'Often there is a good deal to be done, but socially rather than medically': the psychiatric social worker as social therapist, 1945-70

From asylums to deinstitutionalization and after: an analytic review

BACKGROUND

After a period of institution-based mental health care, in which the asylum system was the way in which the mental patients were treated, deinstitutionalization brought a set of significant changes and transformations in the conceptualization of mental illness and, by extension, the traditional therapeutic settings in which those in most need were assisted. However, this shift in the psychiatric domain was not only accompanied by valued achievements, but also by difficulties and challenges, as has been evidenced today.

AIM/OBJECTIVE

The aim of this paper is thus to examine the pros and cons of the closure of asylums, and the subsequent implementation of deinstitutionalization over the 60 years or so of such important transformations in the field of psychiatry.

METHODS

In considering this question, I examine in detail recent works of literature based on scholarly knowledge. In addition, I identify various issues involved, as well as ways of confronting these so as to attempt to overcome the difficulties they present.

RESULTS AND CONCLUSIONS

As I show here, the changes in the treatment and care of the mentally ill after asylum and deinstitutionalization brought a new air of hope to patients and their families, but also had undesirable effects. The paper also considers how mental health professionals today try to solve these effects on behalf of patients and society as a whole.

Reconstructing the eclectic psychiatry of Thomas Ferguson Rodger

This article provides an introduction to the approach of the Scottish psychiatrist Thomas Ferguson Rodger (1907-78), as reconstructed from his archive. Rodger's contribution has been largely neglected within the history of Scottish psychiatry. This paper amends this neglect through situating Rodger's eclecticism in relation to both the biopsychosocial approach of his mentors, Adolf Meyer and David Henderson, and psychiatry's de-institutionalization in the 1950s and 1960s. It is posited that Rodger's eclecticism was a considered response to the pressures of this transitional phase to balance physical, psychological and social approaches, and a critical acknowledgement of the instability of contemporary psychiatric therapeutics. More psychodynamic than his predecessors, the importance of social relations for Rodger led him to acknowledge psychiatry's limitations.

History of social psychiatry

PURPOSE OF REVIEW

The overview focuses on publications relating to the history of social psychiatry and the mental health movement, respectively.

RECENT FINDINGS

The selected works show fundamental developments within psychiatry, which can be conceived in the broadest sense as sociomedical in nature. Main emphases are the criticism of large institutions, reform movements and antipsychiatric movements, the search for alternative therapeutic methods, and the question of the resocialization of the mentally ill. Furthermore, it is important to demonstrate the influences of other scientific disciplines.

SUMMARY

Although social psychiatric approaches can be discerned as early as in the 19th century, the focus of the works lies on the development of social psychiatry in the 20th century. Only from the 1950s onwards did social psychiatry establish itself as an integral part of psychiatric practice and later of research. Accordingly, the main focus of the studies is on the development after the Second World War, not least because processes that began at that time have not yet been concluded. Happily, a trend is apparent in this respect: the one-sided view of physicians and their actions is being increasingly complemented by further professional groups and is consequently broadened by important dimensions.

History of psychiatry and its institutions

PURPOSE OF REVIEW

The purpose of this review is to highlight recent English-language literature on the history of psychiatric institutions. It considers work published since 2010, as well as a few important older articles that have not yet been reviewed in these pages.

RECENT FINDINGS

Developments in the last half of the 20th century suggest that psychiatric historiography might finally be able to put the mental asylum behind it. Deinstitutionalization and the diffusion of professional jurisdictions seem to have consigned institutional histories to the methodological dustbin. But these transformations have also opened new perspectives on the institutional history of psychiatry and its methodologies. This review reflects on some of the enduring historiographic potential and importance of evidence drawn from institutional settings.

SUMMARY

As carceral narratives have begun to lose their paradigmatic status within psychiatric historiography, a much more nuanced picture of asylum culture is becoming visible. The history of psychiatric institutions remains an integral and productive part of psychiatric historiography.