The history of British psychiatric histories

The British Medical Association concedes to the introduction of the National Health Service in a satirical print from 1946. (Wellcome Library, London)In an article made freely available by the Social History of Medicine, 21(3), Martin Gorsky examines the history of the published histories on the British National Health Service (NHS). Of particular interest to readers of AHP will be the changes he charts for psychiatry.

A central theme of psychiatry in the NHS is the shift since the 1960s from institutional to community care. This is not a process which scholars have viewed as liberating or humane, nor is there consensus on the cause. Some, such as Freeman and Jones, regard the old asylums as essentially benign institutions whose demise was due to the unhappy conjunction of Conservative cost-cutting and wrong-headed anti-psychiatry doctrines. The claim that new anti-psychotic drugs explain ‘decarceration’ is dismissed by Scull, who argues that the fiscal stresses of welfare capitalism fell first on unproductive ‘problem populations’; Moncrieff’s recent assault on the ‘myth of the chemical cure’ undergirds the argument that it was economics, not effective pharmacotherapies which explain deinstitutionalisation. Empirical studies have complicated the picture, for example tracing 1950s antecedents to community care, early therapeutic optimism attending chemotherapies, and peculiar local factors which first favoured small psychiatric units in district general hospitals rather than asylums. There is general agreement, however, that community care has been a disappointment, although it remains moot whether this was due to political complacency or to ‘calculated neglect’ in the interest of preserving resources for the acute sector. (pp. 449-450)

This article exemplifies “the other” meaning of historiography: it is a history of histories, rather than a discussion of historical method.

About Jeremy Burman

Jeremy Trevelyan Burman is a senior doctoral student in York University’s Department of Psychology, specializing in the history of developmental psychology and its theory (especially that pertaining to Jean Piaget). Prior to returning to academia, he was a producer at the Canadian Broadcasting Corporation.