Surviving the Lunacy Act of 1890: English Psychiatrists and Professional Development during the Early Twentieth Century

Abstract

In recent decades, historians of English psychiatry have shifted their major concerns away from asylums and psychiatrists in the nineteenth century. This is also seen in the studies of twentieth-century psychiatry where historians have debated the rise of psychology, eugenics and community care. This shift in interest, however, does not indicate that English psychiatrists became passive and unimportant actors in the last century. In fact, they promoted Lunacy Law reform for a less asylum-dependent mode of psychiatry, with a strong emphasis on professional development. This paper illustrates the historical dynamics around the professional development of English psychiatry by employing Andrew Abbott's concept of professional development. Abbott redefines professional development as arising from both abstraction of professional knowledge and competition regarding professional jurisdiction. A profession, he suggests, develops through continuous re-formation of its occupational structure, mode of practice and political language in competing with other professional and non-professional forces. In early twentieth-century England, psychiatrists promoted professional development by framing political discourse, conducting a daily trade and promoting new legislation to defend their professional jurisdiction. This professional development story began with the Lunacy Act of 1890, which caused a professional crisis in psychiatry and led to inter-professional competition with non-psychiatric medical service providers. To this end, psychiatrists devised a new political rhetoric, 'early treatment of mental disorder', in their professional interests and succeeded in enacting the Mental Treatment Act of 1930, which re-instated psychiatrists as masters of English psychiatry.

How did mental health become so biomedical? The progressive erosion of social determinants in historical psychiatric admission registers

“…Bureaucratic or legislative control of a chaotic and potentially abusive system was a key aim of the Lunacy Act 1890. This ‘triumph of legalism’ ( Jones, 1993 : 93) led to a significant reduction in the number of private asylums, from 82 in 1889 to 54 in 1930 ( Takabayashi, 2017 : 251). Since psychiatrists tended to earn much more money in the treatment of private rather than ‘pauper’ patients, this reduction has been called a ‘professional crisis’ (p. 246).…”

“…Neither forms of admission required legal certificates. They have been described as the solution to the professional crisis after 1890 ( Takabayashi, 2017 ). However, these changes also further empowered psychiatrists as medical authorities who could rule on insanity and circumstances in which it is deemed curable.…”

Lunatics’ rights activism in Britain and the German Empire, 1870–1920

“…70 The doctors then tapped other sources of income: 'consultant psychiatry', 'voluntary admissions' or 'early intervention programmes'. 71 Endowed with upper middle-class privileges and assets, Louisa Lowe became an effective 'expert by experience'. Her radical criticism contributed to shaping the political opportunity structure for democratising lunacy legislation in Britain.…”

Psychiatry past and present: do we need history?

“…Historian Andrew Scull highlighted some perils of doctors undertaking historical research. In 1991, he described psychiatrist-historians as a ‘peculiar group of amateurs’ whose: ‘…distortions have seriously compromised the scholarly usefulness of the accounts offered - creating versions of the past that serve (in ways generally obscured from their authors) to legitimate the profession's present-day activities; or that represent a harmless form of antiquarianism but largely fail to satisfy the elementary canons of good historiography.’ (Scull, 1991: p. 239) 14 Recently, Scull admitted that clinician-historians who combine ‘psychiatric expertise and serious historical scholarship’ have ‘greatly enriched the sophistication and the range of questions that have come to mark work in the field.’ 15 Collaborative work between historians and psychiatrists may help ensure that clinicians use ‘serious historical’ methodology, and may help historians better understand and interpret aspects of medical terminology and clinical practice 16 …”