Posts Tagged 'biography and psychology'

Biography & Psychology VII: Henry Maudsley (1835 – 1918)

Henry Maudsley’s name is best remembered today – within the South London and Maudsley Trust, at least – for the Hospital he founded. In 1907, Maudsley offered £30,000 to the London County Council to set up a research hospital for the treatment of acute psychiatric cases. In the event, the Maudsley Hospital was not opened for civilian purposes until after its founder’s death, although it was used as a “Neurological Clearing Hospital” during the First World War.

Much has been written about Henry Maudsley, who was a prolific writer and highly regarded theorist within the nineteenth-century asylum movement. Born into a farming family, near Settle in the Yorkshire Dales, he later went into medicine and graduated from the University of London. The young man apparently contemplated becoming a surgeon and entering the Indian Medical Service but, on taking an appointment at the Essex County Asylum in order to gain experience of mental health services (required for work in the Indian service), he subsequently decided to specialise in the field. His textbooks on the Pathology and Physiology of Mind went into a number of editions, and Maudsley was one of the most well-known psychiatrists of the second half of the nineteenth century, both within asylum psychiatry and beyond.

Henry Maudsley was known personally by doctors at Bethlem, and it was his contemporary and former Bethlem superintendent George Savage who penned an obituary of the great thinker for the Journal of Mental Science. Savage’s article is both intriguing and amusing, claiming to provide a view of Maudsley as he was, as he appeared to others, and as he appeared to himself. The obituary has often been taken to suggest a deeper enmity between the two gentlemen, who certainly argued over a number of issues, not least that of mechanical restraint. But there nonetheless does remain a strong note of friendship within Savage’s text, littered as it is with minor anecdotes about Maudsley’s character: his pride in his appearance which apparently encouraged scrupulous care of his hands, a love of cricket that resulted in a trip to Australia to “see the best of [… it] in its best home” and his “Gladstonian” habit of sending critical postcards, of which Savage had a personal collection he had headed “Maudsley’s Fire”!

Savage regarded Maudsley as a great humanitarian, who, in pursuing grand causes, had little time and inclination to relate to individual men around him. This was the complete opposite of Savage, described by friends as the “most clubbable man I ever knew” (i.e. shown to be popular by his membership of large numbers of social and professional societies). This opposition was reflected in the approaches of the two to psychiatric treatment. Maudsley, who left asylum psychiatry early in his career, preferred a theoretical understanding of mental illness, emphasising universal benevolence and the principles of non-restraint on the one hand and a pessimistic biological view of illness on the other (if insanity was inherited, cure might be a hopeless task). Savage, meanwhile, tended towards an individual approach, taking into account the wide variety of social and environmental factors acting on each patient, while insisting that, in some cases, mechanical restraint was absolutely necessary.

Different as the two men were, they appear to have remained in touch well beyond Maudsley’s asylum days, and Savage concluded his obituary on a sentimental note. With Maudsley’s death, he felt:

“So there passes from our sight a powerful and graceful influence, one with deep human sympathy, masked, to some extent, by reasonable cynicism. His influence was wholly for good, though one feels, with all the poetry and beauty of his writings, there is a want of some definite faith … And so we leave his influence to spread, as were his ashes, on the land he loved.”1

1 George Savage “Henry Maudsley” Journal of Mental Science, 64 (1918), 117-123

Henry Maudsley

Image: Wellcome Library, London

Biography & Psychology VI: W.H.R. Rivers (2 of 2)

(continued from previous post)

As a clinical assistant at Bethlem, Rivers’ duties were widespread, and would have included regular visits to the wards and completion of the statutory casebooks (the latter administrative task was most often carried out by the assistants rather than the paid physicians), as well as examination of patients, attendance in emergencies and routine medical treatments, and procedures such as force-feeding. There was also a social side to the role: clinical assistants, like all medical and ward staff, were expected to get involved in hospital entertainments, whether by playing in the band or performing in plays and variety shows for patients. Their residence in the hospital meant that, for the six months of the appointment, Bethlem effectively became the focus of a clinical assistant’s professional and social life: we even find records of fiancées, family members and friends appearing alongside them in entertainments.

