Adventures in Psychiatry: Narrating and Enacting Reform in Post-War Mental Healthcare

Abstract

The development of psychiatry owed much to the establishment of pauper lunatic asylums throughout Britain in the second half of the nineteenth century. However, the low status of these institutions, combined with psychiatrists' failure to devise effective treatment methods, meant that psychiatry did not enjoy a prestigious reputation in the nineteenth and early twentieth centuries. The post-war era, however, is commonly viewed as a period of rapid change in British mental healthcare. Mental hospitals were brought within the provisions of the new National Health Service in 1948, and this development provided psychiatrists and other mental health care workers with an opportunity to raise the status of psychiatry by reframing the profession as just another branch of medicine. Yet there was little consensus as to how progress was to be achieved, for psychiatrists were developing seemingly antithetical therapeutic models, premised on divergent understandings of the etiology of mental disorders. Some psychiatrists were convinced that mental illnesses had biological causes, just like other illnesses. They developed and applied new physical therapies such as electroconvulsive therapy (ECT) and leucotomy, which they hoped would target the physical origins of mental disorders while also aligning psychiatry to developments in general medicine (Shorter ch. 6). Other psychiatrists were interested in their patients' psychological symptoms, and the ways in which patients' psychosocial environments influenced their mental wellbeing. These psychiatrists developed a model of social psychiatry and sought to establish therapeutic communities within their hospitals, building on wartime experiments in the use of group treatment methods for soldiers displaying psychological symptoms (Harrison and Clarke 698-708; Mills and Harrison 22-43; Whiteley 233-48). In so doing, they hoped to counter institutionalization by transforming mental hospitals into actively therapeutic environments. This article examines how psychiatrists who subscribed to different therapeutic approaches narrated their efforts to transform psychiatric practice within their memoirs. It focuses on accounts authored by William Sargant, an advocate of the physical therapies, and Denis Martin and David Clark, both associated with social psychiatry and the therapeutic community approach. Temporally located views of the space and place of mental healthcare underpinned all three narratives, for the authors premised the need for reform on the legacy of therapeutic pessimism and authoritarianism, physically embodied within Britain's antiquated psychiatric hospitals. However, while Martin and Clark sought to transform the lives of chronic patients within the old psychiatric hospitals, Sargant attempted to relocate psychiatric care within general medicine, discarding chronic patients and psychiatric hospitals as unsalvageable relics from the past. Undeniably, the authors' divergent views on the nature and treatment of mental illness partially account for differences in the ways they represent change. Yet this article argues that we also need to examine how psychiatrists represented their own role in enacting change within their narratives, for this helps account for the varying ways in which each writer represented psychiatry, mental hospitals, mental illness, patients, and the roles played by other parties in reforming mental healthcare. BIOGRAPHY An examination of the background and career of each author provides an insight into each doctor's views of mental illness, while also providing clues as to the personality of each writer, which would in turn shape their narratives. Of the three, Sargant arguably achieved the most prominence within the profession. Born in 1907, Sargant studied medicine at Cambridge University and obtained his MB degree in 1933. Aged twenty-five, he was appointed medical superintendent of St. Mary's Hospital where he undertook research into the treatment of anemia. …