Download Post-War Mental Health

Kill or Cure
To examine the expansion of ‘psychological
medicine’ beyond the asylum to the broader
population
2. To suggest the significance of the WWII as a
turning point, and to provide examples of its
impact in shaping life in post-war Britain
3. To highlight reasons for a critique of this
development
4. To introduce consideration of the degree to
which this became a global phenomenon in the
post-war period
1.
Early optimism of
asylum had faded
 Problems of growing
size (1000+),
overcrowding,
incurablity
 Cost in face of rising
broader demands of
welfare
 In lead up to WWII
answers via eugenics
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Disillusion of doctors with asylum medicine
Desire to reach out to the milder cases who may
be easier to cure
 Rise of outpatient treatment, clinics, and child
guidance services
 Development of new psychotherapies
 Interest too in prevention – promotion of
‘mental health’ and ‘mental hygiene’
 But problems of resource, limited expertise, and
reticence to talk about problems
 Needs moment of crisis to push make mental
health a national problem
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Political extremism,
economic irrationality, and
violence of war in midcentury encourages
serious consideration of
human psychology
Focuses attention on how
to make democratic
subjects
Evident in pre-war writing
about extremism, Nazism,
and political violence
Democracy a result and
necessary condition for
mental health
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Fear of mass mental
breakdown via air attack
following Guernica
Psychological strength
(morale), prevention
from collapse, and
treatment likely to be
keys to war
Need for the state to act,
and willingness to
resource expansion of
psychological medicine
to whole population
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Importance of freedom to
release aggressive
impulses in play as child:
implications for childrearing and education
Importance of security in
first years (evidence of
what happens without this
to camp children and
evacuees): encourages the
attachment theory of John
Bowlby and Donald
Winnicott on dangers of
maternal deprivation
Via BBC radio and
child-rearing literature
reaches into family
home (Donald
Winnicott and John
Bowlby)
 Post-war withdrawal of
support from nurseries
 Progressive pedagogy
in schools
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Model of the wartime
bombsite
 A space for children
(under supervision) to
explore, make things
from junk, and to
develop as children
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Through psychological
advice holds possibility
of designing an ideal
environment for the
child: safe, suited to
the way the child sees
the world, bringing the
outside world into the
protected realm of the
family home
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Encourages/facilitates
what we see as a classic
era of family life:
increasingly focused on
home; home-bound
mother; new
expectations of
fatherhood; smaller
families
But historically this era
of the ‘nuclear family’ is
not the norm but a
rather unique period (Pat
Thane)
The pre-war efforts to control
and regulate through the
imposition of outside
controls (eg via eugenics)
limited via lack of resources
and expertise, and by culture
that supports individual
liberties
 The post-war culture of
normative mental health
works via advice and
internalisation of norms: selfgovernment
 Nikolas Rose: an obligation to
be free
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Defining the family ideal
also provides reason for
intervention on grounds
of mental health when
‘normal’ family life is
absent
This is why the ‘problem
family’ is a major subject
for concern in this period
Is a target for growing
field of social work, but
also for family planning
to limit problems
Post-war immigration
Breakdown of community
with destruction of slums and
relocation to high rise
buildings
 Recognition of persistence of
poverty and social problems
despite a welfare state
 Rising divorce rates and
instability of family structure
 Close of asylums and move to
‘community care’ places
responsibility on families at
time of social breakdown
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Normative family (and
gender roles) challenged
by feminism
Challenge from ‘antipsychiatry’ eg R.D.
Laing: family as a cause
rather than solution to
mental ill health
Challenge from
transcultural perspective
(and in light of high BME
rates in mental health
system)
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Mental health 25% of
‘burden of disease’ UK
but 11% NHS funding;
only 28% of those with
mental health
difficulties receive
treatment; 1/3 GP
consultations mental
health related (NHS
England, 2013)
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1948 World Health
Organisation defines
health as ‘a state of
complete physical,
mental, and social
well-being and not
merely the absence of
disease or infirmity’
1.
2.
3.
Is the history of mental health the history of a
failed project, with rising levels of chronic
mental illness (anxiety, depression, eating
disorders …), and ongoing inadequacies in
response?
If so, why? Does the answer lie in epidemiology
(a disease of civilisation), or in ongoing failures
in response due to stigma, medical focus on
physical disease, inequality, and economics?
Why has the expansion of mental health been
viewed critically by some, and to what extent is
this justified?