While it might be tempting, in light of the role he is later perceived to have held in promoting the psychological side of mental health, to read such interests into Rivers’ notes at Bethlem, this is not necessarily the case. Indeed, Rivers’ entries in the casebooks do not differ materially from those of the other assistants, adhering closely to the guidelines of the Commissioners in Lunacy (who inspected all asylum records) and using similar language to his contemporaries. In November 1892, for example, he wrote that Mary Ann Russell “[c]annot be got to say anything about her trouble. Rubs & picks her face and head very much. Is very resistive.” In March the following year, the patient was “[s]till very troublesome to feed, has required tube once or twice lately. Stands about gallery usually rubbing her head. Will not talk.” Such descriptions – “resistive” and “troublesome”– were part of a common psychiatric language, regularly adopted in cases of patients exhibiting particular behaviours. Indeed, such concerns often became used as a general guide to be applied from one individual to another exhibiting similar symptoms, “anticipating” further behaviours before they had even occurred. While Rivers’ 1911 address to the Anthropological Section of the British Association for the Advancement of Science complained about the general tendency within anthropology to use the psychology of the individual as a guide for the collective action of mankind, such correlations (from one individual to all individuals to society as a whole) were often also made within turn of the century psychiatry. Such generalizations would hold enormous resonance in Rivers’ later career in war psychiatry, when the perceived general tendency of human beings to evade duty would be deemed the main motivation behind individual cases of war neurosis, particularly by war office officials. This exacerbated one of the major tensions within psychiatry, whereby the creation of new classificatory approaches to mental illness (related to efforts to uncover universal truths about normal and abnormal psychology) conflicted with the claims of asylum professionals to treat patients individually, and to see the onset of illness as resulting from a combination of biological, psychological and environmental factors, which would be unique to the individual.

Biography & Psychology VI: W.H.R. Rivers (1864 – 1922)

W.H.R. Rivers is probably most famous today for having been the doctor of poet Siegfried Sassoon, when he was treated for “shell-shock” at the Craiglockhart War Hospital in 1917. Pat Barker’s well-known novel, Regeneration, depicts Rivers as a hero of wartime psychiatric treatment, pioneering psychological approaches to mind over the punitive electro-shock methods of Lewis Yealland. What is less well-known is that Rivers’ career in psychiatry began at Bethlem. Born in 1864, William H.R. Rivers trained in medicine, subsequently deciding to “go in for insanity” (as he put it in his diary), following which he gained a position as clinical assistant at Bethlem Hospital in October 1892.1 These six-month residential (but unpaid) posts were open to fully qualified medical practitioners with a special interest in the field. Although absent from Bethlem over the Christmas period, when he was struck down by an outbreak of scarlet fever in the wards, in March 1893 it was noted that both Rivers and his fellow assistant, Maurice Craig, were “anxious to continue in residence … for another 6 months.” In the event, Rivers only stayed at Bethlem for another two, asking to resign on May 24 when he was offered a Lectureship in Psychology at Cambridge. Yet he continued to lecture at Guy’s Hospital with George Savage, whom he had presumably met while working at Bethlem (Savage, a former superintendent, regularly brought parties of students to the wards for instruction as well as visiting the hospital socially).

Rivers’ interests remained wide, and his career encompassed a variety of elements that may seem contradictory to modern eyes, used to specialism. It is often assumed by historians that neurological approaches to mind required a determinist, “medical materialist” approach, which privileged somatic medicine over psychology and objective physical symptoms of illness above subjective ones. Yet it doesn’t appear that Rivers (or many of his contemporaries) perceived any such conflict between physical and mental medicine. In his early career he combined neurological research with Henry Head (the “nerve regeneration” experiments after which Pat Barker’s book is named) and social anthropology (in the Torres Straits study of 1898, and his own research into the Todas a few years later) with medical and experimental psychology.

