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Humanitarianism or Control? Some Observations on the Historiography of Anglo-American Psychiatry
... In the case of European and Anglo-American psychiatry there is a large scholarship which shows that mental hospitals and mental asylums (and other psychiatric institutions and processes) derive their strength and persistence as instruments of social control (see, for example , Foucault 1967;Rothman 1971;Scull 1977Scull , 1979Ingelby 1981;F. Castel et al. 1982;Sedgwick 1982;Warner 1982;Miller and Rose 1986;Porter 1987;Scherper-Hughes and Lovell 1987;Scheff 1999). ...
... In the case of European and Anglo-American psychiatry there is a large scholarship which shows that mental hospitals and mental asylums (and other psychiatric institutions and processes) derive their strength and persistence as instruments of social control (see, for example , Foucault 1967;Rothman 1971;Scull 1977Scull , 1979Ingelby 1981;F. Castel et al. 1982;Sedgwick 1982;Warner 1982;Miller and Rose 1986;Porter 1987;Scherper-Hughes and Lovell 1987;Scheff 1999). ...
... They may fail to recognize where they appear to imply (absent any demonstrations) that madness is self-evidently a medical problem by unreflectively using medically tainted language. As we described, despite their differences (see Scull, 1985), virtually all infuse their texts with medicalized terms such as mental illness, disorder or disease, as analogs for madness, even when they recognize the inability of these concepts to capture the range of heterogeneous behavioral content that is subsumed under the disjunctive category of madness. Their message to their readers is therefore likely to be: you are reading an account of the laborious journey to the triumphant scientific discovery of the true nature of madness as medical illness of a sort (even if it is not exactly like physical disease) amenable to medical supervision. ...
Summary of the psychiatric present and possibilities of the future for humane treatment of human personal despair and difficulties
... They may fail to recognize where they appear to imply (absent any demonstrations) that madness is self-evidently a medical problem by unreflectively using medically tainted language. As we described, despite their differences (see Scull, 1985), virtually all infuse their texts with medicalized terms such as mental illness, disorder or disease, as analogs for madness, even when they recognize the inability of these concepts to capture the range of heterogeneous behavioral content that is subsumed under the disjunctive category of madness. Their message to their readers is therefore likely to be: you are reading an account of the laborious journey to the triumphant scientific discovery of the true nature of madness as medical illness of a sort (even if it is not exactly like physical disease) amenable to medical supervision. ...
... Marxist writers have argued that what is described as humanitarian approach, was in fact the 'reprogramming' of the insane in order to function as productive members of society (e.g. Scull 1985). Overall, attempts of improving conditions had limited effects and the situation was still more custodial than therapeutic in character (Goodwin 1997). ...
... The rise of medical power, and the subsequent decline in standards of asylum care, also followed the same pattern as in Europe. However, as Scull has pointed out, 53 Rothman places so much faith in the accounts given by the protagonists of the asylum movement themselves that he fails to link this movement to the larger social and political order: his analysis therefore does not penetrate to the level at which developments in America, England and France can be related to each other. Though he sees psychiatry as an attempt to control social unrest and disorder, he does not see this control in the context of economic forces or class interests. ...
... Marxist writers have argued that what is described as humanitarian approach, was in fact the 'reprogramming' of the insane in order to function as productive members of society (e.g. Scull 1985). ...
... The term 'critical social histories' is used here as a generic term to describe those works within social science taking an explicitly critical view of the development of the mental health professions and mental health services. These tend to combine elements of Marxism, hermeneutics, critical realism and poststructuralism, and so are not attributable to a single social theory (Baruch and Treacher, 1978;Scull, 1979Scull, , 1985Ingleby, 1985;Pilgrim and Treacher, 1992). ...
For health and social care practitioners, the accurate understanding of mental health problems is an important aspect of their effective amelioration. The practices of diagnosis and formulation have both been used for this task. The first has been associated with individual cases being allocated to pre-existing professionally agreed categories. The second is typically expressed by some form of tailored description of the patient's presenting problems in his or her life context. Both diagnoses and formulations are thus traceable to professional assumptions, expressed in codified forms of knowledge. This article provides a description of the tensions between diagnostic- and formulation-based mental health assessments. The picture emerging of theoretical contestation and practical compromise is then considered in relation to the potential sense-making value of social theories.
Historians of the American mental hospital still do not firmly grasp who mental hospital patients were. Although the field's signature debate on the nature of the mental hospital as “repressive” or “humanitarian” involves the characterization of the patients —based on their demographic traits—as victims of repression or beneficiaries of humanitarianism, there has actually not been a thorough demographic analysis of the patients. This article ascertains and examines the defining characteristics of the patient population within the context of that enduring debate. It first identifies demographic groups that were more prone to institutionalization than would have been expected from their susceptibility to insanity. They symbolized the patient population in the late nineteenth century when insanity did not necessarily result in institutionalization. This article then discovers essentially the same demographic groups ended up in mental hospitals in both the hinterland and metropolitan areas of the North from the late nineteenth to the early twentieth century. It also finds a protective effect that marriage had against institutionalization operated in a socially conservative way. Finally, it weaves together the demographic traits of the patients deemed indicative of the mental hospital's repressiveness and the ones considered reflective of its humanitarianism into a panoptic portrayal that presents the patients as both victims and beneficiaries of the mental hospital. This article's analysis of the patients as a complex, multifaceted population helps transcend the binary framework of the debate on the nature of the mental hospital and deepen our understanding of who they were.
