'Silent and censured travellers'? Patients' narratives and patients' voices: Perspectives on the history of mental illness since 1948

Social History of Medicine

Volumn 14, Issue 2, 2001, Pages 267-292

  Davies, Kerry ^a  

^a OXFORD BROOKES UNIVERSITY   (United Kingdom)

Author keywords

Mental health illness; Narratives; Oral history; Psychiatry; Twentieth century

Indexed keywords

ARTICLE; AUDITORY REHABILITATION; HISTORY; LITERATURE; MENTAL DISEASE; PATIENT; PSYCHIATRY; UNITED KINGDOM;

COMMUNICATION METHODS, TOTAL; ENGLAND; HISTORIOGRAPHY; HISTORY, 20TH CENTURY; MEDICINE IN LITERATURE; MENTAL DISORDERS; PATIENTS; PSYCHIATRY;

EID: 0035431583     PISSN: 0951631X     EISSN: None     Source Type: Journal    
DOI: 10.1093/shm/14.2.267     Document Type: Review

References (146)

1. For more on the potential and limitations of psychiatric case notes, see S. Swartz, 'Shrinking: a Post-Modern Perspective on Psychiatric Case Histories', South African Journal of Psychology, 26 (1996), 150-6; J. Andrews, 'Case Notes, Case Histories and the Patient's Experience of Insanity at Gartnavel Royal Asylum, Glasgow in the Nineteenth Century', Social History of Medicine, 11 (1998), 255-81.
2. For more on the potential and limitations of psychiatric case notes, see S. Swartz, 'Shrinking: a Post-Modern Perspective on Psychiatric Case Histories', South African Journal of Psychology, 26 (1996), 150-6; J. Andrews, 'Case Notes, Case Histories and the Patient's Experience of Insanity at Gartnavel Royal Asylum, Glasgow in the Nineteenth Century', Social History of Medicine, 11 (1998), 255-81.
3. It is individual stories and accounts - collections of 'mad voices' - which form the basis of works by Porter, Kaplan, Peterson, and Geller and Harris. Nevertheless, there is a definite shift from Kaplan's 1964 work, with its focus on internalized accounts of mental illness - what he terms the 'inner world of mental illness' - and the three later volumes, which are more concerned with placing those accounts within contemporary perceptions of mental illness. Peterson, for example, sets the scene for each account with biographical notes and a discussion of the theories and practices of psychiatry with which the account interacts. B. Kaplan (ed.), The Inner World of Mental Illness. A Series of First Person Accounts of What it was Like (London, 1964); D. A. Peterson (ed.), A Mad People's History of Madness (London, 1987); R. Porter, A Social History of Madness. Stones of the Insane (London, 1987); J. L. Geller and M. Harris (eds.), Women of the Asylum. Voices From Behind the Walls, 1840-1945 (London, 1994).
4. It is individual stories and accounts - collections of 'mad voices' - which form the basis of works by Porter, Kaplan, Peterson, and Geller and Harris. Nevertheless, there is a definite shift from Kaplan's 1964 work, with its focus on internalized accounts of mental illness - what he terms the 'inner world of mental illness' - and the three later volumes, which are more concerned with placing those accounts within contemporary perceptions of mental illness. Peterson, for example, sets the scene for each account with biographical notes and a discussion of the theories and practices of psychiatry with which the account interacts. B. Kaplan (ed.), The Inner World of Mental Illness. A Series of First Person Accounts of What it was Like (London, 1964); D. A. Peterson (ed.), A Mad People's History of Madness (London, 1987); R. Porter, A Social History of Madness. Stones of the Insane (London, 1987); J. L. Geller and M. Harris (eds.), Women of the Asylum. Voices From Behind the Walls, 1840-1945 (London, 1994).
5. It is individual stories and accounts - collections of 'mad voices' - which form the basis of works by Porter, Kaplan, Peterson, and Geller and Harris. Nevertheless, there is a definite shift from Kaplan's 1964 work, with its focus on internalized accounts of mental illness - what he terms the 'inner world of mental illness' - and the three later volumes, which are more concerned with placing those accounts within contemporary perceptions of mental illness. Peterson, for example, sets the scene for each account with biographical notes and a discussion of the theories and practices of psychiatry with which the account interacts. B. Kaplan (ed.), The Inner World of Mental Illness. A Series of First Person Accounts of What it was Like (London, 1964); D. A. Peterson (ed.), A Mad People's History of Madness (London, 1987); R. Porter, A Social History of Madness. Stones of the Insane (London, 1987); J. L. Geller and M. Harris (eds.), Women of the Asylum. Voices From Behind the Walls, 1840-1945 (London, 1994).
6. It is individual stories and accounts - collections of 'mad voices' - which form the basis of works by Porter, Kaplan, Peterson, and Geller and Harris. Nevertheless, there is a definite shift from Kaplan's 1964 work, with its focus on internalized accounts of mental illness - what he terms the 'inner world of mental illness' - and the three later volumes, which are more concerned with placing those accounts within contemporary perceptions of mental illness. Peterson, for example, sets the scene for each account with biographical notes and a discussion of the theories and practices of psychiatry with which the account interacts. B. Kaplan (ed.), The Inner World of Mental Illness. A Series of First Person Accounts of What it was Like (London, 1964); D. A. Peterson (ed.), A Mad People's History of Madness (London, 1987); R. Porter, A Social History of Madness. Stones of the Insane (London, 1987); J. L. Geller and M. Harris (eds.), Women of the Asylum. Voices From Behind the Walls, 1840-1945 (London, 1994).
7. Amongst others, see S. Plath, The Bell Jar (London, 1963); K. Millet, The Loony Bin Trip (London, 1991); S. Kaysen, Girl Interrupted (London, 1995). The significance of the individual in lay perceptions of twentieth-century psychiatry is reflected in and reinforced by the popularity of films such as One Flew Over the Cuckoos Nest (1975), An Angel at my Table (1990), Shine (1996), and Girl, Interrupted (2000).
8. Amongst others, see S. Plath, The Bell Jar (London, 1963); K. Millet, The Loony Bin Trip (London, 1991); S. Kaysen, Girl Interrupted (London, 1995). The significance of the individual in lay perceptions of twentieth-century psychiatry is reflected in and reinforced by the popularity of films such as One Flew Over the Cuckoos Nest (1975), An Angel at my Table (1990), Shine (1996), and Girl, Interrupted (2000).
9. Amongst others, see S. Plath, The Bell Jar (London, 1963); K. Millet, The Loony Bin Trip (London, 1991); S. Kaysen, Girl Interrupted (London, 1995). The significance of the individual in lay perceptions of twentieth-century psychiatry is reflected in and reinforced by the popularity of films such as One Flew Over the Cuckoos Nest (1975), An Angel at my Table (1990), Shine (1996), and Girl, Interrupted (2000).
10. This concept of the importance of the conscious, rather than unconscious meanings of what those designated as mad have to say is derived from Roy Porter's introduction to A Social History of Madness. While recognizing the (arguable) validity of retrospective diagnosis as a way of exploring the history of psychiatry, he then goes on to say: 'I wish to examine not the unconscious of the mad, but their consciousness. Instead of principally reading between the lines, searching out hidden meanings, reconstructing lost childhoods, baring unspoken desires, I wish to explore what mad people meant to say, what was on their minds. Their testimonies are eloquent of their hopes and fears, the injustices they have suffered, above all what it is like to be mad or to be thought to be mad. I wish simply and quite literally to see what they had to say. It is curious how little this has been done; we have been preoccupied with explaining away what they said.' Porter, A Social History of Madness, p. 1.
11. D. Gittins, Madness in its Place. Narratives of Severalls Hospital, 1913-1997 (London, 1998); D. Gittins, 'Silences. The Case of a Psychiatric Hospital', in M. Chamberlain and P. Thompson (eds.), Narrative and Genre (London, 1998), pp. 46-62; J. Goddard, Mixed Feelings. Littlemore Hospital - An Oral History Project (Oxford, 1996).
12. D. Gittins, Madness in its Place. Narratives of Severalls Hospital, 1913-1997 (London, 1998); D. Gittins, 'Silences. The Case of a Psychiatric Hospital', in M. Chamberlain and P. Thompson (eds.), Narrative and Genre (London, 1998), pp. 46-62; J. Goddard, Mixed Feelings. Littlemore Hospital - An Oral History Project (Oxford, 1996).
13. D. Gittins, Madness in its Place. Narratives of Severalls Hospital, 1913-1997 (London, 1998); D. Gittins, 'Silences. The Case of a Psychiatric Hospital', in M. Chamberlain and P. Thompson (eds.), Narrative and Genre (London, 1998), pp. 46-62; J. Goddard, Mixed Feelings. Littlemore Hospital - An Oral History Project (Oxford, 1996).
14. Porter, A Social History of Madness. His work may be seen as the application to the history of psychiatry of the inclusiveness which has characterized much historical writing since the 1960s.
15. A. Beveridge, 'Life in the Asylum: Patients' Letters From Morningside, 1873-1908', History of Psychiatry, 9 (1998), 431-69; P. Barham, Closing the Asylum. The Mental Patient in Modern Society (London, 1992); Gittins, Madness in its Place; Gittins, 'Silences'. This inclusion of patients' accounts within the history of psychiatry can be seen as part of wider developments within the field-a shift of emphasis from changing theories of mental illness and its treatment, to the practices and processes of psychiatry. This involves detailed analysis of how psychiatry worked within specific times and places. The following works exemplify these trends: A. Digby, Madness, Morality and Medicine: A Study of York Retreat, 1796-1914 (Cambridge, 1985); A. Ingram, The Madhouse of Language. Writing and Reading Madness in the Eighteenth Century (London, 1991); A. J. Saris, 'The Proper Place for Lunatics: Asylum, Person and History in a Rural Irish Community' (unpublished Ph.D. thesis, University of Chicago, 1994); J. Sadowsky, 'The Confinements of Isaac O: A Case of "Acute Mania" in Colonial Nigeria', History of Psychiatry, 7 (1996), 91-112; J. Braslow, Mental Ills and Bodily Cures. Psychiatric Treatment in the First Half of the Twentieth Century (Berkley, 1997); Andrews, 'Case Notes, Case Histories'.
16. A. Beveridge, 'Life in the Asylum: Patients' Letters From Morningside, 1873-1908', History of Psychiatry, 9 (1998), 431-69; P. Barham, Closing the Asylum. The Mental Patient in Modern Society (London, 1992); Gittins, Madness in its Place; Gittins, 'Silences'. This inclusion of patients' accounts within the history of psychiatry can be seen as part of wider developments within the field-a shift of emphasis from changing theories of mental illness and its treatment, to the practices and processes of psychiatry. This involves detailed analysis of how psychiatry worked within specific times and places. The following works exemplify these trends: A. Digby, Madness, Morality and Medicine: A Study of York Retreat, 1796-1914 (Cambridge, 1985); A. Ingram, The Madhouse of Language. Writing and Reading Madness in the Eighteenth Century (London, 1991); A. J. Saris, 'The Proper Place for Lunatics: Asylum, Person and History in a Rural Irish Community' (unpublished Ph.D. thesis, University of Chicago, 1994); J. Sadowsky, 'The Confinements of Isaac O: A Case of "Acute Mania" in Colonial Nigeria', History of Psychiatry, 7 (1996), 91-112; J. Braslow, Mental Ills and Bodily Cures. Psychiatric Treatment in the First Half of the Twentieth Century (Berkley, 1997); Andrews, 'Case Notes, Case Histories'.
17. A. Beveridge, 'Life in the Asylum: Patients' Letters From Morningside, 1873-1908', History of Psychiatry, 9 (1998), 431-69; P. Barham, Closing the Asylum. The Mental Patient in Modern Society (London, 1992); Gittins, Madness in its Place; Gittins, 'Silences'. This inclusion of patients' accounts within the history of psychiatry can be seen as part of wider developments within the field-a shift of emphasis from changing theories of mental illness and its treatment, to the practices and processes of psychiatry. This involves detailed analysis of how psychiatry worked within specific times and places. The following works exemplify these trends: A. Digby, Madness, Morality and Medicine: A Study of York Retreat, 1796-1914 (Cambridge, 1985); A. Ingram, The Madhouse of Language. Writing and Reading Madness in the Eighteenth Century (London, 1991); A. J. Saris, 'The Proper Place for Lunatics: Asylum, Person and History in a Rural Irish Community' (unpublished Ph.D. thesis, University of Chicago, 1994); J. Sadowsky, 'The Confinements of Isaac O: A Case of "Acute Mania" in Colonial Nigeria', History of Psychiatry, 7 (1996), 91-112; J. Braslow, Mental Ills and Bodily Cures. Psychiatric Treatment in the First Half of the Twentieth Century (Berkley, 1997); Andrews, 'Case Notes, Case Histories'.