(to be continued…)

[1] Rivers quoted in Richard Slobodin, W.H.R. Rivers: Pioneer Anthropologist, Psychiatrist of “The Ghost Road”, (Stroud: Sutton, 1997) , p. 13

Rivers and Head
Rivers and Head during the nerve regeneration experiment (Rivers seated right)

Image: Wellcome Library, London

Biography and Psychology V: Henry Francis Harding (1826 – 1896)

In September 1896, the editor of Bethlem magazine Under the Dome had “a very serious loss” to report: the death of the un-official “Sub-Editor”, Henry Francis Harding, at the age of seventy. Harding had contributed regularly to the magazine since its foundation, compiling a regular column, Notes Apropos, (which related articles in the outside press to events in Bethlem and vice versa), writing a variety of articles on historical and other topics (signed X. or H.F.H.) and compiling the index to each annual bound volume.1 In addition, Harding received credit in publications going beyond the Hospital. When Theo Hyslop’s Mental Physiology was published in 1895, he thanked “his friend, Mr. H.F. HARDING, for revisal of the proof-sheet”.2

It would not be obvious from either of these sources that Henry Harding was,throughout this time, a patient at Bethlem, although Harding himself made no secret of this fact. Indeed, he often took it upon himself to remind others of the need to avoid the potential separation (at least to outsiders) between the official function of the hospital and its therapeutic one. For example, in a lengthy report of the opening of the new recreation hall in June 1896 by the Duke of Cambridge, Harding listed the many prestigious persons present, before concluding:

Last but not least (seeing that the raison d’être of the Recreation Hall and of the Hospital, generally, is the patients, and which, it should be added, is practically and in kindly form recognised by those governing, or otherwise controlling the inner life of the Hospital), we were pleased to see present a fair contingent of the said patients, with nurses and attendants..3

In one of his earlier columns, Harding commented that “we who write these notes are of the genus patient (species: “Voluntary”) – and very patient, if a somewhat lengthy abiding in Bethlem be taken – and should it not? – as evidence thereof.”.4 When he wrote these lines in 1893, Harding had indeed been at Bethlem for an unusually lengthy period, following his admission in December 1886. His casenotes state that the former Law Stationer (who had left work the previous March, feeling “overworked”, perhaps not surprising at the age of 60), came to Bethlem “because he felt his misery & agitation would make him lose control.” Nonetheless, he was never certified, and it is entirely possible that it was Harding’s personal situation, rather than his state of mind, that led to his lengthy stay. Elderly and un-married, Henry seems to have come to regard the Hospital as the family he never had, emphatically stating of Bethlem: “therein are we not a happy family! We are, we are…”.5

While it is obvious to see the benefit to the Hospital of such an enthusiastic advocate, Harding also reminds us that life within the Hospital was varied, and one person might have multiple roles. Henry Harding was not “just” a Bethlem patient, but also Sub-Editor, social campaigner, chronicler, companion and friend: someone who could legally have left Bethlem at any point, but chose not to. An unusually personal note in the usually factual Physician’s Weekly Report of 19 August 1896 records that “Mr H Harding VB has died of natural causes & his loss will be much felt.”

HF Harding1

Photograph of Henry Harding, c. 1886

1 “Mr H.F. Harding”, Under the Dome , vol. 5, no. 19 (Sept 1896)
2 Hyslop, T.B. Mental Physiology, London (1895)
3 Harding, H.F. “Opening of the Recreation Hall by H.R.H. the Duke of Cambridge” Under the Dome, vol. 5. No. 18 (June 1896)
4 Harding, H.F. “Notes Apropos” Under the Dome, vol. 2, no. 8 (Dec 1893)
5 Harding, H.F. “Notes Apropos” Under the Dome, vol. 2, no. 7 (Sept 1893)

Biography and Psychology IV: Daniel Hack Tuke (1827 – 1895)

Daniel Hack Tuke was a major figure at Bethlem in the late nineteenth century, and well-known within the field of psychiatry. Today he is often over-looked, perhaps due to his self-acknowledged role as a compiler of information, rather than an innovator: his contemporaries saw him as “a sort of scientific sponge”: “the cool-eyed observer of nature, and not the far-seeing prophet.”1 One of his major works in this vein was his enormous two-volume compendium A Dictionary of Psychological Medicine, which included articles by many of the leading psychiatrists, psychologists and neurologists of the day, including Jean-Marie Charcot, Hippolyte Bernheim andVictor Horsley.

