Neurology, the “Unconscious” and Victorian Psychiatry

The copy of Theo Hyslop’s 1895 publication, Mental Physiology in the Wellcome Library was, presumably, originally the doctor’s own, as it is interleaved with reviews, calling cards and letters to Hyslop from other mental health professionals, forming a fascinating archive in itself.

Mental Physiology was written mainly for the psychological part of Hyslop’s London M.D, which he completed while working as Assistant Medical Officer at Bethlem. Hyslop’s successor, William Stoddart, found it “strange” that the book never reached a second edition.¹ Perhaps Hyslop’s efforts to associate somatic and psychological theories of mental health and illness did not integrate easily with a growing divide between neurological and psychotherapeutic approaches. Nonetheless, Mental Physiology certainly shares similar evolutionary concerns with much British psychiatry of the period, in emphasising the importance of volition (or will) to both the individual and broader civilization, simultaneously associating mental ill-health with a loss of, or failure to attain, this self-control.

Hyslop was also heavily influenced by French neurology, much of which stemmed from the work of Jean-Martin Charcot at the Salpêtrière in Paris. Mental Physiology contains numerous references to the writings of Charcot’s pupils, such as Charles Féré and Pierre Janet. Janet is of particular note here: his calling card appears among the numerous psychiatrists’ cards pasted into this copy of Mental Physiology (from physicians across Europe and the United States), presumably received when they either visited Bethlem or attended a conference or meeting of the Medico-Psychological Association. A letter from Janet to Hyslop, also included in Mental Physiology, would seem to be part of a longer correspondence between the two, for it discusses the symptoms, and treatment, of a particular individual, presumably known to both parties. Since Henri Ellenberger’s research into The Discovery of the Unconscious in 1970, Janet’s work has been regarded as important in the formation ‘dynamic psychiatry’ and psychotherapeutic techniques, through his explorations into repressed memory, multiple personality and the connections between past events and present trauma.² It is interesting to see here evidence of an established link between French and English psychiatry during a period in which, according to the traditional historical view, continental ideas had limited influence in England.

1. Stoddart, W. H. B. 1933. “Obituary: Theophilus Bulkeley Hyslop, M.D., CM., M.R.C.P.E., F.R.S.E.”. Journal of Mental Science 79, no. 325: 424-426.

2. Ellenberger, H. 1970. The Discovery of the Unconscious: the History and Evolution of Dynamic Psychiatry. New York: Basic Books.

History of Psychiatry and Psychology Postgraduate Conference: 19 March 2011

As previously announced on this blog, around forty early career researchers from around the world recently attended a conference at the Wellcome Trust Centre for the History of Medicine at UCL on the history of psychiatry and psychology, indicating the breadth of interest in, and relevance of, the field. Many of these presented their own research, which included the exploration of issues such as gender, citizenship, therapeutics, medication, and the social implications and understandings of mental illness from Ancient Mesopotamia to twentieth century Communist Yugoslavia.

These short presentations showed the pertinence of the topics explored to social, political and medical issues today. Thus, in a paper entitled Disabling Democracy, Rabia Belt from the University of Michigan explored the ways in which categories of mental deficiency entered the constitutions of the forty US states which currently prevent those with any form of mental impairment from voting. Many of these rulings still use the nineteenth century terminology of “insanity” and “idiocy” and, moreover, have been heavily indicated in wider political concerns. In the nineteenth and early twentieth centuries, for example, American Indians, African Americans, and women were at various times regarded as unfit for suffrage and full political citizenship because of alleged mental deficiencies.

Similarly, Yoshiya Makita from the University of Tokyo investigated the ways in which medical notions of mental retardation entered the political arena in early twentieth century Japan, where ideas of disability intersected with those of class, criminality, and citizenship through emerging state control. In a paper which may well be of interest to those who visited our Phantasmagoria exhibition last year, Max Gawlich of the University of Heidelberg described how mescaline intoxication became viewed as a “model psychosis” by researchers in Heidelberg in the 1920s (late nineteenth century experimenters with mescaline had not, it seems, assumed that the hallucinations produced by the drug were necessarily the same as those experienced in a psychotic episode), and the ways in which their experiments were entangled with and embedded into historical, social and cultural contexts.

Participants in the conference indicated a keen interest in setting up a virtual research network, enabling easy communication of information and ideas across continents. This will begin with an H-net list for the history of psychiatry, providing an informal environment for discussion of issues, like those above, which appear of extreme importance to twenty-first century society. More to follow soon…

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.

Life in a Victorian Asylum 2: Clerks and Governesses

While certainly connected to moral treatment, improvements at Bethlem were presumably also related to the changing patient profile: throughout the nineteenth century the Hospital became increasingly middle class – by the 1860s, the majority of patients tended to come from lower middle and “educated” working class backgrounds. As Hood lamented in 1854, “The records of all Asylums show how liable are clergymen, authors, artists, governesses, professors and similar persons to be attacked by this terrible calamity. None are more subject to this visitation, none are less able in a pecuniary point of view, to struggle through the trial of such an affliction, yet none are less cared for by the many charitable institutions of our country.” This changing patient profile is indicated in the admissions: 10% of male admissions to Bethlem in 1845-55 were clerks (compared to just 0.01% of the population), while 7% of female admissions were governesses or school mistresses (again, just 0.01% of all women were governesses).

In reflection of this changing class of patient, the Hospital’s wards increasingly came to resemble the Victorian domestic ideal: as the Illustrated London News put it, “that which was once a prison-cell has now become a cheery, domestic room,” while Freeman’s Journal later described photographs of the late nineteenth century hospital as “luxurious” and of “hotel-like magnificence.” This was in line with similar changes described at St Luke’s by Charles Dickens, in his article A Curious Dance Round a Curious Tree. Nonetheless, most contemporary observers were aware that these changes might be little consolation for many patients. As the correspondent from the Illustrated London News concluded: “I thought of the luxuries and the comforts, the plants and the pet animals, the books and the periodicals, the billiard and the ball room, the skill and tenderness of the physician; but all these, to my mind, would not fill up the vast abyss of human mental misery yawning beneath the lofty dome in St George’s fields…”

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.