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…

Exercising the Brain

One of our volunteers has written the following reflection on her experience so far of working at the Archives & Museum:

“I am now into my sixth month as a volunteer archive assistant at Bethlem Royal Hospital Archives & Museum, and the assignment I am currently working on is an in-progress family history project entitled ‘Out of your Census’. The purpose of the project is to ascertain the identities of the patients at Bethlem Royal Hospital when the census returns of 1891, 1901 and 1911 were made. When these records were produced, the patients who inhabited Bethlem during these periods were identified by their initials only. Now that the returns are in the public domain and available online, they are an invaluable resource for family historians – but not in respect of patients of hospitals such as Bethlem. The project utilises historic archival data indices to identify the Bethlem patients whose initials appear in these census returns, with the aim of putting this data online in a searchable form.

“My time at Bethlem Archives & Museum has been rewarding on both a personal and an academic level. My MA was in Art History and I chose to concentrate part of my studies on art and mental health, so the work of Bethlem Museum is of particular interest to me. The research also allows me to utilise my academic knowledge and exercise my brain!  Due to the current economic climate, finding work in this field has been extremely difficult, so volunteering at the museum is a break from the monotony of working in a shop. However, juggling a job in customer service and volunteering is sometimes difficult, as I have to keep to full-time hours in my paid employment, yet my interest and passion lies in my voluntary work!

“I have found reading nineteenth-century handwriting challenging. Moreover, due to the content of the records it has been hard to read the words before me without sentiment due to their content. Though 120 years have passed since the making of the 1891 census, the memories of many of the individuals whose lives are documented in the leather bound records of this era will remain with me; they are an indelible part of Bethlem’s history. When finished, ‘Out of your Census’ will provide a unique means of bringing these ‘invisible’ individuals out of the shadows of history, and I am grateful for the opportunity to contribute to it.”

Madness and Literature 2: “A Hideous Torture on Himself”

When not working at the Archives and Museum, the part-time Friends Secretary is also researching the nineteenth century casebooks. She presented at the Madness and Literature conference, examining representations of self-mutilation (a term introduced and defined by psychiatrists, including Bethlem superintendents George Savage and Theo Hyslop, in the 1880s) in nineteenth century literature and psychiatry. The title bears reference to Nathaniel Hawthorne’s The Scarlet Letter, first published in 1850. Set in puritanical seventeenth-century Massachusetts, the novel tells the story of the punishment of Hester Prynne, forced to wear an embroidered “A” on her chest (the “scarlet letter” of the title) as punishment for having borne an illegitimate child. At the close of the novel, this “A” is exhibited burnt into the chest of the Reverend Arthur Dimmesdale, publicly revealing him to be the child’s father, made physically and mentally ill through the long-guarding of his guilty secret. In Hawthorne’s work, the origins of the wound are debated, although to late nineteenth and early twentieth century psychiatrists, as well as certain of the spectators described by Hawthorne, the only “rational” explanation was that Dimmesdale’s self-punishment had been “followed out by inflicting a hideous torture on himself.”

Although Hawthorne’s representation of Dimmesdale was certainly not intended as a medical case history, the case was referenced by medical writers who had no problems with what some later authors, including Henry James, saw as a crude use of symbolism in an otherwise psychologically interesting novel. Indeed, many nineteenth century medical writers on self-mutilation expected their patients’ acts to be similarly symbolic, analysing motives and “hidden meanings” in a manner often starkly at odds with that in which other problematic behaviours were portrayed (in the Bethlem casebooks, refusal of food or persistent removal of clothes, for example, is usually simply dismissed as troublesome).

We can find many examples in the Bethlem casebooks of these attempts – by patients and practitioners – to give meaning to self-damaging actions such as face-picking, hair-plucking and self-cutting. In 1889, James Hipwood’s attendant stated that the former had cut his face because “he liked to see the blood that followed.” To his mother, meanwhile, Hipwood said that he cut himself because “he wanted to see if he could feel anything.” Yet, in Bethlem, an alternative explanation was implied. Although the doctors found it hard to get anything out of their patient at all, he did tell them “that he does not want to live & hints at something dreadful that is going to happen & at great suffering which he will have to bear.” The medical officers suggested that “he is apparently trying to prepare himself [for this] by inflicting pain on himself now.”

Photograph of Mary Stoate, admitted to Bethlem in 1895

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…”

London Lives: New Online Research Resource

A wide range of primary sources for eighteenth-century London has just been made available online (by a consortium led by the Universities of Sheffield and Hertfordshire) in fully searchable form at http://www.londonlives.org. These sources include the minutes of the Court of Governors of Bridewell and Bethlem Hospital from 1689 to 1800.

The search capability of this new resource makes it particularly useful. After all, the minutes of the Court of Governors from 1559 to 1792 have been available online at http://www.bethlemheritage.org.uk for some years now. But it would be a labour of love, as well as a palaeographical challenge, to browse through them looking for something particular.

Now there is a much easier way, as long as your interest is in something that is recorded in the Bridewell and Bethlem court book minutes (or indeed in any of the other London records digitised as part of the project) between 1689 and 1800.

Say you wanted to find references in the court books to Edward Tyson, Bethlem’s Physician from 1684 to 1708. Just go to the Search Form, type in ‘Tyson’ and ‘Edward’ in the name fields, choose Bridewell Royal Hospital > Minutes of the Court of Governors in the ‘Search in Document Type’ field to limit your search (if that’s what you want to do), and click on ‘Search’.

You should get seven results (the earliest dated 1691), and be able to click through to a transcription and digital image of the original minute book entry for each one.

The London Lives homepage gives details of a conference that will take place on 5 July 2010 at the University of Hertfordshire to celebrate the launch of this new resource. Scholars, take note!