Tuke was the great-grandson of Samuel Tuke, the Quaker founder of the York Retreat, famous for his role in encouraging the humanitarian treatment of the mentally ill. The Tukes recommended “moral treatment” – the use of education and occupation in asylums, rather than whips, chains and the dramatic bleedings and purgings recommended by some eighteenth century doctors. Bethlem, as previous posts have acknowledged, was heavily influenced by these ideas throughout the second half of the nineteenth century.

Tuke first became involved with Bethlem in the 1870s, and was a trustee until his death, regularly attending meetings and walking the wards – his name can often be found mentioned in anecdotes in the patient casebooks. He was a close colleague of George Savage, superintendent from 1878 – 88: the two were joint editors of the Journal of Mental Science (now The British Journal of Psychiatry) for some sixteen years, and Savage wrote more articles for Tuke’s Dictionary than any author other than Tuke himself. Tuke shared Savage’s commitment to the importance of personal relationships between psychiatrists and asylum patients, as reflected in an obituary in Under the Dome written by Bethlem patient Henry Francis Harding. Harding’s obituary is a stark contrast to the medical obituaries found in the Journal of Mental Science, The Lancet and the British Medical Journal, concentrating on his family life and relationships rather than his medical achievements (although the latter articles do refer much to Tuke’s apparently “sentimental” nature).2 He wrote:

The early death of his eldest son, who was a brilliant student of University College Hospital, was a painful blow to Dr. Tuke, but no doubt he found some amount of solace under this loss in the successful career as a painter of his other son, Mr. H.S. Tuke. [Henry Scott Tuke] The latter has been a foremost member of the Newlyn School, and like most of his brother artists of that school of painters, has lived a good deal on his boat on the coast of Cornwall, and, we remember, that about three seasons since, Dr. Tuke, upon his first visit to the Hospital, after his autumn holiday, said to the present writer that he had much enjoyed it, having in good part spent it with his son upon the latter’s studio-boat.3

Henry Scott Tuke, best known for his Impressionistic paintings of male nudes, was a highly successful artist in the late nineteenth and early twentieth centuries, more recently becoming a cult figure in gay cultural circles. Although he was involved in what were then often termed “Uranian” circles, judging by the anecdote above Henry enjoyed a close relationship with his father. Looking at the personal and familial life of nineteenth century psychiatrists, then, can sometimes indicate that the definite and moralistic statements of contemporary published works (Tuke’s Dictionary, for example, includes a piece by Conolly Norman about homosexuality entitled “Sexual Perversion”) were not necessarily adhered to throughout their daily lives – or even, necessarily, in asylum practice.

1 Rollin, H. “Daniel,Hack – Obituary” The Lancet, vol. 145 (1895): 718-20

2 Harding, H.F. “Daniel Hack Tuke, M.D., F.R.C.P., LL.D.” Under the Dome, vol. 4, no. 14 (June 1895)

3 Rollin, op. cit.

Daniel Hack Tuke

Image copyright of the Wellcome Library, London

Biography and Psychology III: Walter Abraham Haigh

Walter Abraham Haigh was first admitted to Bethlem in October 1882. He was a tutor, who held a B.A. from Oxford University, and was 27 years old. He was diagnosed with Delusional Insanity and described as excited, and subject to fixed delusions and hallucinations, particularly of persecution. Victorian society was heavily class-based, and it may thus have been Haigh’s educated background that made his own explanations of his illness seem particularly interesting to his doctors: his casenotes are peppered with quotations, apparently reported verbatim.

Moreover, the extensive nature of the notes concerning Haigh suggests that he often conversed with the doctors, in addition to his usual asylum pursuits of playing the violin and chess. Haigh and superintendent, George Savage, certainly worked closely together. In March 1885, it was recorded that he “has during the last year rendered considerable assistance to Dr Savage in the production of his Manual of Insanity.” Indeed, Haigh is one of just two people acknowledged in the preface to Savage’s textbook: “W. Haigh, Esq., who has not only corrected my proofs, but has by criticism aided me much in the legal chapters.”