18. A. Beveridge, 'Life in the Asylum: Patients' Letters From Morningside, 1873-1908', History of Psychiatry, 9 (1998), 431-69; P. Barham, Closing the Asylum. The Mental Patient in Modern Society (London, 1992); Gittins, Madness in its Place; Gittins, 'Silences'. This inclusion of patients' accounts within the history of psychiatry can be seen as part of wider developments within the field-a shift of emphasis from changing theories of mental illness and its treatment, to the practices and processes of psychiatry. This involves detailed analysis of how psychiatry worked within specific times and places. The following works exemplify these trends: A. Digby, Madness, Morality and Medicine: A Study of York Retreat, 1796-1914 (Cambridge, 1985); A. Ingram, The Madhouse of Language. Writing and Reading Madness in the Eighteenth Century (London, 1991); A. J. Saris, 'The Proper Place for Lunatics: Asylum, Person and History in a Rural Irish Community' (unpublished Ph.D. thesis, University of Chicago, 1994); J. Sadowsky, 'The Confinements of Isaac O: A Case of "Acute Mania" in Colonial Nigeria', History of Psychiatry, 7 (1996), 91-112; J. Braslow, Mental Ills and Bodily Cures. Psychiatric Treatment in the First Half of the Twentieth Century (Berkley, 1997); Andrews, 'Case Notes, Case Histories'.
19. A. Beveridge, 'Life in the Asylum: Patients' Letters From Morningside, 1873-1908', History of Psychiatry, 9 (1998), 431-69; P. Barham, Closing the Asylum. The Mental Patient in Modern Society (London, 1992); Gittins, Madness in its Place; Gittins, 'Silences'. This inclusion of patients' accounts within the history of psychiatry can be seen as part of wider developments within the field-a shift of emphasis from changing theories of mental illness and its treatment, to the practices and processes of psychiatry. This involves detailed analysis of how psychiatry worked within specific times and places. The following works exemplify these trends: A. Digby, Madness, Morality and Medicine: A Study of York Retreat, 1796-1914 (Cambridge, 1985); A. Ingram, The Madhouse of Language. Writing and Reading Madness in the Eighteenth Century (London, 1991); A. J. Saris, 'The Proper Place for Lunatics: Asylum, Person and History in a Rural Irish Community' (unpublished Ph.D. thesis, University of Chicago, 1994); J. Sadowsky, 'The Confinements of Isaac O: A Case of "Acute Mania" in Colonial Nigeria', History of Psychiatry, 7 (1996), 91-112; J. Braslow, Mental Ills and Bodily Cures. Psychiatric Treatment in the First Half of the Twentieth Century (Berkley, 1997); Andrews, 'Case Notes, Case Histories'.
20. A. Beveridge, 'Life in the Asylum: Patients' Letters From Morningside, 1873-1908', History of Psychiatry, 9 (1998), 431-69; P. Barham, Closing the Asylum. The Mental Patient in Modern Society (London, 1992); Gittins, Madness in its Place; Gittins, 'Silences'. This inclusion of patients' accounts within the history of psychiatry can be seen as part of wider developments within the field-a shift of emphasis from changing theories of mental illness and its treatment, to the practices and processes of psychiatry. This involves detailed analysis of how psychiatry worked within specific times and places. The following works exemplify these trends: A. Digby, Madness, Morality and Medicine: A Study of York Retreat, 1796-1914 (Cambridge, 1985); A. Ingram, The Madhouse of Language. Writing and Reading Madness in the Eighteenth Century (London, 1991); A. J. Saris, 'The Proper Place for Lunatics: Asylum, Person and History in a Rural Irish Community' (unpublished Ph.D. thesis, University of Chicago, 1994); J. Sadowsky, 'The Confinements of Isaac O: A Case of "Acute Mania" in Colonial Nigeria', History of Psychiatry, 7 (1996), 91-112; J. Braslow, Mental Ills and Bodily Cures. Psychiatric Treatment in the First Half of the Twentieth Century (Berkley, 1997); Andrews, 'Case Notes, Case Histories'.
21. A. Beveridge, 'Life in the Asylum: Patients' Letters From Morningside, 1873-1908', History of Psychiatry, 9 (1998), 431-69; P. Barham, Closing the Asylum. The Mental Patient in Modern Society (London, 1992); Gittins, Madness in its Place; Gittins, 'Silences'. This inclusion of patients' accounts within the history of psychiatry can be seen as part of wider developments within the field-a shift of emphasis from changing theories of mental illness and its treatment, to the practices and processes of psychiatry. This involves detailed analysis of how psychiatry worked within specific times and places. The following works exemplify these trends: A. Digby, Madness, Morality and Medicine: A Study of York Retreat, 1796-1914 (Cambridge, 1985); A. Ingram, The Madhouse of Language. Writing and Reading Madness in the Eighteenth Century (London, 1991); A. J. Saris, 'The Proper Place for Lunatics: Asylum, Person and History in a Rural Irish Community' (unpublished Ph.D. thesis, University of Chicago, 1994); J. Sadowsky, 'The Confinements of Isaac O: A Case of "Acute Mania" in Colonial Nigeria', History of Psychiatry, 7 (1996), 91-112; J. Braslow, Mental Ills and Bodily Cures. Psychiatric Treatment in the First Half of the Twentieth Century (Berkley, 1997); Andrews, 'Case Notes, Case Histories'.
22. A. Beveridge, 'Life in the Asylum: Patients' Letters From Morningside, 1873-1908', History of Psychiatry, 9 (1998), 431-69; P. Barham, Closing the Asylum. The Mental Patient in Modern Society (London, 1992); Gittins, Madness in its Place; Gittins, 'Silences'. This inclusion of patients' accounts within the history of psychiatry can be seen as part of wider developments within the field-a shift of emphasis from changing theories of mental illness and its treatment, to the practices and processes of psychiatry. This involves detailed analysis of how psychiatry worked within specific times and places. The following works exemplify these trends: A. Digby, Madness, Morality and Medicine: A Study of York Retreat, 1796-1914 (Cambridge, 1985); A. Ingram, The Madhouse of Language. Writing and Reading Madness in the Eighteenth Century (London, 1991); A. J. Saris, 'The Proper Place for Lunatics: Asylum, Person and History in a Rural Irish Community' (unpublished Ph.D. thesis, University of Chicago, 1994); J. Sadowsky, 'The Confinements of Isaac O: A Case of "Acute Mania" in Colonial Nigeria', History of Psychiatry, 7 (1996), 91-112; J. Braslow, Mental Ills and Bodily Cures. Psychiatric Treatment in the First Half of the Twentieth Century (Berkley, 1997); Andrews, 'Case Notes, Case Histories'.
23. A. Beveridge, 'Life in the Asylum: Patients' Letters From Morningside, 1873-1908', History of Psychiatry, 9 (1998), 431-69; P. Barham, Closing the Asylum. The Mental Patient in Modern Society (London, 1992); Gittins, Madness in its Place; Gittins, 'Silences'. This inclusion of patients' accounts within the history of psychiatry can be seen as part of wider developments within the field-a shift of emphasis from changing theories of mental illness and its treatment, to the practices and processes of psychiatry. This involves detailed analysis of how psychiatry worked within specific times and places. The following works exemplify these trends: A. Digby, Madness, Morality and Medicine: A Study of York Retreat, 1796-1914 (Cambridge, 1985); A. Ingram, The Madhouse of Language. Writing and Reading Madness in the Eighteenth Century (London, 1991); A. J. Saris, 'The Proper Place for Lunatics: Asylum, Person and History in a Rural Irish Community' (unpublished Ph.D. thesis, University of Chicago, 1994); J. Sadowsky, 'The Confinements of Isaac O: A Case of "Acute Mania" in Colonial Nigeria', History of Psychiatry, 7 (1996), 91-112; J. Braslow, Mental Ills and Bodily Cures. Psychiatric Treatment in the First Half of the Twentieth Century (Berkley, 1997); Andrews, 'Case Notes, Case Histories'.
24. A. Beveridge, 'Life in the Asylum: Patients' Letters From Morningside, 1873-1908', History of Psychiatry, 9 (1998), 431-69; P. Barham, Closing the Asylum. The Mental Patient in Modern Society (London, 1992); Gittins, Madness in its Place; Gittins, 'Silences'. This inclusion of patients' accounts within the history of psychiatry can be seen as part of wider developments within the field-a shift of emphasis from changing theories of mental illness and its treatment, to the practices and processes of psychiatry. This involves detailed analysis of how psychiatry worked within specific times and places. The following works exemplify these trends: A. Digby, Madness, Morality and Medicine: A Study of York Retreat, 1796-1914 (Cambridge, 1985); A. Ingram, The Madhouse of Language. Writing and Reading Madness in the Eighteenth Century (London, 1991); A. J. Saris, 'The Proper Place for Lunatics: Asylum, Person and History in a Rural Irish Community' (unpublished Ph.D. thesis, University of Chicago, 1994); J. Sadowsky, 'The Confinements of Isaac O: A Case of "Acute Mania" in Colonial Nigeria', History of Psychiatry, 7 (1996), 91-112; J. Braslow, Mental Ills and Bodily Cures. Psychiatric Treatment in the First Half of the Twentieth Century (Berkley, 1997); Andrews, 'Case Notes, Case Histories'.
25. 'Many possible histories are erased in the one history chosen for the record, and this effects the substitution of a knowable identity for the complex, shifting identities which make a life.' Swartz, 'Shrinking', p. 155.
26. This research is based on a case study of Oxfordshire. Before embarking on interviews, this project passed through the rigorous ethics procedure of the Oxfordshire Applied and Qualitative Research Committee, eventually allowing individuals within the system of the Oxfordshire Mental Healthcare Trust to be approached and interviewed. Potential participants have thus far been accessed through mental health support groups, including MIND and Oxfordshire Mental Healthcare Trust. In order to access as broad as possible a cross-section of those who have used mental health services in Oxfordshire since 1948, I will also be seeking to access people through housing support organizations, community groups, work schemes, day centres, and so on. Within this article, participants will be identified using a first name. All names have been changed in order to protect anonymity and confidentiality, unless a participant decided that their real (first) name should be used as a recognition of their authorship. Unless stated, please assume that a pseudonym is being used. This changing of names and masking of identities may be read as a further silencing of people who have experienced mental health problems within their own history. Nevertheless, for almost all participants, assurances of anonymity were crucial in enabling them to tell their stories freely.
27. This is a more than sufficient sample for qualitative oral history analysis, for examination of saturation and emphasis of themes or ideas - that is, those mentioned by a significant number of participants or stressed as significant within individual narratives.
28. Participants were all asked to reflect on their 'first experiences of mental illness or mental distress', at the beginning of the interview. Individuals' perceptions of where and when their illness experiences began did not necessarily tie in with the perceptions of professionals. Thus the starting points of oral testimony and written record do not necessarily coincide.
29. While the themes of this work are essentially drawn from participants' accounts, it is essential to recognize the privileged position of the researcher - both as interviewer and as author of this article. All participants have been given the opportunity to read, discuss, and comment upon this piece and many have provided valuable insights. writing the project more broadly, a group of participants have expressed an interest in collaborative writing work. However, this article, while focusing on the narratives of participants, inevitably privileges my own interpretations. Within the field of oral history, issues of ethics, theory, and practice are increasingly emphasized. These complex debates encompass all the processes involved in oral history, from accessing potential participants to interpretation of evidence, and focus on the complexities of the relationships between partners in oral history projects. For more detail of these discussions, see in particular the articles in the special edition of Oral History on memory, trauma and ethics, Oral History, 24 (1998) and work on oral history work with people with learning disabilities, especially, M. Stuart, 'Stories of Shame and Esteem: Women with Learning Difficulties and the Right To Tell Tales', Oral History, 27 (1999), 47-57; J. Walmsley, 'Life History Interviews with People with Learning Disabilities', Oral History, 23 (1995), 71-7. Such issues are, of course, especially pertinent when working with potentially vulnerable people with potentially traumatic memories, and I hope to explore ethics and practice in relation to this particular project in more depth elsewhere.
30. While the themes of this work are essentially drawn from participants' accounts, it is essential to recognize the privileged position of the researcher - both as interviewer and as author of this article. All participants have been given the opportunity to read, discuss, and comment upon this piece and many have provided valuable insights. writing the project more broadly, a group of participants have expressed an interest in collaborative writing work. However, this article, while focusing on the narratives of participants, inevitably privileges my own interpretations. Within the field of oral history, issues of ethics, theory, and practice are increasingly emphasized. These complex debates encompass all the processes involved in oral history, from accessing potential participants to interpretation of evidence, and focus on the complexities of the relationships between partners in oral history projects. For more detail of these discussions, see in particular the articles in the special edition of Oral History on memory, trauma and ethics, Oral History, 24 (1998) and work on oral history work with people with learning disabilities, especially, M. Stuart, 'Stories of Shame and Esteem: Women with Learning Difficulties and the Right To Tell Tales', Oral History, 27 (1999), 47-57; J. Walmsley, 'Life History Interviews with People with Learning Disabilities', Oral History, 23 (1995), 71-7. Such issues are, of course, especially pertinent when working with potentially vulnerable people with potentially traumatic memories, and I hope to explore ethics and practice in relation to this particular project in more depth elsewhere.
