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

Art in Madness: New Book on Nineteenth Century Collections

One of the most famous former Bethlem patients was artist Richard Dadd, committed to Bethlem’s Criminal Lunatics Department in 1844, after murdering his father in the belief that he was the Devil. During his twenty years in the Hospital (before transfer to the newly-built Broadmoor Hospital), Dadd was encouraged to continue painting, and many of his most famous works were painted there, including Contradiction: Oberon and Titania.

Dadd was not the only patient in Bethlem who painted in this period; casebooks record that both male and female patients were frequently occupied in painting and drawing. Dadd was also not the only artist treated in the Hospital. For example, 25-year-old Henry Hudson, admitted in April 1888, exhibited four paintings at the Royal Academy in 1889, despite the fact that his occupation was deemed, in part, to blame for his illness, for he had ”fallen violently in love with a lady whose portrait he was painting. Was so emotionally disturbed that he could not go on with the work.” Painting was regarded as occupational, preventing patients from dwelling on their troubles. It could also help to make the galleries more “cheerful”, providing an environment regarded as conducive to cure. In 1883, George Savage wrote:

“During the past year we have been engaged in painting artistically one of the male Infirmaries … on the whole the result has been satisfactory … [and] we have had several patients among the ladies who have developed quite a taste for the work, and next year I hope to carry this decorative work into several of the other wards.”

In such an instance, the occupational content of the “decorative work” was regarded as most important – thus suggesting why much patient artwork of the period was not kept by asylums. One collection, however, does remain. A new book, published by the Dumfries & Galloway Health Board, allows fascinating access to the collection of Dr. W.A.F. Browne, former Physician Superintendent of the Crichton Royal Institution. Maureen Park, Lecturer in History of Art at the University of Glasgow, gives extensive historical context and notes on the artworks, created by at least thirty-six men and ten women at the asylum between 1839 and 1857. The full colour prints are thus accompanied by notes on the artists, and their experiences in the hospital, making for an insightful volume. Park regards the collection as a “testament to Browne’s commitment to moral treatment, his dedication to patient care and his belief in the therapeutic power of art.” Yet, as art continues to retain strong links with treatment, and the possible connections between creativity and mental illness remain a topic of considerable debate, the collection surely holds a much broader interest than the simple biographical.

The art collection is now housed in the Dumfries & Galloway Archives. Art in Madness by Maureen Park costs £25, and is available from the Dumfries & Galloway Health Board.

Richard Dadd: Sketch to Illustrate the Passions – Brutality

Invitation to Opening of Bethlem Gallery Exhibition: Unescorted

A new show opens at the Bethlem Gallery next week, showcasing the creative talent of Hospital patients. The exhibition, Unescorted #2, comprises work by over 20 patients, including paintings, drawings photography, digital art and music, offering a glimpse into the artists’ daily lives and unique ways of seeing. The artwork ranges from architectural graphite drawings, to vibrant paintings of Caribbean scenes, and illustrative pen and ink sketches of imaginative characters.

Alongside the traditional psychiatric treatments, art technicians working within Occupational Therapy enable patients to engage in creative activities through the simple process of identifying and nurturing their hidden talents. Similarly, during music sessions participants have the opportunity to record their thoughts, feelings and perceptions and turn them into compositions and lyrics.

A consultant psychiatrist said of the show, “Music, writing, drama, and particularly art are forms by which patients have a chance to share their story with others and in doing so move that bit closer to a safe and successful life in the community. The music concerts and art exhibitions that take place at River House are perhaps a high point in a treatment that is otherwise complex and challenging.”

All are welcome at the Opening Event, on Wednesday 27 October, 3 – 6pm.

Exhibition continues:

28 October – 19 November, Wednesday – Friday, 11am – 6pm



Bethlem Gallery and Museum are both open on Saturday 6 November, 11am – 6pm

www.BethlemGallery.com

In the Frame for June 2010

Artists – and others – have always learnt and drawn inspiration from the work of others. But restricted display space in the Archives and Museum makes it possible to show only a fraction of our collection at any one time. The rest of the artworks we hold are in store. We are always on the lookout for new ways to make our paintings available to a wider audience.

The Archives and Museum have begun working with Bethlem’s Occupational Therapy Department on a new initiative to use pieces from our collection to inspire creative responses from others. Each month, copies of three chosen paintings will be displayed in the Department’s art studio as a visual starting point for others to create their own pieces. One of these three will be selected by a member of Archives and Museum staff as our ‘picture of the month’ to feature on the Bethlem blog, along with details of what made it catch our eye. This month’s picture is Lynda Bamford’s ‘Mother and Father Reading’.