First Person Narratives 1

Our Archivist and Education & Outreach Officer contributed a paper to a recent conference held to ‘evaluate the clinical encounter, the relationship between doctor and patient, and the language of illness and pain’. While their paper explored the visual ‘language’ of recovery ‘spoken’ by ‘before’ and ‘after’ photographs of English psychiatric patients in the late nineteenth and early twentieth centuries, the conference theme was interpreted in a diversity of ways by various speakers.

First-person written testimony always brings fresh perspective to discussions such as these – we recently drew blog readers’ attention to a case in point – and there is no narrative more engaging than that of Mabel Z. Cunningham, whose memoir, published posthumously as Jeremiah’s Sister, is so scarce that it appears to remain available only in online excerpts, nowhere in hardcopy. (If anyone can locate a library copy, no doubt Ellen Dwyer of Indiana University-Bloomington, the academic who brought this narrative to the attention of conference-goers, would be delighted to hear of it.)

We have just had our attention drawn to an article in the British Medical Journal which we wish we had known about in time for the conference. In Through the Wasteland, Jackie Hopson and Jeremy Holmes reflect on their respective experiences of a shared clinical encounter. Here a journey from a family home described as ‘a dangerous place to be’ through county asylum admission (‘places of fear, punishment and long incarceration’ but also ‘the only refuges available to many’) and referral to Bethlem Hospital’s Charles Hood Unit (‘an excellent therapeutic community’) to an adulthood of light and shade is carefully and honestly recounted. So is a movement away from therapy that actually serves to reinforce self-hatred and the ‘division of suffering’ between doctor and patient towards a long-term relationship of support in which acknowledgement of vulnerability can become a two-way street. Jackie has kindly written a more detailed account of her stay in the Charles Hood Unit, which will be posted later this month.

The Evolution of Occupational Therapy for Mental Health

Occupational therapy is ‘an active method of treatment with a profound psychological justification’, variously linked to moral, punitive and economic rationales. The 20^th century codification of the profession was assisted by key individuals, wartime experiences and social context. An assumed mind-body interaction underscored the adoption of occupational therapy within psychiatry, but attention and resources were weighted in favour of its uses in physical rehabilitation.

The development of occupational therapy for mental health was amongst issues discussed at the History of Psychiatry and Psychology Postgraduate Conference at UCL, recently discussed on this blog. Emerging research based on analysis of primary source material used Bethlem as a case study for exploring the establishment and acceptance of this field. Archived hospital records were used in conjunction with relevant scientific literature, and interviews with former Bethlem nurses.

Evidence suggests a modest tradition of occupation for health at Bethlem, initially driven by the social and intellectual environment, and postwar, by economic concerns and fresh input from Maudsley staff within the new Joint Hospital. Pioneering work addressed the damaging effects of prolonged hospitalisation within a framework of bourgeois acceptability; later efforts concentrated on teaching transferable and vocational skills. Enthusiasm of individual proponents was stymied by medical disregard of occupational therapy, limiting activities offered and perpetuating amateurish stereotypes of the profession. However, it was proposed that today’s services evolved from former philosophies and practices, having weathered challenges from inside and outside the hospital gates.

Key themes included the social class and gender of therapists and their patients; global and interdisciplinary sharing of knowledge, changing methods and aims of occupational therapy, and calls for professional accountability. The institutional and wider significance of findings were discussed.

Although one should not over-generalise from case study evidence, the research broadly highlighted the range of factors involved in the conceptualisation and recognition of new fields of expertise. It also illustrated fluctuating motives underlying outwardly similar practices, whilst psychiatry’s ‘inheritance’ of occupational therapy from its hitherto physical – and often transient – uses, reinforces the ‘Cinderella service’ trope. Despite recent augmentation of occupational therapy’s status within psychiatry, there is an ongoing challenge of integrating treatment approaches within mental health care. Further insights can be achieved through continued engagement with current and historical literature, together with the oral histories of those involved in delivery of mental health services during the 20^th century.

The programme for the conference, which took place on March 19^th 2011, is available at:

http://www.ucl.ac.uk/histmed/library/histpsych_call_papers

Conference Season

Further to the conference announcement we posted last month, here are details of more upcoming conferences which may interest our readers:

The Wellcome Trust Centre for the History of Medicine at UCL is hosting a one-day postgraduate History of Psychology and Psychiatry Conference on 19 March 2011. It is intended to provide a forum for the exchange of ideas amongst postgraduate students in the UK and abroad conducting research in this field.

Birmingham City University has organised a one-day conference on Insanity and the Lunatic Asylum in the 19th Century for 13 May 2011, to be held in the redundant chapel of All Saints’ Hospital (formerly Birmingham Lunatic Asylum), now closed.

Birkbeck College is hosting a weekend conference on The Language of Illness and Pain on 2-3 July 2011. It will be supported by an exhibition exploring the creative interaction between medicine and the humanities.