A brief overview is provided of sociological and historical critiques of Western psychiatry before focusing on pre-empirical, non-empirical and empirical aspects of psychiatric diagnosis. These are then discussed using the analytical devices of the ontic fallacy, the epistemic fallacy and generative mechanisms. It is concluded that mental disorders do not really exist but particular presenting problems of unintelligibility, interpersonal dysfunction and common human misery, in particular social contexts, recur in modern life and thus constitute real problems for those intimately implicated and for social order. These require new ways of understanding, beyond the option of deconstruction, which could displace categorical reasoning and be sensitive to causes, meanings and their situated social contexts. The paper concludes with an outline of an alternative future for research into mental health problems, which could be informed by critical realism.
Purpose
– The purpose of this paper is to present an argument for taking the long view of the retention and preservation of inactive medical records.
Design/methodology/approach
– Using the theoretical framework of Actor-Network Theory, the author examines medical records, and especially mental health records, as actants that participate in the classification and treatment of patients, and in the development of psychiatry and mental hospitals as social institutions.
Findings
– The varied and profound roles of medical records demonstrate the ability for records to have multiple “lives” that can touch many individuals beyond a single human lifetime.
Practical implications
– As the current and future custodians of historical medical record collections, information professionals are in a position to be greater advocates for the increased preservation of and mindful access to these materials.
Social implications
– Medical records have potential to be cultural heritage documents, especially for emergent communities.
Originality/value
– This paper articulates the ways in which medical records are an embedded part of many societies, and affect the ways in which illness is defined and treated. It thus suggests that while laws regarding the retention and destruction of and access to medical records continue to be deliberated upon around the world, such records can have enduring value as information artifacts.
Both empirically and interpretively, extant histories of psychiatry reveal a vastly greater degree of difference among themselves than historical accounts of any other field. Scholarship focuses on the period after 1800 and the same is true of historiographical reviews; those of early modern British psychiatry are often brief literature studies. This article sets out in depth the development of this rich and varied branch of history since the 1950s, exploring the many different approaches that have contributed to understanding the mad and how they were treated. Social, cultural, philosophical, religious, and intellectual historians have contributed as much as historians of science and medicine to understanding an enduring topic of fascination: ‘disorders of consciousness and conduct’ and their context. Appreciating the sometimes unacknowledged lineages of the subject and the personal histories of scholars (roots and routes) makes it easier to understand the past, present, and future of the history of psychiatry. The article explores European and North American influences as well as British traditions, looking at both the main currents of historiographical change and developments particular to the history of psychiatry.
There are many grounds for arguing that people with a range of disabilities have more in common than they have differences. However, those grounds to date have not resulted in a unified social movement. This paper examines one possible reason for that lack of unity: the particular force of being unreasonable in modern society. However, being unreasonable is not limited to those with a psychiatric diagnosis, nor does a lack or loss of reason take a simple common form within that group: it is a highly nuanced and context-specific matter. This complexity is discussed in relation to a set of inter-related questions about legalism, morality and post-enlightenment concerns with order and rationality. The paper concludes with a discussion of scenarios available to new social movements concerned with disability.
This paper presents a case study in the use of photographs as data for historical sociological analysis. Based on a larger study of the first century of the social development of a large state mental hospital, the paper describes how a sample of 343 photographs was generated from the over 800 images the authors collected. We developed a layered analysis in which we examine the images in continuously greater depth and discuss the connections between each consecutive stratum of explanation. At the first level we produce anappraisal, a comparison of the images with the written historical record. The next level,inquiry, concentrates on themes in the collection as a whole. Finally, the concept of thick description guides the third level,interpretation, in which we examine in depth individual images. We present a series of images that correspond to each of these layers of analysis. A concluding section evaluates the costs and benefits of photographic evidence for the historical sociology of organizational change.
Over the past two centuries, extensive mental health care systems have come to be a feature of all Western societies. However, the theoretical model generally invoked to account for this process has only limited applicability to Spain, where the growth of capitalism and the liberal state followed an atypical and uneven course. Political power and economic power, usually coterminous, were divided in Spain between center and periphery, so that, until the 1960s, Spain's economic center of gravity was localized in Catalonia, the most culturally and linguistically distinct region. Here we are dealing with a paradox: on the one hand, the failure of the incompletely centralized and economically underdeveloped Spanish state to develop a system of psychiatric care comparable to those of other European states; and on the other hand, the success of the Catalan bourgeoise, though lacking a state of its own, in creating such a system through private initiative.
This paper examines the relationship between the structure and ideology of the psychiatric system and the actions, worldview and subjective experiences of psychiatric nurses working within both the hospital and the community settings. In contrast to previous occupational stress research, which has tended to concentrate on the perspective of staff without interpreting either the interrelationships between the experiences of caregiver and recipients or the ways in which the social context of care influences all participants' interpretations of their situation, this paper will argue that the occupational stresses facing psychiatric professionals cannot be fully understood without a clear understanding of the ambivalent role of welfare institutions within our society. This necessitates moving beyond the decontextualized, micro-level analyses advocated within the traditional occupational stress literature and drawing on alternative theoretical traditions which facilitate richer interpretations of the complex interplay between the structure and ideology of Western psychiatric systems and the motives, understandings, actions and emotions of different players within the system. With these considerations in mind, this article seeks to forge new links between the theoretical analysis of psychiatry's role within our society and the empirical investigation of occupational stress in psychiatric nursing by elucidating the interpersonal processes which enable the structural contradictions of psychiatry to find concrete expression within the fragmented understanding and inconsistent actions of the various players within the system. As the empirical research will reveal, staff attempts to ameliorate the chronic personal insecurities engendered by these contradictions often have the paradoxical effect of augmenting the problems of the psychiatric system and intensifying the very feelings they are struggling to avoid.
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