Book Reviews: Mental illness and learning disability since 1850: finding a place for mental disorder in the United Kingdom.

The papers in this collection originated as presentations to seminars held at the Universities of Southampton and Exeter. The first five substantive chapters deal with a variety of aspects of the history of psychiatry in the period between 1850 and 1930, and, the book's subtitle notwithstanding, focus almost exclusively on English developments. They consort somewhat uneasily with two chapters on mental deficiency and “mental defectives” (one of which actually deals with Scottish materials) before the book concludes with a piece by John Welshman examining the place of hostels in the provision of some sort of “community care” for the mentally ill and the learning disabled in the period between 1940 and 1974. Even more than most such compilations, we have here a very heterogeneous set of contributions, varying widely in tone, in ambition, and in quality. Recent historiography has emphasized the significance of the Poor Law and of kinship structures in understanding nineteenth-century mental health provision, and these themes surface in a number of the early chapters. Elaine Murphy, in particular, contributes a characteristically trenchant analysis of workhouse provision for the insane—a bete noir of the Lunacy Commissioners which, none the less, retained a significant place in the institutional treatment of lunatics even as county asylums proliferated. She is particularly concerned to examine why London moved away from relying on workhouses from 1890 onwards, substantially earlier than the rest of the country, and draws much of her evidence from the poorer unions of the East End. Joseph Melling's essay on the English governess and the asylum contributes some interesting insights into the plight of these women, though, despite a title that suggests a general treatment of the subject, his evidence is generally drawn from those admitted to a small sub-set of institutions in Devon. Like a number of other contributors, Melling seeks to provide some sense of how asylum life was experienced by the patients themselves, a fashionable and worthy goal recommended some two decades ago by the late Roy Porter. But Porter's call to retrieve “the patient's voice” was not matched by any sustained discussion of how this might actually be done for any save a small and unrepresentative group of literate and wealthy inmates. By definition, governesses were possessed of at least a modicum of literacy and education, and they were confined in a spectrum of institutions, not just the overcrowded public museums of madness. For all that, the materials Melling musters are tellingly quite fragmentary, and he rightly laments “the elusive promise of recalling the patient experience”. Frank Crompton's piece on pauper patients admitted to the Worcester County Asylum in Powick fares no better in this regard. We have moved beyond the early polemics about gender and mental illness. In a more careful, nuanced fashion, David Pearce explores the use of the new physical treatments in psychiatry in the immediate aftermath of the 1930 Mental Treatment Act, using data once more drawn from Devon to refute the notion that “female patients were a particular subject of the new treatments, or even of diagnoses of neuroses”. But, lest anyone be inclined to doubt the enduring and deep-seated role of gender inequalities, Louise Westwood provides a chilling account of how deep-seated and entrenched social prejudices damaged and distorted the careers of two pioneer British women psychiatrists, Helen Boyle and Isabel Hutton. The contrast between a grand title and a limited, local focus is once more evident in Pamela Dale's paper on ‘“Lay professionals” and the planning and delivery of mental deficiency services, 1917–45’, which again draws almost exclusively on data from Devon in making its case. There is something distinctly odd about using a single rural county in the west of the country to stand as a proxy for England, and even more so for Britain—since provision in Ireland and Scotland for the mentally ill and the mentally “defective” had its own quite distinct trajectories in the century and a quarter with which this book purports to engage. That distinctiveness, and its limits, is engaged quite directly in the one paper that really ventures north of Hadrian's Wall. Drawing on national rather than purely local data, Matt Egan explores ‘The “manufacture” of mental defectives’ in Scotland between 1857 and 1939, suggesting (as I have previously argued was true for mental illness in nineteenth-century England and Wales) that it was the elasticity of official definitions which largely explains the rapid increase in the number of officially identified “mental defectives”. Specialists will find some useful, if limited, contributions on particular topics in this volume. The book is, however, badly served by its title, which promises a far more ambitious approach to its subject than it even begins to deliver.