31. The broader shifts in mental health policy during the second half of the twentieth century have been covered by, amongst others, K. Jones, Asylums and After. A Revised History of the Mental Health Services from the Early Eighteenth Century to the 1990s (London, 1993); J. Busfield, 'Restructuring Mental Health Services in Twentieth Century Britain', in R. Porter and M. Giwijt-Hostra (eds.), Cultures of Psychiatry and Mental Health Care in Postwar Britain and the Netherlands (Amsterdam, 1998), pp. 9-28. Jones, in particular, writes within the context of late-1980s concerns about communitybased care. Recent, more nuanced, discussions of the historical relationships between hospital and community, are represented in P. Bartlett and D. Wright (eds.), Outside the Walls of the Asylum. The History of Care in the Community, 1750-2000 (London, 1999). On the shifting relationship between psychiatry, patients, and legal processes, with a focus on both legislation and practice, see P. Fennell, Treatment Without Consent. Law, Psychiatry and the Treatment of Mentally Disordered People Since 1845 (London, 1995). For a discussion of the relationships between medicine, the state and concepts of mental illness, see J. Busfield, Managing Madness. Changing Ideas and Practice (London, 1986). On the development and use of psychotropic drugs within psychiatry, see E. M. Tansey, '"They Used to Call it Psychiatry": Aspects of the Development and Impact of Psychopharmocology', in R. Porter and M. Giwijt-Hostra (eds.), Cultures of Medicine and Mental Health Care in Postwar Britain and the Netherlands (Amsterdam, 1998), pp. 79-101; D. Healy, The Anti-depressant Era (London, 1997); D. Healy, 'The History of British Psychopharmocology', in G. E. Berrios and H. Freeman (eds.), 150 Years of British Psychiatry. Volume 2. The Aftennath (London, 1996), pp. 61-88; J. Moncrieff, 'An Investigation into the Precedents of Modern Drug Treatment in Psychiatry', History of Psychiatry, 10 (1999), 475-90. For an overview of Oxfordshire debates on treatments in the 1960s and 1970s, see B. M. Mandelbrote and M. G. Gelder (eds.), Psychiatric Aspects of Medical Practice: A Collection of Oxford Essays (London, 1972). Other works privilege patients' or users' perspectives and experiences as recipients of psychiatric care in this period, most notably, Gittins, Madness in its Place; Barham, Closing the Asylum; P. Campbell, 'A Survivor's View of Community Psychiatry', Journal of Mental Health, 1 (1992), 117-22; P. Barham and R. Hayward, Relocating Madness. From the Mental Patient to the Person (London, 1991). For a discussion of the growth of the user movement, in the context of anti-psychiatry, see A. Claytor, 'A Changing Faith? A History of Developments in Radical Critiques of Psychiatry Since the 1960s' (unpublished Ph.D. thesis, University of Sheffield, 1993). The desire to include service users in the evaluation, and more recently, the planning of services is illustrated by a number of significant surveys, notably A. Rogers, Experiencing Psychiatry: Users' Views of Services (London, 1993).
32. The broader shifts in mental health policy during the second half of the twentieth century have been covered by, amongst others, K. Jones, Asylums and After. A Revised History of the Mental Health Services from the Early Eighteenth Century to the 1990s (London, 1993); J. Busfield, 'Restructuring Mental Health Services in Twentieth Century Britain', in R. Porter and M. Giwijt-Hostra (eds.), Cultures of Psychiatry and Mental Health Care in Postwar Britain and the Netherlands (Amsterdam, 1998), pp. 9-28. Jones, in particular, writes within the context of late-1980s concerns about communitybased care. Recent, more nuanced, discussions of the historical relationships between hospital and community, are represented in P. Bartlett and D. Wright (eds.), Outside the Walls of the Asylum. The History of Care in the Community, 1750-2000 (London, 1999). On the shifting relationship between psychiatry, patients, and legal processes, with a focus on both legislation and practice, see P. Fennell, Treatment Without Consent. Law, Psychiatry and the Treatment of Mentally Disordered People Since 1845 (London, 1995). For a discussion of the relationships between medicine, the state and concepts of mental illness, see J. Busfield, Managing Madness. Changing Ideas and Practice (London, 1986). On the development and use of psychotropic drugs within psychiatry, see E. M. Tansey, '"They Used to Call it Psychiatry": Aspects of the Development and Impact of Psychopharmocology', in R. Porter and M. Giwijt-Hostra (eds.), Cultures of Medicine and Mental Health Care in Postwar Britain and the Netherlands (Amsterdam, 1998), pp. 79-101; D. Healy, The Anti-depressant Era (London, 1997); D. Healy, 'The History of British Psychopharmocology', in G. E. Berrios and H. Freeman (eds.), 150 Years of British Psychiatry. Volume 2. The Aftennath (London, 1996), pp. 61-88; J. Moncrieff, 'An Investigation into the Precedents of Modern Drug Treatment in Psychiatry', History of Psychiatry, 10 (1999), 475-90. For an overview of Oxfordshire debates on treatments in the 1960s and 1970s, see B. M. Mandelbrote and M. G. Gelder (eds.), Psychiatric Aspects of Medical Practice: A Collection of Oxford Essays (London, 1972). Other works privilege patients' or users' perspectives and experiences as recipients of psychiatric care in this period, most notably, Gittins, Madness in its Place; Barham, Closing the Asylum; P. Campbell, 'A Survivor's View of Community Psychiatry', Journal of Mental Health, 1 (1992), 117-22; P. Barham and R. Hayward, Relocating Madness. From the Mental Patient to the Person (London, 1991). For a discussion of the growth of the user movement, in the context of anti-psychiatry, see A. Claytor, 'A Changing Faith? A History of Developments in Radical Critiques of Psychiatry Since the 1960s' (unpublished Ph.D. thesis, University of Sheffield, 1993). The desire to include service users in the evaluation, and more recently, the planning of services is illustrated by a number of significant surveys, notably A. Rogers, Experiencing Psychiatry: Users' Views of Services (London, 1993).
33. The broader shifts in mental health policy during the second half of the twentieth century have been covered by, amongst others, K. Jones, Asylums and After. A Revised History of the Mental Health Services from the Early Eighteenth Century to the 1990s (London, 1993); J. Busfield, 'Restructuring Mental Health Services in Twentieth Century Britain', in R. Porter and M. Giwijt-Hostra (eds.), Cultures of Psychiatry and Mental Health Care in Postwar Britain and the Netherlands (Amsterdam, 1998), pp. 9-28. Jones, in particular, writes within the context of late-1980s concerns about communitybased care. Recent, more nuanced, discussions of the historical relationships between hospital and community, are represented in P. Bartlett and D. Wright (eds.), Outside the Walls of the Asylum. The History of Care in the Community, 1750-2000 (London, 1999). On the shifting relationship between psychiatry, patients, and legal processes, with a focus on both legislation and practice, see P. Fennell, Treatment Without Consent. Law, Psychiatry and the Treatment of Mentally Disordered People Since 1845 (London, 1995). For a discussion of the relationships between medicine, the state and concepts of mental illness, see J. Busfield, Managing Madness. Changing Ideas and Practice (London, 1986). On the development and use of psychotropic drugs within psychiatry, see E. M. Tansey, '"They Used to Call it Psychiatry": Aspects of the Development and Impact of Psychopharmocology', in R. Porter and M. Giwijt-Hostra (eds.), Cultures of Medicine and Mental Health Care in Postwar Britain and the Netherlands (Amsterdam, 1998), pp. 79-101; D. Healy, The Anti-depressant Era (London, 1997); D. Healy, 'The History of British Psychopharmocology', in G. E. Berrios and H. Freeman (eds.), 150 Years of British Psychiatry. Volume 2. The Aftennath (London, 1996), pp. 61-88; J. Moncrieff, 'An Investigation into the Precedents of Modern Drug Treatment in Psychiatry', History of Psychiatry, 10 (1999), 475-90. For an overview of Oxfordshire debates on treatments in the 1960s and 1970s, see B. M. Mandelbrote and M. G. Gelder (eds.), Psychiatric Aspects of Medical Practice: A Collection of Oxford Essays (London, 1972). Other works privilege patients' or users' perspectives and experiences as recipients of psychiatric care in this period, most notably, Gittins, Madness in its Place; Barham, Closing the Asylum; P. Campbell, 'A Survivor's View of Community Psychiatry', Journal of Mental Health, 1 (1992), 117-22; P. Barham and R. Hayward, Relocating Madness. From the Mental Patient to the Person (London, 1991). For a discussion of the growth of the user movement, in the context of anti-psychiatry, see A. Claytor, 'A Changing Faith? A History of Developments in Radical Critiques of Psychiatry Since the 1960s' (unpublished Ph.D. thesis, University of Sheffield, 1993). The desire to include service users in the evaluation, and more recently, the planning of services is illustrated by a number of significant surveys, notably A. Rogers, Experiencing Psychiatry: Users' Views of Services (London, 1993).
34. The broader shifts in mental health policy during the second half of the twentieth century have been covered by, amongst others, K. Jones, Asylums and After. A Revised History of the Mental Health Services from the Early Eighteenth Century to the 1990s (London, 1993); J. Busfield, 'Restructuring Mental Health Services in Twentieth Century Britain', in R. Porter and M. Giwijt-Hostra (eds.), Cultures of Psychiatry and Mental Health Care in Postwar Britain and the Netherlands (Amsterdam, 1998), pp. 9-28. Jones, in particular, writes within the context of late-1980s concerns about communitybased care. Recent, more nuanced, discussions of the historical relationships between hospital and community, are represented in P. Bartlett and D. Wright (eds.), Outside the Walls of the Asylum. The History of Care in the Community, 1750-2000 (London, 1999). On the shifting relationship between psychiatry, patients, and legal processes, with a focus on both legislation and practice, see P. Fennell, Treatment Without Consent. Law, Psychiatry and the Treatment of Mentally Disordered People Since 1845 (London, 1995). For a discussion of the relationships between medicine, the state and concepts of mental illness, see J. Busfield, Managing Madness. Changing Ideas and Practice (London, 1986). On the development and use of psychotropic drugs within psychiatry, see E. M. Tansey, '"They Used to Call it Psychiatry": Aspects of the Development and Impact of Psychopharmocology', in R. Porter and M. Giwijt-Hostra (eds.), Cultures of Medicine and Mental Health Care in Postwar Britain and the Netherlands (Amsterdam, 1998), pp. 79-101; D. Healy, The Anti-depressant Era (London, 1997); D. Healy, 'The History of British Psychopharmocology', in G. E. Berrios and H. Freeman (eds.), 150 Years of British Psychiatry. Volume 2. The Aftennath (London, 1996), pp. 61-88; J. Moncrieff, 'An Investigation into the Precedents of Modern Drug Treatment in Psychiatry', History of Psychiatry, 10 (1999), 475-90. For an overview of Oxfordshire debates on treatments in the 1960s and 1970s, see B. M. Mandelbrote and M. G. Gelder (eds.), Psychiatric Aspects of Medical Practice: A Collection of Oxford Essays (London, 1972). Other works privilege patients' or users' perspectives and experiences as recipients of psychiatric care in this period, most notably, Gittins, Madness in its Place; Barham, Closing the Asylum; P. Campbell, 'A Survivor's View of Community Psychiatry', Journal of Mental Health, 1 (1992), 117-22; P. Barham and R. Hayward, Relocating Madness. From the Mental Patient to the Person (London, 1991). For a discussion of the growth of the user movement, in the context of anti-psychiatry, see A. Claytor, 'A Changing Faith? A History of Developments in Radical Critiques of Psychiatry Since the 1960s' (unpublished Ph.D. thesis, University of Sheffield, 1993). The desire to include service users in the evaluation, and more recently, the planning of services is illustrated by a number of significant surveys, notably A. Rogers, Experiencing Psychiatry: Users' Views of Services (London, 1993).
