Chapter 2 Historical changes in mental health practice

Abstract

However we define ‘community psychiatry’, it is clear that, in contemporary societies, practices addressed to the mental troubles of individuals have proliferated across everyday life. Psychiatric interventions occur in mental hospitals, psychiatric wards in general hospitals, special hospitals, medium secure units, day hospitals, outpatient clinics, child guidance clinics, prisons, children’s homes, sheltered housing, drop-in centres, community mental health centres, domiciliary care by community psychiatric nurses, multiple forms of psychological therapies, and, of course, in the general practitioner’s surgery, not least through the increasing prescription of psychiatric drugs. No phase of life is unknown to these practices: infertility, pregnancy, birth and the postpartum period; infancy; childhood at home and at school; sexual normality, perversion, impotence, and pleasure; family life, marriage and divorce, employment and unemployment, mid-life crises, and failures to achieve; old age, terminal illness, and bereavement.Wherever problems arise — in our homes, on the streets, in factories, schools, hospitals, the army, courtroom, or prison — experts with specialist knowledge of the nature, causes, and remedies for mental distress are on hand to provide its diagnoses and propose remedial action. And, of course, there is a wider penetration of psychiatry, broadly defined, into popular culture, as psychiatrists, mental hospitals, those with mentally illness, and the problems of mental health feature daily in political and social debates, in our newspapers, in television documentaries, exposés, talk shows, and soap operas. The languages that have been disseminated have given us new vocabularies in which to think and talk about our problems — stress, trauma, depression, neuroses, compulsions, phobias. They have also provided us with new ways of explaining, judging, and accounting for our personal miseries, of distinguishing the normal and the abnormal, identifying what is illness, when to seek assistance and from whom. It would not, therefore, be too much of an exaggeration to say that we lived in a ‘psychiatric society’. ‘Community psychiatry’, then, is one dimension of the ‘psychiatric societies’ that has taken shape over the course of the 20th century. There have been many international variations in the historical paths followed in different national contexts, but the rationalities and practices that have taken shape are remarkably similar across the Western world. In this chapter, focusing upon the United Kingdom, I want to sketch out some of the key moments in this history.