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Mental Health Care in Modern England

Mental Health Care in Modern England: The Norfolk Lunatic Asylum/St Andrew's Hospital, 1810-1998

Steven Cherry
Copyright Date: 2003
Edition: NED - New edition
Published by: Boydell and Brewer,
Pages: 347
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  • Book Info
    Mental Health Care in Modern England
    Book Description:

    The Norfolk Lunatic Asylum opened in 1814 as a pioneer county pauper institution and in 1998 St Andrew's featured among the last of the large psychiatric hospital closures. This history of one particular place for "madness" covers changing approaches to insanity and treatments over two centuries. It draws extensively upon archival sources to examine the use of buildings and environments; the regimes of long-serving masters, superintendents and medical superintendents; the patients' own experiences; and the rationales, including cultural and gender issues, which informed therapies, relationships and hospital life. However, the contexts of national policies and economic constraints, professional and therapeutic developments, local economy and society, and current research findings are also acknowledged. Chapters dealing with the asylum's transformation as the 1915-19 Norfolk War Hospital and 1940-47 Emergency Hospital have disturbing revelations concerning wartime mental health care: similarly with the loss of local accountability and the experience of resource control under the National Health Service. Interviews with former staff and current personnel recall first-hand experiences of hospital life since the 1920s, the privations of wartime and the early NHS, hopes for new medications and conflicting views surrounding the closure of St Andrew's and the delivery of community mental health care. STEVEN CHERRY is senior lecturer in history, Wellcome Unit for the History of Medicine, University of East Anglia.

    eISBN: 978-1-84615-120-0
    Subjects: Health Sciences

Table of Contents

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  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
  3. List of figures
    (pp. vii-viii)
  4. Acknowledgements
    (pp. ix-xii)
  5. 1 Contexts: asylums, insanity and locality
    (pp. 1-26)

    James Thomas Secker, a pauper aged 36 from Aylsham, was among the first eight people, ‘all of a very bad description of lunatic’, admitted into the new Norfolk Lunatic Asylum in May 1814.¹ He suffered from fits but his noisy and violent behaviour appears to have led to his admission. Had he lived a century earlier, he might have been regarded as wild, ‘furiously and dangerously mad’ or worse: a century later, his epilepsy would have featured primarily in medical treatment. Thomas Caryl, the barely literate asylum master, reported early in June that Secker had been ‘ordered to bed by...

  6. 2 Norfolk Lunatic Asylum: plans, problems and patients, 1814–43
    (pp. 27-52)

    Although the 1808 Act encouraged county justices to establish lunatic asylums, it provided few specific instructions and there was no compulsion to build until additional legislation was passed in 1845.¹ A complex of national and local influences, outlined in the previous chapter, may have featured when the Norfolk Quarter Sessions first discussed this possibility in October 1808 but the dominant contributions were not recorded.² This chapter examines the establishment of the Norfolk Lunatic Asylum and its physical features, its medical and lay personnel, the patients and treatments, focusing upon local records but drawing upon contemporary surveys and accounts. It suggests...

  7. 3 A superintendent and ‘work therapy’, 1843–61
    (pp. 53-81)

    Thomas Caryl had begun his twenty-ninth year as master at Norfolk Lunatic Asylum when the justices advertised for a new appointment in February 1843. Their decision, prompted by Caryl’s ill-health and advancing years, also reflected plans to extend the asylum and an inspection by the Metropolitan Commissioners in Lunacy. They sought an unmarried man, aged under 45 years, ‘able to read and write and do accounts’.¹ Ebenezer Owen, former master of Malmsbury Union workhouse and one time attendant at the Hanwell Asylum, was selected from twelve applicants in rather unusual circumstances.² He was offered the post from 24 April 1843...

  8. 4 A medical superintendent, expansion and reform, 1861–87
    (pp. 82-111)

    William Hills was 33 years old when he became medical superintendent at Norfolk Lunatic Asylum on 17 October 1861 and he completed his working life there, retiring early in 1887. He had obtained his M.D. at Aberdeen and held membership of the Royal College of Surgeons and the Association of Asylum Medical Officers. Given the context of his appointment, the temptation to associate Hills’ regime with reform and ‘medicalisation’ at the asylum is strong. Evidence might include: a greater emphasis upon treatments, drugs and medicines; the public presentation of medical explanations of recovery, sickness or death; a more caring and...