35. The broader shifts in mental health policy during the second half of the twentieth century have been covered by, amongst others, K. Jones, Asylums and After. A Revised History of the Mental Health Services from the Early Eighteenth Century to the 1990s (London, 1993); J. Busfield, 'Restructuring Mental Health Services in Twentieth Century Britain', in R. Porter and M. Giwijt-Hostra (eds.), Cultures of Psychiatry and Mental Health Care in Postwar Britain and the Netherlands (Amsterdam, 1998), pp. 9-28. Jones, in particular, writes within the context of late-1980s concerns about communitybased care. Recent, more nuanced, discussions of the historical relationships between hospital and community, are represented in P. Bartlett and D. Wright (eds.), Outside the Walls of the Asylum. The History of Care in the Community, 1750-2000 (London, 1999). On the shifting relationship between psychiatry, patients, and legal processes, with a focus on both legislation and practice, see P. Fennell, Treatment Without Consent. Law, Psychiatry and the Treatment of Mentally Disordered People Since 1845 (London, 1995). For a discussion of the relationships between medicine, the state and concepts of mental illness, see J. Busfield, Managing Madness. Changing Ideas and Practice (London, 1986). On the development and use of psychotropic drugs within psychiatry, see E. M. Tansey, '"They Used to Call it Psychiatry": Aspects of the Development and Impact of Psychopharmocology', in R. Porter and M. Giwijt-Hostra (eds.), Cultures of Medicine and Mental Health Care in Postwar Britain and the Netherlands (Amsterdam, 1998), pp. 79-101; D. Healy, The Anti-depressant Era (London, 1997); D. Healy, 'The History of British Psychopharmocology', in G. E. Berrios and H. Freeman (eds.), 150 Years of British Psychiatry. Volume 2. The Aftennath (London, 1996), pp. 61-88; J. Moncrieff, 'An Investigation into the Precedents of Modern Drug Treatment in Psychiatry', History of Psychiatry, 10 (1999), 475-90. For an overview of Oxfordshire debates on treatments in the 1960s and 1970s, see B. M. Mandelbrote and M. G. Gelder (eds.), Psychiatric Aspects of Medical Practice: A Collection of Oxford Essays (London, 1972). Other works privilege patients' or users' perspectives and experiences as recipients of psychiatric care in this period, most notably, Gittins, Madness in its Place; Barham, Closing the Asylum; P. Campbell, 'A Survivor's View of Community Psychiatry', Journal of Mental Health, 1 (1992), 117-22; P. Barham and R. Hayward, Relocating Madness. From the Mental Patient to the Person (London, 1991). For a discussion of the growth of the user movement, in the context of anti-psychiatry, see A. Claytor, 'A Changing Faith? A History of Developments in Radical Critiques of Psychiatry Since the 1960s' (unpublished Ph.D. thesis, University of Sheffield, 1993). The desire to include service users in the evaluation, and more recently, the planning of services is illustrated by a number of significant surveys, notably A. Rogers, Experiencing Psychiatry: Users' Views of Services (London, 1993).
36. The broader shifts in mental health policy during the second half of the twentieth century have been covered by, amongst others, K. Jones, Asylums and After. A Revised History of the Mental Health Services from the Early Eighteenth Century to the 1990s (London, 1993); J. Busfield, 'Restructuring Mental Health Services in Twentieth Century Britain', in R. Porter and M. Giwijt-Hostra (eds.), Cultures of Psychiatry and Mental Health Care in Postwar Britain and the Netherlands (Amsterdam, 1998), pp. 9-28. Jones, in particular, writes within the context of late-1980s concerns about communitybased care. Recent, more nuanced, discussions of the historical relationships between hospital and community, are represented in P. Bartlett and D. Wright (eds.), Outside the Walls of the Asylum. The History of Care in the Community, 1750-2000 (London, 1999). On the shifting relationship between psychiatry, patients, and legal processes, with a focus on both legislation and practice, see P. Fennell, Treatment Without Consent. Law, Psychiatry and the Treatment of Mentally Disordered People Since 1845 (London, 1995). For a discussion of the relationships between medicine, the state and concepts of mental illness, see J. Busfield, Managing Madness. Changing Ideas and Practice (London, 1986). On the development and use of psychotropic drugs within psychiatry, see E. M. Tansey, '"They Used to Call it Psychiatry": Aspects of the Development and Impact of Psychopharmocology', in R. Porter and M. Giwijt-Hostra (eds.), Cultures of Medicine and Mental Health Care in Postwar Britain and the Netherlands (Amsterdam, 1998), pp. 79-101; D. Healy, The Anti-depressant Era (London, 1997); D. Healy, 'The History of British Psychopharmocology', in G. E. Berrios and H. Freeman (eds.), 150 Years of British Psychiatry. Volume 2. The Aftennath (London, 1996), pp. 61-88; J. Moncrieff, 'An Investigation into the Precedents of Modern Drug Treatment in Psychiatry', History of Psychiatry, 10 (1999), 475-90. For an overview of Oxfordshire debates on treatments in the 1960s and 1970s, see B. M. Mandelbrote and M. G. Gelder (eds.), Psychiatric Aspects of Medical Practice: A Collection of Oxford Essays (London, 1972). Other works privilege patients' or users' perspectives and experiences as recipients of psychiatric care in this period, most notably, Gittins, Madness in its Place; Barham, Closing the Asylum; P. Campbell, 'A Survivor's View of Community Psychiatry', Journal of Mental Health, 1 (1992), 117-22; P. Barham and R. Hayward, Relocating Madness. From the Mental Patient to the Person (London, 1991). For a discussion of the growth of the user movement, in the context of anti-psychiatry, see A. Claytor, 'A Changing Faith? A History of Developments in Radical Critiques of Psychiatry Since the 1960s' (unpublished Ph.D. thesis, University of Sheffield, 1993). The desire to include service users in the evaluation, and more recently, the planning of services is illustrated by a number of significant surveys, notably A. Rogers, Experiencing Psychiatry: Users' Views of Services (London, 1993).
37. The broader shifts in mental health policy during the second half of the twentieth century have been covered by, amongst others, K. Jones, Asylums and After. A Revised History of the Mental Health Services from the Early Eighteenth Century to the 1990s (London, 1993); J. Busfield, 'Restructuring Mental Health Services in Twentieth Century Britain', in R. Porter and M. Giwijt-Hostra (eds.), Cultures of Psychiatry and Mental Health Care in Postwar Britain and the Netherlands (Amsterdam, 1998), pp. 9-28. Jones, in particular, writes within the context of late-1980s concerns about communitybased care. Recent, more nuanced, discussions of the historical relationships between hospital and community, are represented in P. Bartlett and D. Wright (eds.), Outside the Walls of the Asylum. The History of Care in the Community, 1750-2000 (London, 1999). On the shifting relationship between psychiatry, patients, and legal processes, with a focus on both legislation and practice, see P. Fennell, Treatment Without Consent. Law, Psychiatry and the Treatment of Mentally Disordered People Since 1845 (London, 1995). For a discussion of the relationships between medicine, the state and concepts of mental illness, see J. Busfield, Managing Madness. Changing Ideas and Practice (London, 1986). On the development and use of psychotropic drugs within psychiatry, see E. M. Tansey, '"They Used to Call it Psychiatry": Aspects of the Development and Impact of Psychopharmocology', in R. Porter and M. Giwijt-Hostra (eds.), Cultures of Medicine and Mental Health Care in Postwar Britain and the Netherlands (Amsterdam, 1998), pp. 79-101; D. Healy, The Anti-depressant Era (London, 1997); D. Healy, 'The History of British Psychopharmocology', in G. E. Berrios and H. Freeman (eds.), 150 Years of British Psychiatry. Volume 2. The Aftennath (London, 1996), pp. 61-88; J. Moncrieff, 'An Investigation into the Precedents of Modern Drug Treatment in Psychiatry', History of Psychiatry, 10 (1999), 475-90. For an overview of Oxfordshire debates on treatments in the 1960s and 1970s, see B. M. Mandelbrote and M. G. Gelder (eds.), Psychiatric Aspects of Medical Practice: A Collection of Oxford Essays (London, 1972). Other works privilege patients' or users' perspectives and experiences as recipients of psychiatric care in this period, most notably, Gittins, Madness in its Place; Barham, Closing the Asylum; P. Campbell, 'A Survivor's View of Community Psychiatry', Journal of Mental Health, 1 (1992), 117-22; P. Barham and R. Hayward, Relocating Madness. From the Mental Patient to the Person (London, 1991). For a discussion of the growth of the user movement, in the context of anti-psychiatry, see A. Claytor, 'A Changing Faith? A History of Developments in Radical Critiques of Psychiatry Since the 1960s' (unpublished Ph.D. thesis, University of Sheffield, 1993). The desire to include service users in the evaluation, and more recently, the planning of services is illustrated by a number of significant surveys, notably A. Rogers, Experiencing Psychiatry: Users' Views of Services (London, 1993).
38. The broader shifts in mental health policy during the second half of the twentieth century have been covered by, amongst others, K. Jones, Asylums and After. A Revised History of the Mental Health Services from the Early Eighteenth Century to the 1990s (London, 1993); J. Busfield, 'Restructuring Mental Health Services in Twentieth Century Britain', in R. Porter and M. Giwijt-Hostra (eds.), Cultures of Psychiatry and Mental Health Care in Postwar Britain and the Netherlands (Amsterdam, 1998), pp. 9-28. Jones, in particular, writes within the context of late-1980s concerns about communitybased care. Recent, more nuanced, discussions of the historical relationships between hospital and community, are represented in P. Bartlett and D. Wright (eds.), Outside the Walls of the Asylum. The History of Care in the Community, 1750-2000 (London, 1999). On the shifting relationship between psychiatry, patients, and legal processes, with a focus on both legislation and practice, see P. Fennell, Treatment Without Consent. Law, Psychiatry and the Treatment of Mentally Disordered People Since 1845 (London, 1995). For a discussion of the relationships between medicine, the state and concepts of mental illness, see J. Busfield, Managing Madness. Changing Ideas and Practice (London, 1986). On the development and use of psychotropic drugs within psychiatry, see E. M. Tansey, '"They Used to Call it Psychiatry": Aspects of the Development and Impact of Psychopharmocology', in R. Porter and M. Giwijt-Hostra (eds.), Cultures of Medicine and Mental Health Care in Postwar Britain and the Netherlands (Amsterdam, 1998), pp. 79-101; D. Healy, The Anti-depressant Era (London, 1997); D. Healy, 'The History of British Psychopharmocology', in G. E. Berrios and H. Freeman (eds.), 150 Years of British Psychiatry. Volume 2. The Aftennath (London, 1996), pp. 61-88; J. Moncrieff, 'An Investigation into the Precedents of Modern Drug Treatment in Psychiatry', History of Psychiatry, 10 (1999), 475-90. For an overview of Oxfordshire debates on treatments in the 1960s and 1970s, see B. M. Mandelbrote and M. G. Gelder (eds.), Psychiatric Aspects of Medical Practice: A Collection of Oxford Essays (London, 1972). Other works privilege patients' or users' perspectives and experiences as recipients of psychiatric care in this period, most notably, Gittins, Madness in its Place; Barham, Closing the Asylum; P. Campbell, 'A Survivor's View of Community Psychiatry', Journal of Mental Health, 1 (1992), 117-22; P. Barham and R. Hayward, Relocating Madness. From the Mental Patient to the Person (London, 1991). For a discussion of the growth of the user movement, in the context of anti-psychiatry, see A. Claytor, 'A Changing Faith? A History of Developments in Radical Critiques of Psychiatry Since the 1960s' (unpublished Ph.D. thesis, University of Sheffield, 1993). The desire to include service users in the evaluation, and more recently, the planning of services is illustrated by a number of significant surveys, notably A. Rogers, Experiencing Psychiatry: Users' Views of Services (London, 1993).
39. The broader shifts in mental health policy during the second half of the twentieth century have been covered by, amongst others, K. Jones, Asylums and After. A Revised History of the Mental Health Services from the Early Eighteenth Century to the 1990s (London, 1993); J. Busfield, 'Restructuring Mental Health Services in Twentieth Century Britain', in R. Porter and M. Giwijt-Hostra (eds.), Cultures of Psychiatry and Mental Health Care in Postwar Britain and the Netherlands (Amsterdam, 1998), pp. 9-28. Jones, in particular, writes within the context of late-1980s concerns about communitybased care. Recent, more nuanced, discussions of the historical relationships between hospital and community, are represented in P. Bartlett and D. Wright (eds.), Outside the Walls of the Asylum. The History of Care in the Community, 1750-2000 (London, 1999). On the shifting relationship between psychiatry, patients, and legal processes, with a focus on both legislation and practice, see P. Fennell, Treatment Without Consent. Law, Psychiatry and the Treatment of Mentally Disordered People Since 1845 (London, 1995). For a discussion of the relationships between medicine, the state and concepts of mental illness, see J. Busfield, Managing Madness. Changing Ideas and Practice (London, 1986). On the development and use of psychotropic drugs within psychiatry, see E. M. Tansey, '"They Used to Call it Psychiatry": Aspects of the Development and Impact of Psychopharmocology', in R. Porter and M. Giwijt-Hostra (eds.), Cultures of Medicine and Mental Health Care in Postwar Britain and the Netherlands (Amsterdam, 1998), pp. 79-101; D. Healy, The Anti-depressant Era (London, 1997); D. Healy, 'The History of British Psychopharmocology', in G. E. Berrios and H. Freeman (eds.), 150 Years of British Psychiatry. Volume 2. The Aftennath (London, 1996), pp. 61-88; J. Moncrieff, 'An Investigation into the Precedents of Modern Drug Treatment in Psychiatry', History of Psychiatry, 10 (1999), 475-90. For an overview of Oxfordshire debates on treatments in the 1960s and 1970s, see B. M. Mandelbrote and M. G. Gelder (eds.), Psychiatric Aspects of Medical Practice: A Collection of Oxford Essays (London, 1972). Other works privilege patients' or users' perspectives and experiences as recipients of psychiatric care in this period, most notably, Gittins, Madness in its Place; Barham, Closing the Asylum; P. Campbell, 'A Survivor's View of Community Psychiatry', Journal of Mental Health, 1 (1992), 117-22; P. Barham and R. Hayward, Relocating Madness. From the Mental Patient to the Person (London, 1991). For a discussion of the growth of the user movement, in the context of anti-psychiatry, see A. Claytor, 'A Changing Faith? A History of Developments in Radical Critiques of Psychiatry Since the 1960s' (unpublished Ph.D. thesis, University of Sheffield, 1993). The desire to include service users in the evaluation, and more recently, the planning of services is illustrated by a number of significant surveys, notably A. Rogers, Experiencing Psychiatry: Users' Views of Services (London, 1993).
