Waltraud Ernst (ed.), Work, psychiatry and society, c. 1750-2015 (Manchester: Manchester University Press, 2016). ISBN: 978-0-7190-9769-0 (hardback), £75.00.
by Louise Hide
Given the amount of work that has been produced on labour and economic history on the one hand and asylum history on the other, it is surprising that the two have not been brought together more often. As this excellent volume shows, these sub-disciplines have much to learn from each other because the meanings given to patients’ work and occupation inside institutions have always reflected wider socio-political concerns on the outside.
In this volume, Waltraud Ernst has brought together 17 essays with great skill. Together, they demonstrate how ‘work’ with its myriad meanings has different significance – treatment, punishment, reform, exploitation, empowerment – within shifting conditions brought about by colonialism, revolution, war, economic change, and new medical ideologies. The collection makes a great temporal and geographical sweep across the entire modern period to the present day, addressing attitudes and praxis in North America, Japan, India, and Western and Eastern Europe.
The introduction is impressive. Ernst takes her discussion of patient activity back to the Graeco-Roman era before deftly contextualising it within later periods of feudalism and industrialisation, giving due consideration to the influence of socialism, urbanisation, colonialism and migration along the way. Whilst she identifies a number of themes that the volume addresses as a whole, she has organised the essays loosely by geographical region and time period. Generally, this works well. However, the contributions are a little uneven, not only in terms of their word length, but of their content and approach too: some span a century or more offering an overview of changing attitudes, while others make greater use of case studies to draw out more nuanced interpretations.
Inevitably, issues around gender, social class and race are drawn out of wider socio-political contexts, as are responses to overarching questions such as how the notion of ‘industriousness’ has been defined and redefined within medical, legal and moral discourse. Oonagh Walsh shows how in late nineteenth century Ireland work was used as a ‘test of sanity’ that was viewed by patients as a privilege and as a way of demonstrating their worth inside the institution. According to Monika Ankele, the meaning of work changed in one German asylum as its boundaries became more porous over a period of unemployment and economic instability during the Weimar Republic. This situation was not dissimilar to that of the First Republic of Austria where the ‘workshy’ were forced into labour facilities to receive moral improvement and where, as Sonja Hinsch has illustrated, the focus was not on whether or not patients worked, but on how they worked.
Mental hospitals have always faced accusations of exploiting patient labour. Kathryn McKay has analysed institutional reports in Canada to detail how alienists negotiated a course that demonstrated both the therapeutic and the economic benefits of patients’ work. Vicky Long addresses a later period to illustrate how industrial therapy of the 1950s was phased out with deinstitutionalisation, shifting the responsibility for employing people with mental health problems from the medico-social sphere to one that needed to be met by the labour market. John Hall traces the professionalisation of occupational therapy during the first half of the twentieth century, demonstrating how the shift from biological psychiatry to post-war psychosocial approaches, which included rehabilitation, also contributed to the process of deinstitutionalisation. Interestingly, the reverse was happening in Japan where, as Akira Hashimoto shows, ‘life therapy’ – a combination of work and occupational therapy – was introduced in the 1950s and psychiatric hospital populations continued to rise until the 1990s.
Gauging an individual’s moral and mental state by his or her approach to work is another important theme. Sarah Chaney comments on how ‘malingering’ as a concept was increasingly associated with some asylum patients who were believed to self-harm in order to shirk work. James Moran’s essay describes how New Jersey legislators used the meaning invested in productive work to signify whether or not an individual was deemed to be compos mentis and entitled to own property. Valentin-Veron Toma explores the ways in which work was promulgated as a social obligation, especially for the poor, in Romania’s psychiatric hospitals. Thomas Müller illustrates how attitudes to mental patient labour changed over a century in Germany, leading to the horrific consequences brought about by National Socialism from the 1930s.
Reflecting Ernst’s cross-cultural interests, many contributors examine the ways in which certain paradigms from the West were fused with local cultures and practices, particularly in colonial settings. Leonard Smith writes about the medical men who took their ‘civilising mission’ to the British West Indies where asylums also appropriated practices and attitudes from the plantations. A useful comparative approach within a single geographical region is taken by Jane Freebody who weighs up differences between France, Tuscany and Britain in the early nineteenth century when notions of moral treatment were gaining traction across the early discipline of psychiatry. Ben Harris demonstrates how American enthusiasm for this approach waned towards the end of the century as institutions became overcrowded with the chronically ill. And in Japan, Osamu Nakamura reveals how the practice of ‘boarding out’ patients to local families was brought to an abrupt end in 1950 as greater emphasis was given to a Western model of institutional care.
Jennifer Laws’ essay ends the volume with a beautifully written, thoughtful and intellectually sophisticated reflection on the relationship between reason and work, suggesting that scholars look beyond the standard framing of work to how meanings have been constructed out of the more intangible relationships between patients and staff. This is a superb ending to a rich volume of essays, which Ernst eloquently describes as offering insights into ‘moments when humans realise their humanity through their working relationships’. It will be of interest to historians of medicine and psychiatry, labour and economics, as well as to sociologists, anthropologists, and healthcare professionals.
Louise Hide is a Birkbeck/Wellcome Trust ISSF Fellow based in the Department of History, Classics and Archaeology at Birkbeck, University of London. Her monograph Gender and Class in English Asylums, 1890-1914 was published by Palgrave Macmillan in 2014. Her current research is on cultures of harm and abuse in psychiatric spaces in the twentieth century.