‘Communicating Mental Health, c.1700–2013’ was a workshop held at the University of Birmingham’s Institute of Advanced Studies, aiming to bring together researchers from a range of backgrounds to consider the communication of mental health and illness, both in the past and in the present. Communication took many forms in the papers presented – verbal, written, and visual.
Kicking off the proceedings, Louise Hide from Birkbeck, University of London examined letters written by 19th-century asylum patients. Letter-writing by patients was a significant activity, with around 100 letters a day written at London’s Claybury Asylum in 1895. Such letters are complex both in their contents and the ways in which they might be read by the historian – Hide particularly emphasised patient’s use of metaphor as a way of communicating their experiences within the asylum. This was a trend also evident in the spoken words of patients, as I briefly noted in a paper on the role of the patient in diagnosis. As the asylum admission process in the 19th century didn’t involve the input of an asylum doctor (rather, general practitioners and Poor Law authorities), the information provided on admission documents was often re-assessed in the asylum in light of the patient’s own story. One man, who had told the general practitioner certifying him that the ‘flesh was dropping off his bones’, explained to the asylum doctor that he didn’t really think this, but had employed the phrase to describe his feelings of numbness in the toes.
Letters sent by patients were also examined by Jane Hamlett (Royal Holloway University of London), who described how demands for goods from families may have been a way for the patient to assert authority after being placed in an institution. One patient at Bethlem wrote an astonishingly long list of goods that he ‘required’, asking his father to send him – amongst other things – a harmonium and an alarm clock. That letters were a means of maintaining one’s position as head of the household was evident in the letter written by a man to his wife, who declared that she ‘need not send the cake [she had mentioned], as he did not care for it’, but she might send some rashers of bacon instead. In their provision (or not) of foodstuffs and domestic items, then, we can see families engaging in a form of object-based communication.
That objects might be communicative was a possibility also explored in Rob Ellis’s (University of Huddersfield) talk, which examined the Stephen Beaumont Museum of Mental Health – previously discussed on this blog, here. Ellis argued that museum collections are very much bound up with who ‘owns’ the history of psychiatry (the closure of asylums in the late 20th century, for example, prompted some curators to highlight the ‘progressive’ nature of psychiatry).
This much broader issue of ownership was a concern that ran throughout the two days of the workshop. Towards the end of the first day, we were already asking ourselves if historians were part of ‘myth-making’ about mental illness and, if we were, what we could do about it. But was ‘myth-making’ too simplistic a label to put on the issue? Was there, asked Peter Bartlett (University of Nottingham), any area of life where – as humans – we weren’t constantly constructing myths about history, the present, and ourselves? Many of the papers presented at the workshop had highlighted how there was rarely a single narrative of mental health or illness that enjoyed relative hegemony at any one time. In the stories we were telling about past and present mental health practice, we were also adding other voices to an already varied narrative.
The languages spoken by these voices seemed diverse – historical, medical, psychoanalytical – but displayed some important similarities. That there was an easily discernible line between ‘normal’ and ‘abnormal’, or ‘health’ and ‘illness’, was complicated by many of the speakers present. Katherine Chisholm and Sarah-Jane Fenton both addressed the importance of identifying mental ill-health in adolescence – the point at which many serious psychiatric disorders began and often manifested themselves in ways that made it difficult to determine the lines between ‘mental illness’ and ‘typical’ teenage behaviour. The language used to talk about mental health issues was also a rapidly changing one, so that – as one current practitioner pointed out – an individual might be diagnosed with something that meant little as a diagnostic label years later. How language and the labels we assign to disorders could profoundly affect an individual’s sense of self, then, was a consideration that came through in papers both by historians and current practitioners.
Methodology also turned out to be an area of common experience: though we might lack a methodology that can properly capture the experience of mental illness at different points in time (as Joseph Melling [University of Exeter] noted), there was a clear similarity across the disciplines in terms of research methods employed. Thematic analysis was central for many speakers, whether analysing the letters of 19th-century asylum patients, or in working with young autistic adults (Susy Ridout, University of Birmingham).
Fittingly, the workshop ended with participants reflecting on how we had communicated with each other. Fostering interdisciplinary study was a laudable aim, but something that involved more than simply delivering papers together at the same event. How could the discussion continue beyond that context, and how far were historians, practitioners, and service users really integrated? Whilst we’d been using the same languages and methodologies, there was still a sense of a divide within the room at times – almost that historians were distanced, detached observers with little direct experience of mental health issues. How could we bridge that divide?
This was a big question that I had the chance to explore a little further a few days later, at the Wellcome Trust’s Engaging Science Day, a workshop for grantholders about public engagement. In our session, ‘Are historians human? Communicating medical history’, we talked about the mental health issue directly. Should we, as historians, communicate our own experiences of mental health and illness to make our field of study more accessible to others? The general consensus was no, unless you felt strongly about doing so. There was, though, a case to be made for engaging with medical and psychiatric history on a more personal level as a way of capturing other’s imaginations. Appealing to people’s preconceptions about the history of psychiatry and medicine as a starting point for discussion was one suggestion. Opening up a talk with an appeal to the audience – such as ‘What do you think the first drug treatments used in psychiatry were?’ – was a way in to a subject that the speaker specialised in, but which the audience might also have some knowledge of, going a small way to bridging that gap between speaker and audience, or historian and service user. Maybe the issue wasn’t one of language, of methodology, even of different disciplines, then, but in the very simple way we communicated with others.
‘Communicating Mental Health’ ended with a discussion amongst University of Birmingham participants about taking the dialogue opened up at the workshop further, and we look forward to hearing more about this in due course. You can view the full timetable of speakers and papers here, and Vanessa Heggie (@HPS_Vanessa) has kindly Storified (or Storify-ed?) live tweets from the two days here.