40. The broader shifts in mental health policy during the second half of the twentieth century have been covered by, amongst others, K. Jones, Asylums and After. A Revised History of the Mental Health Services from the Early Eighteenth Century to the 1990s (London, 1993); J. Busfield, 'Restructuring Mental Health Services in Twentieth Century Britain', in R. Porter and M. Giwijt-Hostra (eds.), Cultures of Psychiatry and Mental Health Care in Postwar Britain and the Netherlands (Amsterdam, 1998), pp. 9-28. Jones, in particular, writes within the context of late-1980s concerns about communitybased care. Recent, more nuanced, discussions of the historical relationships between hospital and community, are represented in P. Bartlett and D. Wright (eds.), Outside the Walls of the Asylum. The History of Care in the Community, 1750-2000 (London, 1999). On the shifting relationship between psychiatry, patients, and legal processes, with a focus on both legislation and practice, see P. Fennell, Treatment Without Consent. Law, Psychiatry and the Treatment of Mentally Disordered People Since 1845 (London, 1995). For a discussion of the relationships between medicine, the state and concepts of mental illness, see J. Busfield, Managing Madness. Changing Ideas and Practice (London, 1986). On the development and use of psychotropic drugs within psychiatry, see E. M. Tansey, '"They Used to Call it Psychiatry": Aspects of the Development and Impact of Psychopharmocology', in R. Porter and M. Giwijt-Hostra (eds.), Cultures of Medicine and Mental Health Care in Postwar Britain and the Netherlands (Amsterdam, 1998), pp. 79-101; D. Healy, The Anti-depressant Era (London, 1997); D. Healy, 'The History of British Psychopharmocology', in G. E. Berrios and H. Freeman (eds.), 150 Years of British Psychiatry. Volume 2. The Aftennath (London, 1996), pp. 61-88; J. Moncrieff, 'An Investigation into the Precedents of Modern Drug Treatment in Psychiatry', History of Psychiatry, 10 (1999), 475-90. For an overview of Oxfordshire debates on treatments in the 1960s and 1970s, see B. M. Mandelbrote and M. G. Gelder (eds.), Psychiatric Aspects of Medical Practice: A Collection of Oxford Essays (London, 1972). Other works privilege patients' or users' perspectives and experiences as recipients of psychiatric care in this period, most notably, Gittins, Madness in its Place; Barham, Closing the Asylum; P. Campbell, 'A Survivor's View of Community Psychiatry', Journal of Mental Health, 1 (1992), 117-22; P. Barham and R. Hayward, Relocating Madness. From the Mental Patient to the Person (London, 1991). For a discussion of the growth of the user movement, in the context of anti-psychiatry, see A. Claytor, 'A Changing Faith? A History of Developments in Radical Critiques of Psychiatry Since the 1960s' (unpublished Ph.D. thesis, University of Sheffield, 1993). The desire to include service users in the evaluation, and more recently, the planning of services is illustrated by a number of significant surveys, notably A. Rogers, Experiencing Psychiatry: Users' Views of Services (London, 1993).
41. The broader shifts in mental health policy during the second half of the twentieth century have been covered by, amongst others, K. Jones, Asylums and After. A Revised History of the Mental Health Services from the Early Eighteenth Century to the 1990s (London, 1993); J. Busfield, 'Restructuring Mental Health Services in Twentieth Century Britain', in R. Porter and M. Giwijt-Hostra (eds.), Cultures of Psychiatry and Mental Health Care in Postwar Britain and the Netherlands (Amsterdam, 1998), pp. 9-28. Jones, in particular, writes within the context of late-1980s concerns about communitybased care. Recent, more nuanced, discussions of the historical relationships between hospital and community, are represented in P. Bartlett and D. Wright (eds.), Outside the Walls of the Asylum. The History of Care in the Community, 1750-2000 (London, 1999). On the shifting relationship between psychiatry, patients, and legal processes, with a focus on both legislation and practice, see P. Fennell, Treatment Without Consent. Law, Psychiatry and the Treatment of Mentally Disordered People Since 1845 (London, 1995). For a discussion of the relationships between medicine, the state and concepts of mental illness, see J. Busfield, Managing Madness. Changing Ideas and Practice (London, 1986). On the development and use of psychotropic drugs within psychiatry, see E. M. Tansey, '"They Used to Call it Psychiatry": Aspects of the Development and Impact of Psychopharmocology', in R. Porter and M. Giwijt-Hostra (eds.), Cultures of Medicine and Mental Health Care in Postwar Britain and the Netherlands (Amsterdam, 1998), pp. 79-101; D. Healy, The Anti-depressant Era (London, 1997); D. Healy, 'The History of British Psychopharmocology', in G. E. Berrios and H. Freeman (eds.), 150 Years of British Psychiatry. Volume 2. The Aftennath (London, 1996), pp. 61-88; J. Moncrieff, 'An Investigation into the Precedents
42. The broader shifts in mental health policy during the second half of the twentieth century have been covered by, amongst others, K. Jones, Asylums and After. A Revised History of the Mental Health Services from the Early Eighteenth Century to the 1990s (London, 1993); J. Busfield, 'Restructuring Mental Health Services in Twentieth Century Britain', in R. Porter and M. Giwijt-Hostra (eds.), Cultures of Psychiatry and Mental Health Care in Postwar Britain and the Netherlands (Amsterdam, 1998), pp. 9-28. Jones, in particular, writes within the context of late-1980s concerns about communitybased care. Recent, more nuanced, discussions of the historical relationships between hospital and community, are represented in P. Bartlett and D. Wright (eds.), Outside the Walls of the Asylum. The History of Care in the Community, 1750-2000 (London, 1999). On the shifting relationship between psychiatry, patients, and legal processes, with a focus on both legislation and practice, see P. Fennell, Treatment Without Consent. Law, Psychiatry and the Treatment of Mentally Disordered People Since 1845 (London, 1995). For a discussion of the relationships between medicine, the state and concepts of mental illness, see J. Busfield, Managing Madness. Changing Ideas and Practice (London, 1986). On the development and use of psychotropic drugs within psychiatry, see E. M. Tansey, '"They Used to Call it Psychiatry": Aspects of the Development and Impact of Psychopharmocology', in R. Porter and M. Giwijt-Hostra (eds.), Cultures of Medicine and Mental Health Care in Postwar Britain and the Netherlands (Amsterdam, 1998), pp. 79-101; D. Healy, The Anti-depressant Era (London, 1997); D. Healy, 'The History of British Psychopharmocology', in G. E. Berrios and H. Freeman (eds.), 150 Years of British Psychiatry. Volume 2. The Aftennath (London, 1996), pp. 61-88; J. Moncrieff, 'An Investigation into the Precedents of Modern Drug Treatment in Psychiatry', History of Psychiatry, 10 (1999), 475-90. For an overview of Oxfordshire debates on treatments in the 1960s and 1970s, see B. M. Mandelbrote and M. G. Gelder (eds.), Psychiatric Aspects of Medical Practice: A Collection of Oxford Essays (London, 1972). Other works privilege patients' or users' perspectives and experiences as recipients of psychiatric care in this period, most notably, Gittins, Madness in its Place; Barham, Closing the Asylum; P. Campbell, 'A Survivor's View of Community Psychiatry', Journal of Mental Health, 1 (1992), 117-22; P. Barham and R. Hayward, Relocating Madness. From the Mental Patient to the Person (London, 1991). For a discussion of the growth of the user movement, in the context of anti-psychiatry, see A. Claytor, 'A Changing Faith? A History of Developments in Radical Critiques of Psychiatry Since the 1960s' (unpublished Ph.D. thesis, University of Sheffield, 1993). The desire to include service users in the evaluation, and more recently, the planning of services is illustrated by a number of significant surveys, notably A. Rogers, Experiencing Psychiatry: Users' Views of Services (London, 1993).
43. The broader shifts in mental health policy during the second half of the twentieth century have been covered by, amongst others, K. Jones, Asylums and After. A Revised History of the Mental Health Services from the Early Eighteenth Century to the 1990s (London, 1993); J. Busfield, 'Restructuring Mental Health Services in Twentieth Century Britain', in R. Porter and M. Giwijt-Hostra (eds.), Cultures of Psychiatry and Mental Health Care in Postwar Britain and the Netherlands (Amsterdam, 1998), pp. 9-28. Jones, in particular, writes within the context of late-1980s concerns about communitybased care. Recent, more nuanced, discussions of the historical relationships between hospital and community, are represented in P. Bartlett and D. Wright (eds.), Outside the Walls of the Asylum. The History of Care in the Community, 1750-2000 (London, 1999). On the shifting relationship between psychiatry, patients, and legal processes, with a focus on both legislation and practice, see P. Fennell, Treatment Without Consent. Law, Psychiatry and the Treatment of Mentally Disordered People Since 1845 (London, 1995). For a discussion of the relationships between medicine, the state and concepts of mental illness, see J. Busfield, Managing Madness. Changing Ideas and Practice (London, 1986). On the development and use of psychotropic drugs within psychiatry, see E. M. Tansey, '"They Used to Call it Psychiatry": Aspects of the Development and Impact of Psychopharmocology', in R. Porter and M. Giwijt-Hostra (eds.), Cultures of Medicine and Mental Health Care in Postwar Britain and the Netherlands (Amsterdam, 1998), pp. 79-101; D. Healy, The Anti-depressant Era (London, 1997); D. Healy, 'The History of British Psychopharmocology', in G. E. Berrios and H. Freeman (eds.), 150 Years of British Psychiatry. Volume 2. The Aftennath (London, 1996), pp. 61-88; J. Moncrieff, 'An Investigation into the Precedents of Modern Drug Treatment in Psychiatry', History of Psychiatry, 10 (1999), 475-90. For an overview of Oxfordshire debates on treatments in the 1960s and 1970s, see B. M. Mandelbrote and M. G. Gelder (eds.), Psychiatric Aspects of Medical Practice: A Collection of Oxford Essays (London, 1972). Other works privilege patients' or users' perspectives and experiences as recipients of psychiatric care in this period, most notably, Gittins, Madness in its Place; Barham, Closing the Asylum; P. Campbell, 'A Survivor's View of Community Psychiatry', Journal of Mental Health, 1 (1992), 117-22; P. Barham and R. Hayward, Relocating Madness. From the Mental Patient to the Person (London, 1991). For a discussion of the growth of the user movement, in the context of anti-psychiatry, see A. Claytor, 'A Changing Faith? A History of Developments in Radical Critiques of Psychiatry Since the 1960s' (unpublished Ph.D. thesis, University of Sheffield, 1993). The desire to include service users in the evaluation, and more recently, the planning of services is illustrated by a number of significant surveys, notably A. Rogers, Experiencing Psychiatry: Users' Views of Services (London, 1993).
