Gender and Madness in Post-War Bethlem: A Meeting of Minds?

World War Two has been depicted as an era of innovation, professional growth and public acceptance for British psychiatry. Nevertheless, in the psychiatric treatment of women, ‘progress’ may have been transient: they have been considered more susceptible to insanity due to supposed biological propensity or exacting social expectations. Clinically, a rising tide of voluntary admissions from the 1930s coincided with the emergence of ‘psycho-neuroses’, a category in which women were over-represented. Women also outlived and outnumbered men, and gender disparities in admissions were subject to preferences of GPs and other ‘gatekeepers’. Whilst some evidence also links male admissions to transgression of stereotyped career norms, this finding is obscured by historical emphasis on female patients.

The gendered experience of mental health was amongst issues debated at a recent conference on the history of post-war women’s health, hosted by the University of Manchester’s Centre for the History of Science, Technology and Medicine. Emerging research based on analysis of primary source material used Bethlem Hospital as a case study for exploring similarities and differences in the experiences of male and female patients in this period. Admission register and casenote data provided a unique glimpse into prevailing theories of mental illness, and the changing character of the hospital and its patients. This was complemented by interviews with former Bethlem staff.

Key patterns were identified in the demographic composition of Bethlem’s patients, diagnostic practices and treatment delivery, with discussion of how these characteristics evolved over fifty years, against a wider backdrop of legal, social and scientific change. The findings chiefly indicate a postwar convergence, and, in some cases, reversal, of traditionally ‘gendered’ diagnoses – such as anxiety – and the ascent of ‘affective psychosis’ (e.g. manic depression) amongst women. This was countered by a widening age disparity between male and female admissions, most prominent within the over-60 age groups, where a middle-class bias remained apparent. Although the psychological effects of marriage are unresolved, the research suggested that women may also benefit, and that in this area too, the experiences of men and women had more in common than has previously been acknowledged. Finally, investigation of psychotherapy services is shedding further light on how shifts in theory and practice affected the hospital’s population and recovery rates.

Although one should not over-generalise from case study evidence, it is very striking that the Bethlem data do not conform to gender dichotomies of mental illness established in both academic discourse and the popular imagination. This, in itself, highlights the value of such research in deconstructing accepted accounts of male/female disparity in psychiatric experience and the need for continued engagement with documentary and oral histories of mental health care.

The programme for the conference, which took place last month, is
available on the University of Manchester website.

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