The November 2018 special issue “Cultures of Harm in Institutions of Care” in Social History of Medicine may be of interest to AHP readers. Full details below.

“Cultures of Harm in Institutions of Care: Introduction,” by Louise Hide; Joanna Bourke.

“Broken Minds and Beaten Bodies: Cultures of Harm and the Management of Mental Illness in Mid- to Late Nineteenth-century English and Irish Prisons,” by Catherine Cox; Hilary Marland. Abstract:

This article explores the relationship between the prison and mental illness, focusing on the ways in which the system of separate confinement was associated with mental breakdown and how maintaining the integrity of prison discipline mitigated against prisoners obtaining treatment or removal to an asylum. Examples are taken from English and Irish prisons, from the introduction of separate confinement at Pentonville Prison in London in 1842 until the late nineteenth century, exploring the persistence of the system of separation in the face of evidence that it was harming the minds of prisoners. The article also briefly examines the ways in which prison doctors argued that they were dealing with special categories of prisoner, adept at feigning, intrinsically weak-minded and whose mental deterioration was embedded in their criminality, factors that served to reinforce the harmful environment for mentally ill prisoners.

“Police Surgeons and Victims of Rape: Cultures of Harm and Care,” by Joanna Bourke. Abstract:

Between the late 1960s and the late 1980s, police surgeons found themselves under concerted attack for their treatment of victims of rape and sexual assault. This article explores the tensions they faced between the needs of victims and their legal responsibilities. Should they prioritise care or the collection of evidence? How did they respond to criticism and why were reforms inadequate? I show how institutional structures and ideologies help explain the longevity of cultures of harm within the sub-discipline of police doctors. However, to understand the tenacity of these practices, we need to interrogate more fundamental processes associated with bodily interactions, emotion and language.

“In Plain Sight: Open Doors, Mixed-sex Wards and Sexual Abuse in English Psychiatric Hospitals, 1950s—Early 1990s,” by Louise Hide. Abstract:

This article investigates the consequences of unlocking psychiatric wards and allowing male and female patients and staff to mix freely in the post-war period. I argue that the sexes were allowed to socialise with each other primarily for the benefit of male patients, and that some superintendents were ‘blind’ to the dangers of sexual abuse to which female patients were exposed, especially given the growing number of male ‘sexual psychopaths’ who were being admitted to open wards. While male nurses did complain about mixed wards in the mid 1960s, it was not until the rise of feminism and patient activism that the extent of sexual abuse and violence in hospitals began to be revealed a decade later. By the 1980s, despite calls to return to segregated living, psychiatric hospitals were no longer able to fund single-sex wards, exposing many women to sexual danger and deterring them from seeking help as in-patients.

“Single Rooms, Seclusion and the Non-Restraint Movement in British Asylums, 1838–1844,” by Leslie Topp. Abstract:

This article shows how the practice of seclusion—the confinement of asylum patients in locked rooms alone—entered the spotlight during the bitter controversy over the abolition of mechanical restraints in the late 1830s and early 1840s. Drawing on letters to The Lancet, asylum reports, reports of the Commissioners in Lunacy and polemical pamphlets, and focusing on the two asylums at the centre of the controversy, Lincoln and Hanwell, the article sets out the range of positions taken, from pro-restraint and anti-seclusion to anti-restraint and pro-seclusion. It shows how seclusion was associated with a lack of transparency, how it was seen as parallel to the disputed practice of solitary confinement in the prison system and how both the practice of seclusion and the single room itself were modified in the face of these challenges. John Conolly emerges as the most committed proponent of seclusion.

“A Home or a Gaol? Scandal, Secrecy, and the St James’s Inebriate Home for Women,” by Jennifer Wallis. Abstract:

In the 1880?s and 1890?s the operations of the St James’s Home for Female Inebriates in Kennington, London, attracted the attention of both the Charity Organisation Society and the popular press when the proprietors of the Home were accused of mistreating women in their care. Such mistreatment, it was suggested, had been allowed to continue for many years due to the cloak of secrecy that surrounded the Home. Both medical and popular conceptions of the inebriate had functioned to legitimise institutionalisation as necessary for cure and—by implying a degree of moral culpability that aligned inebriate women with ‘fallen women’ more generally—to sanction the secrecy of such treatment. This article discusses the St James’s case in detail in order to consider how the institutional culture of the private inebriate home could also be a culture of harm.

“‘Put Right Under’: Obstetric Violence in Post-war Canada,” by Whitney Wood. Abstract:

This paper takes the personal narratives of Canadian mothers and fathers as a starting point to examine the broader state of obstetrics in post-war Canada. As natural childbirth ideologies attracted growing North American attention from the mid-1940s onwards, an increasing number of Canadians sought less-medicalised births. Despite these desires, anaesthetisation—often without consent and contrary to the expressed wishes of the labouring woman—remained a mainstay of obstetric practice, and was used to prevent ‘untimely’ deliveries beyond a physician’s control. A growing group of Canadians spoke out against the ongoing use of this strategy, and, in voicing their support for natural childbirth, drew attention to the various types of abuse and mistreatment (both physical and psychological) that expectant mothers received at the hands of medical professionals. Professional tensions sustained a particular culture of harm in Canadian obstetric practice throughout the post-war period.

“Contracting Health: Procurement Contracts, Total Institutions, and the Problem of Virtuous Suffering in Post-war Human Experiment,” by Laura Stark. Abstract:

The American medical research industry seemed poised to collapse in the wake of the US civil rights movement because of sudden, sharp restrictions on access to human subjects for medical research. Yet research on healthy people continued to expand, eventually taking a new organizational form with the rise of Contract Research Organizations. This surprising outcome emerged because a set of private religious organizations during the 1950s aligned with the US National Institutes of Health (NIH) to produce the legal possibility of a sustained, large-scale civilian market for human subjects and, simultaneously, to create the living reality of that market. NIH made novel use of the government ‘procurement contract’ mechanism, and the churches offered a logic of suffering to ‘volunteers’ to make sense of their experiences. Together, they enabled the formal exchange of money for human subjects that anchors medicine in the present day and invites critique beyond the conventional categories of bioethics.