44. The broader shifts in mental health policy during the second half of the twentieth century have been covered by, amongst others, K. Jones, Asylums and After. A Revised History of the Mental Health Services from the Early Eighteenth Century to the 1990s (London, 1993); J. Busfield, 'Restructuring Mental Health Services in Twentieth Century Britain', in R. Porter and M. Giwijt-Hostra (eds.), Cultures of Psychiatry and Mental Health Care in Postwar Britain and the Netherlands (Amsterdam, 1998), pp. 9-28. Jones, in particular, writes within the context of late-1980s concerns about communitybased care. Recent, more nuanced, discussions of the historical relationships between hospital and community, are represented in P. Bartlett and D. Wright (eds.), Outside the Walls of the Asylum. The History of Care in the Community, 1750-2000 (London, 1999). On the shifting relationship between psychiatry, patients, and legal processes, with a focus on both legislation and practice, see P. Fennell, Treatment Without Consent. Law, Psychiatry and the Treatment of Mentally Disordered People Since 1845 (London, 1995). For a discussion of the relationships between medicine, the state and concepts of mental illness, see J. Busfield, Managing Madness. Changing Ideas and Practice (London, 1986). On the development and use of psychotropic drugs within psychiatry, see E. M. Tansey, '"They Used to Call it Psychiatry": Aspects of the Development and Impact of Psychopharmocology', in R. Porter and M. Giwijt-Hostra (eds.), Cultures of Medicine and Mental Health Care in Postwar Britain and the Netherlands (Amsterdam, 1998), pp. 79-101; D. Healy, The Anti-depressant Era (London, 1997); D. Healy, 'The History of British Psychopharmocology', in G. E. Berrios and H. Freeman (eds.), 150 Years of British Psychiatry. Volume 2. The Aftennath (London, 1996), pp. 61-88; J. Moncrieff, 'An Investigation into the Precedents of Modern Drug Treatment in Psychiatry', History of Psychiatry, 10 (1999), 475-90. For an overview of Oxfordshire debates on treatments in the 1960s and 1970s, see B. M. Mandelbrote and M. G. Gelder (eds.), Psychiatric Aspects of Medical Practice: A Collection of Oxford Essays (London, 1972). Other works privilege patients' or users' perspectives and experiences as recipients of psychiatric care in this period, most notably, Gittins, Madness in its Place; Barham, Closing the Asylum; P. Campbell, 'A Survivor's View of Community Psychiatry', Journal of Mental Health, 1 (1992), 117-22; P. Barham and R. Hayward, Relocating Madness. From the Mental Patient to the Person (London, 1991). For a discussion of the growth of the user movement, in the context of anti-psychiatry, see A. Claytor, 'A Changing Faith? A History of Developments in Radical Critiques of Psychiatry Since the 1960s' (unpublished Ph.D. thesis, University of Sheffield, 1993). The desire to include service users in the evaluation, and more recently, the planning of services is illustrated by a number of significant surveys, notably A. Rogers, Experiencing Psychiatry: Users' Views of Services (London, 1993).
45. The broader shifts in mental health policy during the second half of the twentieth century have been covered by, amongst others, K. Jones, Asylums and After. A Revised History of the Mental Health Services from the Early Eighteenth Century to the 1990s (London, 1993); J. Busfield, 'Restructuring Mental Health Services in Twentieth Century Britain', in R. Porter and M. Giwijt-Hostra (eds.), Cultures of Psychiatry and Mental Health Care in Postwar Britain and the Netherlands (Amsterdam, 1998), pp. 9-28. Jones, in particular, writes within the context of late-1980s concerns about communitybased care. Recent, more nuanced, discussions of the historical relationships between hospital and community, are represented in P. Bartlett and D. Wright (eds.), Outside the Walls of the Asylum. The History of Care in the Community, 1750-2000 (London, 1999). On the shifting relationship between psychiatry, patients, and legal processes, with a focus on both legislation and practice, see P. Fennell, Treatment Without Consent. Law, Psychiatry and the Treatment of Mentally Disordered People Since 1845 (London, 1995). For a discussion of the relationships between medicine, the state and concepts of mental illness, see J. Busfield, Managing Madness. Changing Ideas and Practice (London, 1986). On the development and use of psychotropic drugs within psychiatry, see E. M. Tansey, '"They Used to Call it Psychiatry": Aspects of the Development and Impact of Psychopharmocology', in R. Porter and M. Giwijt-Hostra (eds.), Cultures of Medicine and Mental Health Care in Postwar Britain and the Netherlands (Amsterdam, 1998), pp. 79-101; D. Healy, The Anti-depressant Era (London, 1997); D. Healy, 'The History of British Psychopharmocology', in G. E. Berrios and H. Freeman (eds.), 150 Years of British Psychiatry. Volume 2. The Aftennath (London, 1996), pp. 61-88; J. Moncrieff, 'An Investigation into the Precedents of Modern Drug Treatment in Psychiatry', History of Psychiatry, 10 (1999), 475-90. For an overview of Oxfordshire debates on treatments in the 1960s and 1970s, see B. M. Mandelbrote and M. G. Gelder (eds.), Psychiatric Aspects of Medical Practice: A Collection of Oxford Essays (London, 1972). Other works privilege patients' or users' perspectives and experiences as recipients of psychiatric care in this period, most notably, Gittins, Madness in its Place; Barham, Closing the Asylum; P. Campbell, 'A Survivor's View of Community Psychiatry', Journal of Mental Health, 1 (1992), 117-22; P. Barham and R. Hayward, Relocating Madness. From the Mental Patient to the Person (London, 1991). For a discussion of the growth of the user movement, in the context of anti-psychiatry, see A. Claytor, 'A Changing Faith? A History of Developments in Radical Critiques of Psychiatry Since the 1960s' (unpublished Ph.D. thesis, University of Sheffield, 1993). The desire to include service users in the evaluation, and more recently, the planning of services is illustrated by a number of significant surveys, notably A. Rogers, Experiencing Psychiatry: Users' Views of Services (London, 1993).
46. The broader shifts in mental health policy during the second half of the twentieth century have been covered by, amongst others, K. Jones, Asylums and After. A Revised History of the Mental Health Services from the Early Eighteenth Century to the 1990s (London, 1993); J. Busfield, 'Restructuring Mental Health Services in Twentieth Century Britain', in R. Porter and M. Giwijt-Hostra (eds.), Cultures of Psychiatry and Mental Health Care in Postwar Britain and the Netherlands (Amsterdam, 1998), pp. 9-28. Jones, in particular, writes within the context of late-1980s concerns about communitybased care. Recent, more nuanced, discussions of the historical relationships between hospital and community, are represented in P. Bartlett and D. Wright (eds.), Outside the Walls of the Asylum. The History of Care in the Community, 1750-2000 (London, 1999). On the shifting relationship between psychiatry, patients, and legal processes, with a focus on both legislation and practice, see P. Fennell, Treatment Without Consent. Law, Psychiatry and the Treatment of Mentally Disordered People Since 1845 (London, 1995). For a discussion of the relationships between medicine, the state and concepts of mental illness, see J. Busfield, Managing Madness. Changing Ideas and Practice (London, 1986). On the development and use of psychotropic drugs within psychiatry, see E. M. Tansey, '"They Used to Call it Psychiatry": Aspects of the Development and Impact of Psychopharmocology', in R. Porter and M. Giwijt-Hostra (eds.), Cultures of Medicine and Mental Health Care in Postwar Britain and the Netherlands (Amsterdam, 1998), pp. 79-101; D. Healy, The Anti-depressant Era (London, 1997); D. Healy, 'The History of British Psychopharmocology', in G. E. Berrios and H. Freeman (eds.), 150 Years of British Psychiatry. Volume 2. The Aftennath (London, 1996), pp. 61-88; J. Moncrieff, 'An Investigation into the Precedents of Modern Drug Treatment in Psychiatry', History of Psychiatry, 10 (1999), 475-90. For an overview of Oxfordshire debates on treatments in the 1960s and 1970s, see B. M. Mandelbrote and M. G. Gelder (eds.), Psychiatric Aspects of Medical Practice: A Collection of Oxford Essays (London, 1972). Other works privilege patients' or users' perspectives and experiences as recipients of psychiatric care in this period, most notably, Gittins, Madness in its Place; Barham, Closing the Asylum; P. Campbell, 'A Survivor's View of Community Psychiatry', Journal of Mental Health, 1 (1992), 117-22; P. Barham and R. Hayward, Relocating Madness. From the Mental Patient to the Person (London, 1991). For a discussion of the growth of the user movement, in the context of anti-psychiatry, see A. Claytor, 'A Changing Faith? A History of Developments in Radical Critiques of Psychiatry Since the 1960s' (unpublished Ph.D. thesis, University of Sheffield, 1993). The desire to include service users in the evaluation, and more recently, the planning of services is illustrated by a number of significant surveys, notably A. Rogers, Experiencing Psychiatry: Users' Views of Services (London, 1993).
47. Millet, The Loony Bin Trip, p. 313.
48. The metaphor of travel - madness as a strange land to which one travels and from which one hopes to return - is to be found within autobiographical accounts of mental disorder and case note portrayals of patient experiences, as well as in theories of psychiatry and anti-psychiatry. In her novel, Faces in the Water, Janet Frame begins, 'I will write about the season of peril. I was put in hospital because a great gap opened in the ice floe between myself and the other people whom I watched, with their world, drifting away through a violet-coloured sea where hammerhead sharks in tropical ease swam side by side with the seals and the polar bears. I was alone on the ice.' J. Frame, Faces in the Water (London, 1980), p. 10. For some, most influentially Goffman, it is the places of treatment, the hospitals, more than 'madness' which is the strange world to and from which the individual travels. E. Goffman, Asylums. Essays on the Social Situation of Mental Patients and Other Inmates (London, 1961).
49. The metaphor of travel - madness as a strange land to which one travels and from which one hopes to return - is to be found within autobiographical accounts of mental disorder and case note portrayals of patient experiences, as well as in theories of psychiatry and anti-psychiatry. In her novel, Faces in the Water, Janet Frame begins, 'I will write about the season of peril. I was put in hospital because a great gap opened in the ice floe between myself and the other people whom I watched, with their world, drifting away through a violet-coloured sea where hammerhead sharks in tropical ease swam side by side with the seals and the polar bears. I was alone on the ice.' J. Frame, Faces in the Water (London, 1980), p. 10. For some, most influentially Goffman, it is the places of treatment, the hospitals, more than 'madness' which is the strange world to and from which the individual travels. E. Goffman, Asylums. Essays on the Social Situation of Mental Patients and Other Inmates (London, 1961).
50. Participant 5, 30 May 1999 and 19 July 1999; participant 3, 27 May 1999.
51. M. Wood, 'Culture and Imperialism', New York Review of Books, XLI (3 March 1994), 44-7. E. W. Said, 'Permission to Narrate', London Review of Books (29 February 1984), 13-17. This quotation was originally found, and cited as Said, in K. Johnson, Deinstitutionalising Women. An Ethnographic Study of Institutional Closure (Cambridge, 1998).
52. M. Wood, 'Culture and Imperialism', New York Review of Books, XLI (3 March 1994), 44-7. E. W. Said, 'Permission to Narrate', London Review of Books (29 February 1984), 13-17. This quotation was originally found, and cited as Said, in K. Johnson, Deinstitutionalising Women. An Ethnographic Study of Institutional Closure (Cambridge, 1998).
53. M. Wood, 'Culture and Imperialism', New York Review of Books, XLI (3 March 1994), 44-7. E. W. Said, 'Permission to Narrate', London Review of Books (29 February 1984), 13-17. This quotation was originally found, and cited as Said, in K. Johnson, Deinstitutionalising Women. An Ethnographic Study of Institutional Closure (Cambridge, 1998).
54. This is a term used by at least two participants to describe meetings immediately prior to discharge in which their future treatment and other service provisions are discussed with reference to section 117 of the 1983 Mental Health Act. This section of the act states that all patients detained under the act are entitled to health and social care on discharge from hospital.
55. This concept of narrative frames seems to resonate with Charles Rosenberg's use of the term 'framing disease' to describe definitions of an illness, its causes and symptoms at a particular historical moment. This perspective is more fluid than social constructionist arguments, hinting at the possibilities of social negotiation and a more active role for the patient. C. Rosenberg, 'Framing Disease: Illness, Society and History', in C. Rosenberg, Explaining Epidemics and Other Studies in the History of Medicine (Cambridge, 1992), pp. 305-19.
56. On genre, see in particular: E. Tonkin, 'History and the Myth of Realism', in R. Samuel and P. Thompson (eds.), The Myths We Live By (London, 1990), pp. 25-35; E. Tonkin, Narrating Our Pasts: The Social Construction of Oral History (Cambridge, 1992); M. Chamberlain and P. Thompson (eds.), Narrative and Genre (London, 1998); A. Portelli, Oral History as Genre', in Chamberlain and Thompson (eds.), Narrative and Genre, pp. 23-45. On the dialogue between interviewee and participant, see in particular S. B. Gluck and D. Patai (eds.), Women's Words: The Feminist Practice of Oral History (London, 1991); A. Portelli, 'The Peculiarities of Oral History', History Workshop Journal, 12 (1981), 96-107.
57. On genre, see in particular: E. Tonkin, 'History and the Myth of Realism', in R. Samuel and P. Thompson (eds.), The Myths We Live By (London, 1990), pp. 25-35; E. Tonkin, Narrating Our Pasts: The Social Construction of Oral History (Cambridge, 1992); M. Chamberlain and P. Thompson (eds.), Narrative and Genre (London, 1998); A. Portelli, Oral History as Genre', in Chamberlain and Thompson (eds.), Narrative and Genre, pp. 23-45. On the dialogue between interviewee and participant, see in particular S. B. Gluck and D. Patai (eds.), Women's Words: The Feminist Practice of Oral History (London, 1991); A. Portelli, 'The Peculiarities of Oral History', History Workshop Journal, 12 (1981), 96-107.
58. On genre, see in particular: E. Tonkin, 'History and the Myth of Realism', in R. Samuel and P. Thompson (eds.), The Myths We Live By (London, 1990), pp. 25-35; E. Tonkin, Narrating Our Pasts: The Social Construction of Oral History (Cambridge, 1992); M. Chamberlain and P. Thompson (eds.), Narrative and Genre (London, 1998); A. Portelli, Oral History as Genre', in Chamberlain and Thompson (eds.), Narrative and Genre, pp. 23-45. On the dialogue between interviewee and participant, see in particular S. B. Gluck and D. Patai (eds.), Women's Words: The Feminist Practice of Oral History (London, 1991); A. Portelli, 'The Peculiarities of Oral History', History Workshop Journal, 12 (1981), 96-107.