  9. 5 ‘Successful conversion’: a managed community, 1887–1915
    (pp. 112-143)

    David Thomson, born and educated in Edinburgh, received his M.D. and studied in Dresden before he became medical officer at the Derby County and then Camberwell asylums. He was senior medical officer at Surrey County Asylum and only 30 years old when appointed medical superintendent at Norfolk County Asylum on Boxing Day 1886. Yet he was already ‘favourably known’ to the lunacy commissioners, who had ‘some confidence that, under his charge, this Asylum will not fall back’.¹ Thomson took up his position on 12 February 1887 and remained there until 1 May 1922, well beyond his due retirement date, because...

  10. 6 Two histories: the Norfolk War Hospital, 1915–19
    (pp. 144-170)

    The Norfolk County Asylum’s centenaryAnnual Reportnoted that, although the institution was the oldest provincial public asylum in constant use, much of the physical fabric was new or had been renovated, ‘comparing favourably with the most modern of mental hospitals’.¹ Like many other medical superintendents Thomson presented the institution as a community aiming for greater self-reliance and, increasingly, as ‘a hospital for the mind’.² If less directly involved with individual patients, he sought to improve their physical environment and comfort and had improved nurse training and nursing standards. Correspondents for theJournal of Mental Science, visiting to mark the...

  11. 7 St Andrew’s Hospital: innovation and constraints, 1920–39
    (pp. 171-207)

    The inter-war years mark a period of contrasts in the treatment of mental illness, as in many other aspects of economic and social policy, between the best intentions of policy formulation and the delivery of services for large numbers of people. Although the 1890 Act remained on the statute book, it was considerably modified and partly supplanted by new legislation. Material provision for ‘idiots’ or ‘the feeble minded’, specified under the 1913 Mental Deficiency Act and the 1914 Elementary Education (Defective and Epileptic Children) Act, had barely begun.¹ The 1913 Act also triggered administrative and legal changes, notably the replacement...

  12. 8 Wartime and post-war crises, 1939–48
    (pp. 208-242)

    The association of ‘total war’, in which the civilian population is heavily and directly involved, with longer-term welfare arrangements is a familiar subject for historians. Links between the domestic war effort, the emergency organisation of national health services and the establishment of a welfare state in Britain are strong, if complex.¹ As the part of mental hospitals and their patients in this context is less obvious and local or grass-roots experiences are comparatively unexplored, St Andrew’s offers the opportunity for a case study. There are fewer source materials, however, and wartime records were often compiled less accurately or comprehensively. Under...

  13. 9 ‘Modern treatment carried out under difficulty’, 1948–64
    (pp. 243-273)

    Few people with direct experience of mental hospitals expected a bright new dawn on the Appointed Day, 5 July 1948, but they can hardly have envisaged the nature of developments over the next decades. Overcrowding in mental hospitals nationally was estimated at 14 per cent in 1950; there was an acute shortage of nursing staff and, with an increasing proportion of elderly patients, some form of expansion was seen as a priority.¹ Yet annual spending on mental hospitals averaged only £ 1 million between 1948 and 1954, compared with £ 2.3 millions in 1938–9. More invasive physical and electric...

  14. 10 Community care and the end of a community, 1964–98
    (pp. 274-304)

    By the time James Fraser was formally appointed medical superintendent in August 1965 St Andrew’s was earmarked for a reduced role within Norfolk Group 8 hospitals and the closure of the satellite St Nicholas’ hospital was under active consideration.¹ Fraser was the last medical superintendent – the post was abolished in 1971 – and the closure of the hospital was a recurring issue over almost four decades. Care in the community proved to be a controversial subject and its development was slower and less extensive than originally envisaged. The national and county context, surveyed briefly below, involved the closure of psychiatric hospitals...

  15. 11 Postscript: findings and speculations
    (pp. 305-316)

    The history of St Andrew’s Hospital as examined in previous chapters reveals a strong institutional ‘storyline’ and provides a case example for a wider theme: the rise and fall of the asylum/psychiatric hospital. It has been placed in the contexts of local and national developments in mental health care, drawing particularly upon public statements concerning the hospital and the more private medical observations of its patients. Such information is more extensive and accessible compared with that offering intimate details of hospital life or glimpses of patients when considered essentially as people rather than as cases. It does not guarantee accuracy...

  16. Select bibliography
    (pp. 317-328)
  17. Index
    (pp. 329-340)
  18. Back Matter
    (pp. 341-341)