Tag Archives: medical museums

Communicating Mental Health, University of Birmingham, 16-17 September 2013

‘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.

L0028860 Case notes: Holloway Sanatorium Hospital for the InsaneKicking 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.

Inside the padded cell in the Stephen Beaumont Museum of Mental Health.

Inside the padded cell in the Stephen Beaumont Museum of Mental Health.

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.

Poster from the Birmingham campaign, ‘Don’t Turn Your Back on the Symptoms of Psychosis’.

Poster from the Birmingham campaign, ‘Don’t Turn Your Back on the Symptoms of Psychosis’.

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).

300px-Speech_bubble.svgFittingly, 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.

Post-mortems in the asylum: What were they for?

DSCF1077Last month, the Idaho State Journal reported that 120 headstones had been placed on the graves of former patients at State Hospital South (previously Idaho Insane Asylum). The new markers were unveiled as just one stage in an ongoing project of placing headstones on over 1,000 unmarked graves in the area. The unmarked or numbered graves of the asylum cemetery provoke strong feelings for present-day observers, suggesting large numbers of people who were forgotten by relatives, as well as raising questions about past psychiatric treatment. Reports on the unveiling of the latest headstones noted that some patients underwent lobotomies and other procedures. The Hospital’s current administrator said that, in the treatments they had undergone, these patients could be considered ‘pioneers’ in the treatment of mental illness whose legacy can still be seen today. Commemorating the dead in a cemetery leads us inescapably to the body of the asylum patient, something that is present throughout my own research and that can’t be overlooked when considering the history of psychiatry.

In the 19th century, the physical body was at the heart of much psychiatric research, but it is the body at post-mortem that this and a subsequent post will focus upon. In the search for the origins of mental illness, the post-mortem was crucial for asylum doctors and was a practice increasingly encouraged by the Commissioners in Lunacy in order that the ‘scientific spirit’ of asylum research be kept up. At the West Riding Asylum for instance, an 1885 Commissioners’ report noted that ‘[t]he number of post-mortem examinations, 193, [was] very satisfactory’.

What were the purposes of the post-mortem?

Why were the Commissioners so interested in the amount of post-mortems being performed? Firstly, as in any other medical arena, the post-mortem was crucial in identifying the cause of death. The West Riding’s Regulations and Orders of the Committee of Visitors stated that ‘A post-mortem examination [would] be made of the body of every Patient dying in the Asylum, and a searching inquiry … instituted as to the cause of any bruise or injury found upon a body’. As well as establishing the immediate cause of death, then, the asylum post-mortem acted as a check on asylum care. In examining the state of the body at death – post-mortem books might remind the doctor to note things such as bedsores, fractures, or if the body was emaciated – the procedure mirrored the admission exam in which the patient was bathed and checked for physical injuries. Sometimes the post-mortem revealed injuries that had been overlooked during life (such as a broken bone), and in this way could be conceived of as a deterrent to any attendants who were tempted to use violence towards patients.

Brain dissection, seen from above. © Wellcome Library, London.

Brain dissection, seen from above. © Wellcome Library, London.

Secondly, the post-mortem was a means of gathering evidence about the pathology of mental illness. Unusual appearances within the skull itself – adhesions of the membranes to the surface of the brain, blood clots, or wasting away of the brain substance – were recorded and tabulated in order to establish any patterns. Francis O. Simpson’s The Pathological Statistics of Insanity (1900) collected together a staggering amount of post-mortem data, organised by type of mental affliction so that the reader could chart the appearances found in the brains of melancholic, maniacal, or epileptic patients. Post-mortem record books might have an index added by recording doctors, where one could look up all instances of ‘adhesion’ or ‘haemorrhage’ in order to identify any similarities between the cases.

Thirdly, such data could be matched up with the clinical information kept on a patient during their lifetime. That post-mortem books often allowed the practitioner to note the ‘Form of mental disorder at admission’ and ‘Form of mental disorder at death’ suggests that mental illness wasn’t necessarily viewed as a static condition, but also – as Gayle Davies notes in ‘The Cruel Madness of Love’ – that the post-mortem could sometimes lead to a ‘re-diagnosis at death’. Conversely, the post-mortem often confirmed the suspicions of the doctor about the root of a patient’s problem, with a tumour or other anomaly found in the region of the brain that corresponded to a motor disorder exhibited during life.

Asylum museums were often smaller versions of those like the Royal Free Hospital's, above. © Wellcome Library, London.

Asylum museums were often smaller versions of those like the Royal Free Hospital’s, above. © Wellcome Library, London.

Lastly, this focus on the physical fabric of the insane body as a site of knowledge about mental illness led to many body parts being preserved for asylum museums. These on-site museums were used for teaching purposes as well as forming a permanent ‘catalogue’ of brain anomalies. Some specimens might be ‘put aside for hardening for general purposes’ – likely for students to examine or practice their dissection skills upon – or even sent to a researcher at another asylum for study (a brain from a patient at the West Riding Asylum who died in the early 1870s was sent to fellow alienist John Batty Tuke to examine). Towards the end of the century, bacteriological research also began to draw upon the fabric of the body, with  a researcher in 1895 ‘[inoculating] slices of sterilized potato … with blood from [a] spleen … [A] pure cultivation of typhoid bacilli resulted’. The post-mortem was, then, bound up with several other practices evolving at the time, and was a site where doctors honed their pathological skills as well as accounted for the basic facts of death.

Within all this, it often seems that the patients themselves are worryingly absent. What were the rules governing consent for post-mortems? Did families know what precisely a post-mortem entailed? Did they voice their objections to the asylum doctor? These are questions I’ll be turning to in our next post. In the meantime, for a fuller discussion of all of these issues you might like to take a look at a special issue of History of Psychiatry journal, ‘Lunacy’s last rites: dying insane in Britain, c.1629–1939’.