59. On genre, see in particular: E. Tonkin, 'History and the Myth of Realism', in R. Samuel and P. Thompson (eds.), The Myths We Live By (London, 1990), pp. 25-35; E. Tonkin, Narrating Our Pasts: The Social Construction of Oral History (Cambridge, 1992); M. Chamberlain and P. Thompson (eds.), Narrative and Genre (London, 1998); A. Portelli, Oral History as Genre', in Chamberlain and Thompson (eds.), Narrative and Genre, pp. 23-45. On the dialogue between interviewee and participant, see in particular S. B. Gluck and D. Patai (eds.), Women's Words: The Feminist Practice of Oral History (London, 1991); A. Portelli, 'The Peculiarities of Oral History', History Workshop Journal, 12 (1981), 96-107.
60. On genre, see in particular: E. Tonkin, 'History and the Myth of Realism', in R. Samuel and P. Thompson (eds.), The Myths We Live By (London, 1990), pp. 25-35; E. Tonkin, Narrating Our Pasts: The Social Construction of Oral History (Cambridge, 1992); M. Chamberlain and P. Thompson (eds.), Narrative and Genre (London, 1998); A. Portelli, Oral History as Genre', in Chamberlain and Thompson (eds.), Narrative and Genre, pp. 23-45. On the dialogue between interviewee and participant, see in particular S. B. Gluck and D. Patai (eds.), Women's Words: The Feminist Practice of Oral History (London, 1991); A. Portelli, 'The Peculiarities of Oral History', History Workshop Journal, 12 (1981), 96-107.
61. On genre, see in particular: E. Tonkin, 'History and the Myth of Realism', in R. Samuel and P. Thompson (eds.), The Myths We Live By (London, 1990), pp. 25-35; E. Tonkin, Narrating Our Pasts: The Social Construction of Oral History (Cambridge, 1992); M. Chamberlain and P. Thompson (eds.), Narrative and Genre (London, 1998); A. Portelli, Oral History as Genre', in Chamberlain and Thompson (eds.), Narrative and Genre, pp. 23-45. On the dialogue between interviewee and participant, see in particular S. B. Gluck and D. Patai (eds.), Women's Words: The Feminist Practice of Oral History (London, 1991); A. Portelli, 'The Peculiarities of Oral History', History Workshop Journal, 12 (1981), 96-107.
62. Portelli, 'The Peculiarities of Oral History'.
63. J. Giles, '"Playing Hard to Get": Working Class Women, Sexuality and Respectability in Britain, 1918-1940', Women's History Review, 1 (1992), 239-55.
64. A. Kleinman, The Illness Narratives. Suffering, Healing and the Human Condition (New York, 1988), p. xiii.
65. The ways in which participants in this research project negotiate and layer professional and lay discourses of illness can be compared to the ways in which people talk about living with aphasia, as discussed by S. Parr et al., Talking About Aphasia. Living with Loss of Language After a Stroke (Buckingham, 1997).
66. Participant 15, interview two, 4 November 1999.
67. This approach to illness narratives is similar to that used by Jamie Saris, analysing the account of Finbar McTernan, an Irish man diagnosed with schizophrenia. Within the overall narrative structure of his 'career' as a patient, McTernan weaves in tales of anti-psychiatry and protest, as well as the politics and violence of contemporary Northern Ireland. A. J. Saris, 'Telling Stories: Life-histories, Illness Narratives and Institutional Landscapes', Culture, Medicine and Psychiatry, 19 (1995), 39-72.
68. Participant 4, 15 June 1999.
69. Participant 1, 12 May 1999. Littlemore Hospital was originally established as the Oxford County Pauper Lunatic Asylum in 1846 to serve the whole of the county as well as Berkshire and the boroughs of Reading, Abingdon, and Windsor (until the opening of the Berkshire County Asylum in Fairmile in 1870). It operated as the Ashurst War Hospital from 1918 until 1920 and in 1922 was re-named The Oxford County and City Mental Hospital. In 1948 (the year in which my study begins) it was again re-named Litdemore Mental Hospital. Patient numbers peaked at 936 in 1943. In 1968, the two major psychiatric hospitals in Oxfordshire - the Littlemore and the Warneford Mental Hospital-amalgamated to form the Isis Group Hospital Management Committee, which became the Oxfordshire Mental Healthcare Trust in 1994. The original hospital buildings at Littlemore were closed in 1997 (now partly converted into apartments) and all services were transferred to existing and newly built buildings in the same village. The other large hospital in Oxford is the Warneford. This opened as a private hospital, The Oxford Radcliffe Lunatic Asylum in 1826, and was re-named the Warneford Lunatic Asylum in 1843. This hospital continues to operate within the original 1826 buildings. Of the people who have taken part in interviews so far, approximately two-thirds have spent some time as in-patients at Littlemore hospital and two-thirds as in-patients at the Warneford hospital. This study is not an institutional history of any single hospital within Oxfordshire, but rather is looking more broadly at patients' experiences, including institutional experiences, over the past 50 years. Participants have also spent time at The Elms clinic in Banbury, Fairmile Hospital in Cholsey, near Reading, and numerous other hospitals within Britain and abroad.
70. See in particular Portelli, Oral History as Genre'.
71. This process can be compared and contrasted with other interview situations involving users or patients, including those with psychiatrists, GP's and social workers.
72. Participant 1, 12 May 1999. Tom used clapping throughout his account in order to add emphasis to what he was saying.
73. Participant 16, 30 November 1999.
74. Participant 11, 13 June 1999.
75. The paper was in some ways a revival of Little more Lights (1954-9), which focused on and was largely written by members of staff. Littlemore Lights (4 volumes), Oxfordshire Health Archives, L4 Al-4. Littlemore Life (14 volumes), Oxfordshire Health Archives, L4 B1-14. As with other hospital magazines, this grew from and reinforced identification with a hospital-based community, though it became increasingly outward-looking in both style and content. An editorial in the final edition of Littlemore Life explicitly linked its demise with the move to community-based support and treatment: 'As the trend towards community care expands it is possible that Littlemore Life will have outlived its usefulness so let us make its last issue as good as those painstakingly produced during the last three decades.' Littlemore Life (March 1987) Oxfordshire Health Archives, L4 B16.
76. Anonymous author, The Way Ahead', Littlemore Life, 226 (17 January 1969), Oxfordshire Health Archives, L4 B4.
77. Alessandro Portelli claims that the value of oral testimony lies not in their reflection of shared experiences, but of shared possibilities, both real and imagined. A. Portelli, 'Philosophy and the Facts. Subjectivity and Narrative Form in Autobiography and Oral History', in A. Portelli, The Battle of Valle Giulia. Oral History and the Art of Dialogue (London, 1997), 79-90.
78. Participant 17, 26 January 2000; participant 4, 15 June 1999.
79. Participant 2, 4 June 1999.
80. Participant 3, 27 May 1999.
81. Participant 4, 15 June 1999; participant 15, 25 October 1999 and 4 November 1999.
82. This proliferation of seemingly contradictory presentations of 'the hospital' within single accounts is reminiscent of Joseph, talking with Peter Barham, who recalled his hospital as a 'rubbish tip, a dirty scruffy rotten hole', a 'college' and a 'farm'. For Barham, this apparent confusion reflects, not some internal disorder, but the contradictory messages about hospitals and patients presented to Joseph and others in late twentieth-century Britain. Barham, Closing the Asylum, p. ix.
83. Participant 4, 15 June 1999.
84. Participant 19, 9 December 1999.
85. Participant 17, 26 January 2000.
86. Participant 1, 12 May 1999.
87. Participant 12, 20 August 1999; participant 6, 5 July 1999.
88. See in particular Barham, Closing the Asylum; P. Barham and R. Hayward, Relocating Madness. From the Mental Patient to the Person (2nd edition) (London, 1991); MIND Inquiry Into Social Exclusion and Mental Health Problems, 4 November 1999. This independent inquiry recommended that the government's Social Exclusion Unit should explicitly focus on the social exclusion of people who have experienced mental health problems. This suggestion neatly demonstrates the interaction between shifting and general political, social, and ideological themes and particular issues: in this case, that of mental health.
89. See in particular Barham, Closing the Asylum; P. Barham and R. Hayward, Relocating Madness. From the Mental Patient to the Person (2nd edition) (London, 1991); MIND Inquiry Into Social Exclusion and Mental Health Problems, 4 November 1999. This independent inquiry recommended that the government's Social Exclusion Unit should explicitly focus on the social exclusion of people who have experienced mental health problems. This suggestion neatly demonstrates the interaction between shifting and general political, social, and ideological themes and particular issues: in this case, that of mental health.
90. See in particular Barham, Closing the Asylum; P. Barham and R. Hayward, Relocating Madness. From the Mental Patient to the Person (2nd edition) (London, 1991); MIND Inquiry Into Social Exclusion and Mental Health Problems, 4 November 1999. This independent inquiry recommended that the government's Social Exclusion Unit should explicitly focus on the social exclusion of people who have experienced mental health problems. This suggestion neatly demonstrates the interaction between shifting and general political, social, and ideological themes and particular issues: in this case, that of mental health.
91. Participant 1, 12 May 1999.
92. Participant 15, interview one, 25 October 1999. Rachel described how she was taken through the door which separated out-patients from in-patients, stressing the significance this move from one place to another, from person to patient, had for her both at the time and later. Rachel was one of the very few people interviewed thus far who was able and willing to recall the processes of first admission in any detail.
93. Barham, Closing the Asylum; Barham and Hayward, Relocating Madness.
94. Judith Zaruches, quoted in A. W. Frank, The Wounded Storyteller. Body, Illness, Ethics (London, 1995).
95. This model is, perhaps unsurprisingly, dominant within published autobiographical and fictional accounts of mental illness, hospitalization, and treatment. In Faces in the Water, Estina escapes from, initially, the threat of psychosurgery and ultimately the hospital, thanks to her own inner strength and the interventions of Dr Portman. Frame, Faces in the Water, pp. 217-19, 242-3. This presentation of the interventions of one supportive doctor within a largely hostile regime leading to escape and resolution bears a striking resemblance to the narrative of a female patient admitted into Toronto Psychiatric Hospital in 1956. P. Keefe, 'Recollections of a Patient at TPH. Snakepit', in E. Shorter (ed.), TPH. History and Memories of the Toronto Psychiatric Hospital, 1925-1966 (Toronto, 1996), pp. 171-82. Alongside the main narrative of the survival of the protagonist, there is often another, or many other, tales of others who didn't survive. In The Bell Jar, for example, Esther's release from hospital is juxtaposed with Joan's suicide. Plath, The Bell Jar, p. 255.
96. This model is, perhaps unsurprisingly, dominant within published autobiographical and fictional accounts of mental illness, hospitalization, and treatment. In Faces in the Water, Estina escapes from, initially, the threat of psychosurgery and ultimately the hospital, thanks to her own inner strength and the interventions of Dr Portman. Frame, Faces in the Water, pp. 217-19, 242-3. This presentation of the interventions of one supportive doctor within a largely hostile regime leading to escape and resolution bears a striking resemblance to the narrative of a female patient admitted into Toronto Psychiatric Hospital in 1956. P. Keefe, 'Recollections of a Patient at TPH. Snakepit', in E. Shorter (ed.), TPH. History and Memories of the Toronto Psychiatric Hospital, 1925-1966 (Toronto, 1996), pp. 171-82. Alongside the main narrative of the survival of the protagonist, there is often another, or many other, tales of others who didn't survive. In The Bell Jar, for example, Esther's release from hospital is juxtaposed with Joan's suicide. Plath, The Bell Jar, p. 255.
97. This model is, perhaps unsurprisingly, dominant within published autobiographical and fictional accounts of mental illness, hospitalization, and treatment. In Faces in the Water, Estina escapes from, initially, the threat of psychosurgery and ultimately the hospital, thanks to her own inner strength and the interventions of Dr Portman. Frame, Faces in the Water, pp. 217-19, 242-3. This presentation of the interventions of one supportive doctor within a largely hostile regime leading to escape and resolution bears a striking resemblance to the narrative of a female patient admitted into Toronto Psychiatric Hospital in 1956. P. Keefe, 'Recollections of a Patient at TPH. Snakepit', in E. Shorter (ed.), TPH. History and Memories of the Toronto Psychiatric Hospital, 1925-1966 (Toronto, 1996), pp. 171-82. Alongside the main narrative of the survival of the protagonist, there is often another, or many other, tales of others who didn't survive. In The Bell Jar, for example, Esther's release from hospital is juxtaposed with Joan's suicide. Plath, The Bell Jar, p. 255.
