Mental Health in Historical Perspective
Series Editors of Mental Health in Historical Perspective, Catharine Coleborne and Matthew Smith, discuss 'madness', institutions and asylums.
What does it mean to talk about ‘mental health in historical perspective’? Our Palgrave book series is open to studies of madness, the asylum, mental breakdown, psychiatric interventions and practices, as well as the experiences of all of those affected by mental illness – in short, it is an intentionally broad series, designed to attract a wide range of titles and historians. It is also envisioned as a series for interdisciplinary work, and a series that engages meaningfully with contemporary mental health issues.
Mental illness has long frustrated and bedeviled societies across the globe; not much has changed today. While there are serious questions about how and why certain disorders are diagnosed, the rates of mental illness continue to rise globally, levying a high price on families, health systems and society more generally. Although we may be more able to treat the symptoms of some disorders with drugs and other therapies, the complicated causes of mental illness remain elusive. We believe that in order to solve some of the problems posed by mental illness, it is vital to understand its history.
As the editors of this series, we see how the development of the intellectual traditions of mental health history has a long history of its own. The field of mental health histories has always been very rich, ever since the 1970s and the many critical studies of institutional populations which followed Foucault’s work. This vast historiography now presents real challenges to the students of the topic who must wade through an ever-increasing list of titles and authors. Even in the early to mid-1990s, when a new generation of scholars commenced doctoral studies focused on the history of the nineteenth-century asylum, the bibliography of both secondary histories and primary sources of insanity was intimidating. There were those who said, in the late 1990s, that surely historians were done with studies of asylums. But following that, more critical and adventurous accounts of psychiatric institutions in the colonised world appeared, opening up potentially new understandings of madness in history.
Voices of ‘madness’
Interest in first-person accounts of mental breakdown is one of the most salient features of the research in this field, and yet paradoxically it remains the most under-researched and arguably the least theorised of domains. Despite the difficulty inherent in capturing and interpreting the ‘voices’ of the mentally ill, historians are increasingly determined to examine the history of mental health ‘from below’. While patient letters, memoirs, diaries and publications (such as asylum newsletters and patient magazines) remain some of the ways of tracing the experiences of patients in the more distant past, oral history has proven to be one of the most revealing ways in which to uncover the stories of not only patients, but also family members and the broad array of mental health workers.
Institutions themselves have provided the most material for studies of psychiatry because of their laboratory-like status as sites where protocols, regimes and understandings of mental health were practiced until their eventual closure, across the Western World, from the 1980s onwards. At the macro level, institutional histories can provide both a broad sense of how societies understood and chose to deal with madness, providing insights into the reasons for admission, the types of disorders diagnosed and changing treatment practices. At the micro level, however, a tighter focus on institutions can reveal countless stories about the lives of the hundreds of thousands of patients and staff for whom the asylum was either home or their place of work. Psychiatric institutions remain a crucial site through which to understand the connection between psychiatric theory and practice.
After the Asylum
Institutional care dominated psychiatric practice for approximately 150 years in many parts of the world. Yet by the 1950s, questions were being raised about the financial, moral and therapeutic appropriateness of the asylum, and gradually they began to be replaced by other models of care. Memories of places where sufferers of mental illness spent time, and where those who cared for them carved out careers, tend to occupy a slightly different audience, a multidisciplinary readership across the areas of history, geography, psychology, anthropology, and psychiatry itself.
The emergence of two new treatment methodologies helped to convince psychiatrists that the asylum was no longer needed: psychoanalysis and psychopharmacology. The historiography of post-asylum history – though nascent – has been dominated by the study of these two developments. While those who have examined how the ideas of psychoanalysis stretched far beyond medicine, including art and culture, the history of psychopharmacology has been in part an exploration of how mental health became essentially brain health, and the ramifications of this transformation. For more glimpses into this rich array of histories, visit our series’ growing list of titles during Mental Health Awareness Week/Month.
NB: All opinions expressed here are the author’s own and do not represent the views of Palgrave Macmillan.