doll houses). Finally, practice-based Art and Design lecturer Judith Tucker gave a moving account of her artistic exploration of her Jewish grandparents’ holiday snapshots from pre-World War Two Germany.

Between these key-note lectures, speakers from a similarly broad range of disciplines offered wide-ranging perspectives. A particularly affecting talk was given by Nursing Lecturer Tommy Dickinson, giving a voice to former patients who received medical treatment for “sexual deviations.” The paper was based on oral histories obtained from seven former male patients, who had sought treatment for homosexuality or transvestism between 1935 and 1974 in Britain. The disturbing accounts of the electro-shock and chemical aversion therapies carried out had a lasting effect on the participants, who all remained emotionally troubled by experiences many regarded as akin to torture. As Dickinson concluded, the study should act as a reminder to nurses (many of whom carried out the treatments detailed) to ensure that their interventions have a sound evidence base, and to constantly reflect on the influence and intersection of science and societal norms.

Two papers made use of material from the Bethlem Archive. One, by the Museum’s Friends Secretary, expanded on material already available on this blog, on late nineteenth-century patients Walter Abraham Haigh, “Kentish Scribbler” and Henry Francis Harding. Meanwhile, Diana Peschier drew on material from Bethlem and county asylum records to look at religious language in the words of female patients in the second half of the nineteenth century. Women, she claimed, seemed to make far greater use of religious language than men, and the feeling that God had abandoned them or was punishing them for a great sin appeared especially common in female psychiatric patients. This, Peschier felt, reflected the wider experiences of women in this period, for whom religion played in important role in their daily lives and their mental health. Overall, the conference provided an interesting opportunity for reflection on how varied states of mind can be, in health and illness, and across history and culture.

DSM-1907: Diagnosis in the Edwardian Era

The fourth and current edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders list 297 disorders or diagnoses. A fifth edition is in preparation. The history of psychiatric pathological classification is controversial and contested. The most dramatic visual statement of its pre-history on this side of the Atlantic must be Caius Gabriel Cibber’s statues of ‘Raving and Melancholy Madness’ (featured on Bethlem blog at the start of May 2010) which once dominated the entrance to Bethlem Hospital and constituted part of the iconography of the city of London, and are now on display in the Archives & Museum. ‘Mania’ and ‘melancholia’ were the two syndromes rendered in Portland stone by this ‘DSM-1676’.

A more elaborate, and more recent, diagnostic effort is represented by the Schedule of Forms of Insanity first issued by the Lunacy Commissioners (later the Board of Control) in 1907. The Lunacy Commissioners governed admission to and conditions within the asylums of England and Wales by a system of regulation, inspection and tribunal, and published annual reports containing reports and statistics on mental health. >From 1907, the Commissioners required asylums to record diagnostic details in conformity with their Schedule. (Parallel developments in the United States of America are described in the introduction to DSM-IV TR.) Register entries on ‘manic’ patients were coded II.8 a. b or c (a for recent, b for chronic, c for recurrent) thereafter. Entries on patients suffering ‘general paralysis of the insane’ were coded II.2. And so on. Without the codes in the Schedule, some of the details given in the asylum registers of the early twentieth century are difficult, if not impossible, to interpret.

Now that these codes (and a number of the asylum registers in which they were used) are over one hundred years old, the Health Archives and Records Group of the UK and Ireland have published a version of the Schedule online (at www.healtharchives.org). This publication opens a window not only onto asylum register data, but also onto the theory and practice of psychiatric diagnosis in the Edwardian era.