98. Participant 4, 15 June 1999.
99. Participant 20, 1 December 1999.
100. The language and metaphors of battle pervade professional and lay narratives of health, illness, and treatment as persuasively argued by Susan Sontag. S. Sontag, Illness as Metaphor. Aids and its Metaphors (London, 1991).
101. Participant 1, 12 May 1999.
102. Participant 12, 20 August 1999.
103. The widespread use of the term 'survivors' reflects the multiple political positions linked with the phrase. It would be misleading to assume that the terms 'survivors' or 'user movement' may be used to describe a unified movement. Language is vitally important to many who identify themselves in these terms - leading to much debate over terms such as 'patient', 'service user', and 'loony'. This focus on language may be understood, in part, as an identification with other disempowered groups, such as lesbians and gay men, most explicitly manifested in the series of events and organizations under the banner 'Mad Pride' (http://www.ctono.freeserve.co.uk/index.htm. 21 March 2000).
104. Anonymous author, Littlemore Life, 226 (17 January 1969). Oxfordshire Health Archives, L4 B4.
105. Participant 3, 27 May 1999.
106. The language of faith, spirituality and religion saturates a number of the accounts, notably those of participants with earlier (pre-1980s) experiences of mental health problems and contact with services. Not all of these accounts are 'closed' or resolved in the same way as Peggy's. Adam, for example, commented, towards the end of his account, I'd like to get better one day and be healed. I mean, I used to think that if you've got an illness or a mental illness, you'd be healed . . .', Participant 17, 26 January 2000. One could speculate that there is some relationship between these narratives and the importance of concepts of faith and the family in hospitals at this time.
107. Participant 10, 8 July 1999.
108. Participant 1, 12 May 1999.
109. Participant 6, 5 July 1999; participant 2, 4 June 1999.
110. Participant 8, 28 June 1999.
111. This community-based system includes day centres, formal and informal user or patient groupings - from survivors meeting at a 'known' cafe, to work schemes and supported housing. Thus, it is not simply a medicalized, professional model of mental illness which is being challenged within these survival stories. Rather, the common theme within these accounts is a desire and an expectation to move on from wider and more individually varied concepts of mental illness.
112. Participant 7, 26 August 1999; participant 4, 4 June 1999. In almost all the accounts collected thus far, one can observe the presence of twin narratives - that of the self at the time and of the present self reflecting back.
113. Participant 14, 17 November 1999.
114. Sue, for example, also explained her (general) complicity with her medication regime by comparing herself to a diabetic person who needs to take insulin. At the same time, her account reflected, in both content and language, her involvement with the local user movement and the politics of mental health. Participant 13, 28 July 1999.
115. Participant 7, 26 August 1999.
116. Participant 13, 28 July 1999.
117. S. Estroff, Making in Crazy: An Ethnography of Psychiatric Patients in an American Community (Berkeley, 1981).
118. Peggy used humour to distinguish between herself in her story and herself as knowledgeable narrator reflecting on her life. Recalling an incident when she collapsed outside the hospital in the 1970s: 'Well, I don't know what it was, you know, in hospital. 'Cos this actually, drug I took which was obviously . . . made my legs go from under me. I don't know, see I don't know what that was. . . . They changed it you see. I wasn't well enough to . . . um, if you're ill you just take the medication. Whether that's wrong. Perhaps it is wrong. I know it's wrong now. You should check your medication, really before you came out of the door. . . . But. . . but I never did. I just assumed they knew what they were doing. You shouldn't really do that, 'cos they're only human! (laughs)'. Participant 3, 27 May 1999. In a similar way, Raymond spoke about gaining knowledge as he got older: 'Since I've got older, I've found out a bit more about the illness and that. It has helped me in that way. Though I still don't fully understand it.' And later, 'I've been to the library and that, you know. I've got - I've read all about the different illnesses. You know, I've looked up about all the treatments, you know.' Participant 19, 9 December 1999.
119. This idea of 'bartering' was introduced to me by Sue through her descriptions of communities of patients or users, both within and beyond the hospital, in the 1980s and 1990s. She referred to swapping and sharing information about medication as 'a sort of curious currency' amongst service users. Participant 13, 28 July 1999.
120. Participant 4, 15 June 1999. In a similar way, Brian claimed, I' understand people. I can probably more or less cure 'ern. I understand better than the psychiatrists does, know what I mean - if you've had it, experienced it, over the years.' At other points in his narrative, Brian was far less confident in expressing an understanding of his situation. Participant 22, interview two, 5 January 2000. Here both Arthur and Brian claim knowledge and expertise based on experience and time, rather than on professional qualifications.
121. These patterns of communication are of course not revealed through examination of written records.
122. Dr Bertram Mandelbrote introduced concepts of therapeutic community - what he termed 'therapeutic community proper' - into Littlemore in 1959. This was characterized by 'a community structure which involves regular face-to-face meetings of both staff and patients and the provision of a forum for the exploration of social behaviour within the community. Dr B. M. Mandelbrote, 'Therapeutic Communities and Community Psychiatry', in Mandelbrote and Gelder (eds.), Psychiatric Aspects of Medical Practice, pp. 70-87. Looking into the report of hospital visitors, however, 'group therapy' was taking place in Littlemore from at least 1958, as illustrated by the following comment from one visitor: 'Men's group therapy was just finishing in the Recreation Hall,' 19 June 1958, Littlemore Visitors Book, Oxfordshire Health Archives, L1/C3/2. Further work is needed to examine the interrelationship between patient and staff experiences and understandings of group therapy, therapeutic communities, and present-day ward meetings.
123. For a wide-ranging and thorough analysis of the relationship between the law and psychiatric treatment, see Fennell, Treatment Without Consent.
124. Participant 6, 5 July 1999.
125. Participant 12, 20 August 1999.
126. The concepts of advocacy have been increasingly understood and accepted within the structures of mental health services. In the proposed reforms to the 1983 Mental Health Act, advocacy is described thus, 'The benefits detained patients can derive from an advocate have become more and more apparent in recent years. An advocate is someone who can represent and defend the views, needs, wishes, worries, and rights of patients who do not feel able to do this themselves. Advocacy can also help patients participate and make decisions. Advocates are wholly independent; they represent their patients without taking a view on their "best interests"' (Reform of the Mental Health Act 1983. Proposals for Consultation Presented to Parliament by the Secretary of State for Health by Command of Her Majesty, November 1999). This green paper also emphasizes the rights of users to be involved in their own care and treatment, stressing cooperation and partnership (alongside the need to extend powers of compulsory treatment). On a more local level, the April 1999 Ricketts report into the Oxfordshire Mental Healthcare Trust criticized a lack of meaningful user and advocate involvement within the trust ( B. Ricketts, Review of Oxfordshire Mental Healthcare Trust. Summary of the Report to the Regional Director, South East Regional Office of the NHS Executive and the Broad of Oxfordshire Mental Health NHS Trust, April 1999). This report highlights both acceptance of, and resistance to, concepts of user inclusion. These tensions are reflected within accounts of more recent experiences of services.
127. The concepts of advocacy have been increasingly understood and accepted within the structures of mental health services. In the proposed reforms to the 1983 Mental Health Act, advocacy is described thus, 'The benefits detained patients can derive from an advocate have become more and more apparent in recent years. An advocate is someone who can represent and defend the views, needs, wishes, worries, and rights of patients who do not feel able to do this themselves. Advocacy can also help patients participate and make decisions. Advocates are wholly independent; they represent their patients without taking a view on their "best interests"' (Reform of the Mental Health Act 1983. Proposals for Consultation Presented to Parliament by the Secretary of State for Health by Command of Her Majesty, November 1999). This green paper also emphasizes the rights of users to be involved in their own care and treatment, stressing cooperation and partnership (alongside the need to extend powers of compulsory treatment). On a more local level, the April 1999 Ricketts report into the Oxfordshire Mental Healthcare Trust criticized a lack of meaningful user and advocate involvement within the trust ( B. Ricketts, Review of Oxfordshire Mental Healthcare Trust. Summary of the Report to the Regional Director, South East Regional Office of the NHS Executive and the Broad of Oxfordshire Mental Health NHS Trust, April 1999). This report highlights both acceptance of, and resistance to, concepts of user inclusion. These tensions are reflected within accounts of more recent experiences of services.
128. Concepts of resistance - particularly in the context of institutions - have become increasingly significant in socio-historical discussions of medicine, largely as a response to Foucault's lack of consideration of agency in works such as Discipline and Punish. See, in particular, C. Jones and R. Porter (eds.), Reassessing Foucault. Power, Medicine and the Body (London, 1994); M. Foucault, Discipline and Punish. The Birth of the Clinic (London, 1979). For a sociological perspective on strategies of resistance, see S. Cohen and L. Taylor, Escape Attempts: The Theory and Practice of Resistance to Everyday Life (London, 1976).
129. Concepts of resistance - particularly in the context of institutions - have become increasingly significant in socio-historical discussions of medicine, largely as a response to Foucault's lack of consideration of agency in works such as Discipline and Punish. See, in particular, C. Jones and R. Porter (eds.), Reassessing Foucault. Power, Medicine and the Body (London, 1994); M. Foucault, Discipline and Punish. The Birth of the Clinic (London, 1979). For a sociological perspective on strategies of resistance, see S. Cohen and L. Taylor, Escape Attempts: The Theory and Practice of Resistance to Everyday Life (London, 1976).
130. Concepts of resistance - particularly in the context of institutions - have become increasingly significant in socio-historical discussions of medicine, largely as a response to Foucault's lack of consideration of agency in works such as Discipline and Punish. See, in particular, C. Jones and R. Porter (eds.), Reassessing Foucault. Power, Medicine and the Body (London, 1994); M. Foucault, Discipline and Punish. The Birth of the Clinic (London, 1979). For a sociological perspective on strategies of resistance, see S. Cohen and L. Taylor, Escape Attempts: The Theory and Practice of Resistance to Everyday Life (London, 1976).
131. Participant 2, 4 June 1999.
132. Participant 8, 28 June 1999. A similar point is made by Sally Swartz: 'It is common for patients to learn the correct responses to mental state questions either to effect their discharge from, or to prolong their stay in mental hospitals.' Swartz, 'Shrinking', p. 154.
133. Participant 15, 25 October and 4 November 1999.
134. This manifestation of familial models within psychiatric hospitals with clear gendered hierarchies, deference to the patriarchal figure of the medical superintendent, and a strong sense of collective identity, has been previously noted by Diana Gittins amongst others. Gittins, Madness in its Place, p. 99. Gittins also suggests that a more militaristic model on the male side supplemented this model.
135. Participant 3, 27 May 1999. Isabelle Bertaux-Wiame argues that women are more likely to speak of 'we' or 'One' - thus identifying themselves as part of a group - while men are more likely to speak of 'I' or 'me', perceiving themselves as the sole/significant actor in their lives. P. Thompson and R. Samuel, The Myths We Live By (London, 1990), p. 7. Elizabeth Tonkin argues convincingly that one should examine accounts closely, looking for the use of phrases such as 'we' which give us clues to an individual's sense of the self as belonging to a particular group, place or time. Tonkin, 'History and the Myth of Realism'.
136. Participant 3, 27 May 1999. Isabelle Bertaux-Wiame argues that women are more likely to speak of 'we' or 'One' - thus identifying themselves as part of a group - while men are more likely to speak of 'I' or 'me', perceiving themselves as the sole/significant actor in their lives. P. Thompson and R. Samuel, The Myths We Live By (London, 1990), p. 7. Elizabeth Tonkin argues convincingly that one should examine accounts closely, looking for the use of phrases such as 'we' which give us clues to an individual's sense of the self as belonging to a particular group, place or time. Tonkin, 'History and the Myth of Realism'.
137. Participant 4, 15 June 1999.
138. Participant 13, 28 July 1999.
139. As illustrated by the title and focus of The Alleged Lunatics' Friends Society. See, for example, N. Hervey, 'Advocacy or Folly? The Alleged Lunatics' Friends Society, 1845-63', Medical History, 30 (1986), 245-75. For more on the changing focus and definition of consent issues since 1845, see Fennel, Treatment Without Consent.
140. As illustrated by the title and focus of The Alleged Lunatics' Friends Society. See, for example, N. Hervey, 'Advocacy or Folly? The Alleged Lunatics' Friends Society, 1845-63', Medical History, 30 (1986), 245-75. For more on the changing focus and definition of consent issues since 1845, see Fennel, Treatment Without Consent.
141. Participant 10, 8 July 1999.
142. M. Stuart, 'Stories of Shame and Esteem'.
143. J. Killick, '"Climb up the Family Tree and Look at the Vista From There": Writing Work With People With Dementia', Oral History, 26 (1998), 81-5.
144. The same point is made by D. W. Jones - 'Perhaps what people are communicating when they cry about something, when they communicate distress is: this is important', (original emphasis) D. W. Jones, 'Distressing Histories and Unhappy Interviewing', Oral History, 26 (1998), 49-56.
145. Participant 2, 4 June 1999.
146. Thompson and Samuel, The Myths We Live By, p. 2.