17 examines how mental health and counselling research agendas and practices are often shaped by external forces.
Chapter 18 considers the important links between ideas about mental disorder and criminal justice.
Chapter 19 explores whether it can be helpful to think about mental health difficulties as societal versus individual problems.
Chapter 20 reviews the debates about the idea that we now live in a ‘therapeutic culture’.
The book ends with a conclusion drawing together these themes.
Activities, reflections, readings and images
We have included activities and ‘pause for reflections’ in each chapter. One aim of this is to help you reflect on your own understanding and opinion about the topics covered in the chapters. Another aim is to help you connect the material to your own experiences. Additionally, reflection – the ability to think about your thinking (and feelings) – is a key skill for counsellors, and so it is apposite to practise reflection in a book where the focus is mental health and counselling. We have also included suggestions for further readings at the end of each chapter.
Finally, we hope that you will enjoy the artwork in this book. The cover image was created by Fatma Durmush, an artist represented by the Bethlem Gallery. This gallery is based within the grounds of the Bethlem Royal Hospital, which supports artists who are current or former patients of the South London and Maudsley NHS Foundation Trust. Lucy Owen, the Interim Director of the gallery, explains: ‘Our mission is to make an equitable space for our artists, leading change within arts, health and society.’ Artist Fatma Durmush offers some personal background: ‘I started painting when I was 37 years old. I wanted to bring colour into my world. I became ill and received art therapy but then went on to study painting and printmaking at the University of East London at undergraduate and masters level. At University I received encouragement and support and most of the students there were adults. Now I paint at home with passion.’
The images within this book were created by Open University students. Andreas Vossler, co-editor of this book, organised this crowdsourcing initiative. As he explains: ‘We were overwhelmed by how many students submitted images for us to consider including in the book, with many submitting numerous photographs, paintings and drawings. It was difficult to select an image for each chapter, but we think they are amazing and we really hope you enjoy them.’
– Naomi, Andreas, David and David
References
Bion, W.R. (1967) ‘Notes on memory and desire’, in Langs, R. (ed.) Classics in psychoanalytic technique. New York, US and Oxford, UK: Jason Aronson, Inc., pp. 259–260.
Time to Change (2020) Mind your language! Available at: https://www.time-to-change.org.uk/media-centre/responsible-reporting/mind-your-language (Accessed date: 21 April 2020).
Chapter 1 The birth of psychiatry: questions of power, control and care
David W. Jones
Contents
Introduction 19
1 ‘Madness’ before psychiatry 22
2 The birth of psychiatry as the medical specialism of the mind 262.1 The asylum movement and moral treatment 272.2 Moral insanity and criminological expertise 33
3 The fall of asylums and the move to community care 35
Conclusion 37
Further reading 39
References 40
Introduction
‘Breathe’ by Joanna Crane
Questions about ‘mental health’ and ‘mental illness’ loom large amid many media discussions about the health and well-being of the population and society. Those individuals understood as suffering from some form of mental distress or unhappiness might be offered, or may seek, help from a variety of sources, including psychologists, psychiatrists, mental health nurses, social workers, counsellors and psychotherapists. All these professionals might become involved in the provision of care or treatment. They might be employed within state-run hospitals or clinics, or they might provide private treatment for those willing and able to pay. This chapter will suggest that our awareness of the contemporary scene of mental health and illness can be aided by understanding where its ideas and practices have come from.
This chapter presents a history of ‘psychiatry’, with the word used as shorthand for the development of a set of ideas and practices that deal with what came to be defined as ‘mental illness’. While the emergence of psychiatry was largely led by those who saw themselves as working within a medical specialism, many other interest groups and forces have shaped the development of the various institutions and practices surrounding the world of mental illness. Since any history limited to a single chapter can only tell part of the story, the focus here is on how that history needs to be understood as shaped by contradictory forces: power and control versus care and concern.
Indeed, it can reasonably be claimed that there are two contrasting versions of the history of psychiatry. The first might be called ‘the progressive view’ of the development of a dedicated field of practice that specialised in the treatment of ‘mental’ illness. It recognised areas of human suffering and misery that could be amenable to cure or alleviation if the right treatments were discovered and made available. The second, more critical view, is the anti-psychiatry perspective, which suggests that the profession of psychiatry and the surrounding notions of mental illness and health developed as important tools of a culture that has sought to marginalise and control those individuals whose behaviour deviates from the norm and might pose a threat to the social order.
Anti-psychiatry A term used to describe a broad coalition of people and ideas who have opposed the theories and practices of psychiatry.
The focus here is on the emergence of psychiatry within Great Britain, but it should be noted that its early development was embedded in European endeavours, with North American practices becoming important later on. It is certainly the case that psychiatry, now global in its reach, was very much a western enterprise. It is also important to be aware that, as this chapter deals with historical matters, it draws on language (e.g. ‘lunacy’ and ‘mad’) that would be considered offensive if used in the present day. These terms are preserved here, since there is uncertainty about how accurately they could be translated into modern language. Nowadays the term ‘mad’ tends to be equated with something like psychosis, where a person loses touch with reality, whereas in the past it has been used more generally to refer to states of mental turmoil.