The 24th Congress of the British Society for the History of Medicine will take place at the University of Guildford from 31 August to 3 September 2011, and will cover topics ranging from ‘museums and archives’ to ‘medicine and madness’.

The 2010 Conference of the European Association for the History of Medicine and Health, devoted to the theme of ‘Body and Mind in the History of Medicine and Health’, will take place at Utrecht University on 1-4 September 2011.

Getting into Georgian Bethlem 3

In previous posts we described the restrictions placed on admissions to Bethlem Hospital, and to its ‘incurable’ ward, in the eighteenth century, and told the first of two stories of attempts made to gain admission for a patient. The second concerns Sarah Lufkin of Little Bentley near Manningtree, Essex, who came into the Hospital on 16 February 1782, and was discharged uncured on 15 February of the following year, in strict accordance with the previously-described rules governing admission and discharge. Mrs Lufkin was considered a ‘fit Object’ for transfer to Bethlem’s ‘incurable’ ward, but had to go on the waiting list for a vacancy. It took seven years for her to be offered a place, and a letter written to the Hospital by Sarah’s son John Lufkin is preserved in the archives.

‘My Brothers, Sisters and myself have Deliberated on the matter,’ John wrote, ‘and although her who has been one of the tenderest Mothers still continue in a state of Insanity, I leve [sic] you to judge from your own feelings if it would not be a heard, very heard work for us to part from her and perhaps never to see her more.’ This was no exaggeration on John’s part. Little Bentley was at least two days’ coach journey away from London in the eighteenth century, and the fare was not cheap.

By 1790 Sarah Lufkin’s children had been seven years without Bethlem’s assistance in caring for her. ‘Ever since she left London she has been in a very Creditable Famaly [sic] where she is treated with the greatest kindness and has every Indulgence a person in her Situation can have, and where we can see her as often as we please as the Distance is only half a mile from our own Famaly.’ What would they do, then, with Bethlem’s renewed offer of help?

‘Although it is a very heavy Expence’, John Lufkin continued, ‘we hope with the Blessing of God to be able to support her till it shall please the Lord to release her from her heavy affliction, for can we do two [sic] much for a good Parent’? That John Lufkin’s filial devotion was shot through with practicality is evidenced by the next (and effectively last) line of his letter: ‘Sir, if we omit this opportunity and if at a futer [sic] time any thing unforeseen should happen so that we find the Expence more than we are able to support, could she then at a Vacancy be admitted’? No record survives of the answer given by the Hospital, but we may surmise that, if that it stuck by its rules, the answer would probably have been ‘No’.

Getting into Georgian Bethlem 2

Correspondence between two eighteenth century solicitors, currently being edited for publication by the Sussex Record Society, provides an unexpected insight into how the rules of admission to Bethlem Hospital (described in an earlier post) functioned in practice at that time. We are grateful to the editor of these letters for drawing our attention to this example, and for permission to cite it here.

On 12 November 1745, James Collier of Hastings wrote to John Collier ‘in relation to the unhappy affair of Mary Cousens, whom my uncle and I though a proper person’ for admission to Bethlem.

‘I shall be able I beleive [sic] to have some respite in regard to her removal, and when the committee are known, shall endeavour to get her minuted down for the ward of the incurables which depends principally upon the report of Dr Monro; and I am glad to find that our case, viz. a raving madness, is a circumstance that particularly induces the committee to send such poor people there.’

In seeking a place for Mary Cousens at Bethlem, Mr Collier was acting as a professional agent of the Hastings authorities legally and financially responsible for the care of all ‘pauper lunatics’ resident within their parish boundaries. His communications with Bethlem’s Physician, Dr Monro, seem to have been conducted via a third party. At any rate, he had been poorly advised. As noted in the previous post in this series, in the ordinary course of events patients were not admitted directly to the ‘incurable’ department, and people judged ‘incurable’ would not be admitted to the Hospital in the first place.

While he hoped for a Bethlem admission for Mary, James Collier did not put all his eggs in one basket. ‘By next post, I shall be able to acquaint you with certainty what will be done as to Guy’s hospital,’ his letter to John continues. ‘They never suffer anybody to enter there, who has once been in bedlam, and I am afraid private madhouses will be attended with great expence.’

How did matters turn out? From a second letter, written by James Collier to John nine days later, it appears that Mary lived under Bethlem’s roof while being assessed for admission, but was not in the event admitted. ‘Mary Cousens is not as yet removed out of Bethlem hospitall [sic], but it is impossible to get her continued there’, he writes. ‘Mr Alnright of Lambeth marsh will take her for one month upon trial for 8sh per week, but if her distemper is such as to require a more than ordinary attendance, he will have more.’ With an eye to parish finances, Mr Collier would have preferred Bethlem to relent, an outcome for which he continued to hope against hope. ‘I don’t despair at present of getting her minuted down in the list of persons who are to supply the vacancys in the ward of incurables.’ In the event, however, Mary Cousens’ name does not appear in any of the Hospital’s admission registers, incurable or otherwise. Where she went, we cannot say.