Without prior knowledge, it would be impossible to tell from Savage’s book that Haigh was one of Savage’s patients. Indeed, Haigh and Savage’s relationship serves to blur the distinction between doctor and patient entirely: it is Haigh who suggests his own treatment (the insertion of a seton in his neck – see image below for explanation of this treatment by “counter-irritation”), and the doctors quickly acquiesce. Moreover, despite continuing to admit to hallucinations and delusions often considered “dangerous” by Victorian psychiatrists, Haigh is given a free pass key to the asylum, although he is unwilling to leave the grounds, feeling suspicious of strangers.

Walter remained in touch with doctors at Bethlem after his discharge, regarded as well, in July 1888. He visited the Hospital over the Christmas of the same year, mentioning that he had been living in Dieppe as a tutor. The next year, he decided to go into the Church, and in 1890 took priest’s orders. Judging from his many letters, Haigh continued to suffer from the “hallucinations and illusions of contempt and persecution” that he had long complained of, but was nonetheless able to work and live outside the asylum (without, of course, the aid of medication), and does not appear to have been certified again, although he did return to Bethlem three times for a short stay as a voluntary boarder in the 1890s. “As to what my perversions of sensations are no “sane” person would have any idea.” He wrote in 1890, “But I do despise those who know I have been certified and who judge ignorantly.”

 Image of a Seton in the Neck

Image from Armamentarium Chirurgicum by Johannes Scultetus, c. 1655

Wellcome Library, London

Biography and Psychology II: George Savage (1842 – 1921)

Our recent post on biography in the history of psychology has inspired a new series, exploring the lives of certain individuals at Bethlem, beginning with late-nineteenth-century psychiatrist, George Savage.

Savage is little remembered today: he is most famous in the field of literature, having for a while attended Virginia Woolf. His lack of contribution towards any major theoretical approaches to mental illness, or shifts in diagnostic classification, make him often appear a minor figure in the history of psychiatry. Yet, for his case-based approach, Savage serves as an interesting example of the late Victorian asylum psychiatry and, in the late nineteenth and early twentieth centuries, he thus held a prominent position in the field. Indeed, Savage appears to have been the only psychiatrist who appeared in Vanity Fair’s prestigious “Men of the Day” series (on his knighthood in 1912) and, on his death in 1921, was declared by The Times an “authority on insanity.”

George Henry Savage was born in Brighton in 1842, into a middle class family. He went into medicine, qualifying in 1865, with his first post being as House-Surgeon at Guy’s Hospital. However, after taking on a six-month post as “resident student” at the Bethlem Royal Hospital the following year, Savage later claimed that he “saw the possibility which might open as a life’s work.” After a period as a country GP, Savage returned to Bethlem as Assistant Medical Officer in 1872, later becoming Physician-Superintendent, before leaving in 1888 to embark on a successful career as a consultant psychiatrist, while remaining in regular contact with Bethlem, and on the board of governors until his death.

Savage was an active member of the Medico-Psychological Association (meetings of which were often held at Bethlem), served a term as President, and was co-editor of the Journal of Mental Science, the main psychiatric journal, from 1878 until 1894. Yet, this professional engagement should not blind us to the importance of seeing Savage, also, as an individual. He was not only well-known in the field of psychiatry, but also appears to have been popular in a broader swathe of contemporary urban bourgeois society, described by a friend after his death as “the most clubbable man I ever knew.” Savage’s membership of a huge number of dining and literary clubs attests to this. His contemporaries described him as a “big-brained vigorous-bodied man,” who “revelled in climbing crags, sport on the moors … and ski-ing over snow and icy roads.” As a follow-up post will indicate, seeing Savage as a person as well as a doctor reminds us that his relationship with his patients was often personal, as well as professional.

Savage in Vanity Fair

Caricature of Savage in Vanity Fair, 1912