Post-War Mental Health: Defining the Family/Freeing the Self?

Kill or Cure

Aims of the lecture

1. To examine the role of psychological medicine continuing the process of ‘doctoring the nation’ that we looked at in relation to eugenics

2. To examine the role of psychological medicine in defining the ‘normal’ family as a central feature of post-war life

3. To examine the role of psychological medicine in a liberation of the individual

The limits of asylumdom

Early optimism of asylum had faded

Problems of growing size (1000+), overcrowding, incurablity

Cost in face of rising broader demands of welfare

In lead up to WWII answers via eugenics

The move to mental health Disillusion of doctors with asylum medicine Desire to reach out to the milder cases who may

be easier to cure Rise of outpatient treatment, clinics, and child

guidance services Development of new psychotherapies Interest too in prevention – promotion of ‘mental

health’ and ‘mental hygiene’ But problems of resource, limited expertise, and

reticence to talk about problems Needs moment of crisis to push make mental

health a national problem

Democracy, War, and Mental Health

Political extremism, economic irrationality, and violence of war in mid-century encourages serious consideration of human psychology

Focuses attention on how to make democratic subjects

Evident in pre-war writing about extremism, Nazism, and political violence

Democracy a result and necessary condition for mental health

War as catalyst

Fear of mass mental breakdown via air attack following Guernica

Psychological strength (morale), prevention from collapse, and treatment likely to be keys to war

Need for the state to act, and willingness to resource expansion of psychological medicine to whole population

Making democratic subjects Importance of freedom to

release aggressive impulses in play as child: implications for child-rearing and education

Importance of security in first years (evidence of what happens without this to camp children and evacuees): encourages the attachment theory of John Bowlby and Donald Winnicott on dangers of maternal deprivation

Implementing the psychological reproduction of democratic subjects

Via BBC radio and child-rearing literature reaches into family home (Donald Winnicott and John Bowlby)

Post-war withdrawal of support from nurseries

Progressive pedagogy in schools

The adventure playground Model of the

wartime bombsite A space for

children (under supervision) to explore, make things from junk, and to develop as children

The virtual landscape of children’s television

Through psychological advice holds possibility of designing an ideal environment for the child: safe, suited to the way the child sees the world, bringing the outside world into the protected realm of the family home

The post-war family

Encourages/facilitates what we see as a classic era of family life: increasingly focused on home; home-bound mother; new expectations of fatherhood; smaller families

But historically this era of the ‘nuclear family’ is not the norm but a rather unique period (Pat Thane)

A new form of governance The pre-war efforts to

control and regulate through the imposition of outside controls (eg via eugenics) limited via lack of resources and expertise, and by culture that supports individual liberties

The post-war culture of normative mental health works via advice and internalisation of norms: self-government

Nikolas Rose: an obligation to be free

The problem family

Defining the family ideal also provides grounds for intervention on grounds of mental health when ‘normal’ family life is absent

This is why the ‘problem family’ is a major subject for concern in this period

Is a target for growing field of social work, but also for family planning to limit problems

Social change exacerbates the situation

Post-war immigration Breakdown of community

with destruction of slums and relocation to high rise buildings

Recognition of persistence of poverty and social problems despite a welfare state

Rising divorce rates and instability of family structure

Close of asylums and move to ‘community care’ places responsibility on families at time of social breakdown

The emergence of critiques Normative family (and

gender roles) challenged by feminism

Challenge from ‘anti-psychiatry’ eg R.D. Laing: family as a cause rather than solution to mental ill health

Challenge from transcultural perspective (and in light of high BME rates in mental health system)

Concluding thoughts

1. Continuities with eugenics in focus on the ‘social problem group/family’

2. Shift from biological to psychological arguments3. Limited reach of medicine via clinical sites, and case for

preventive strategies instead4. Demands expansion of expertise (eg social work), but also

strategies of education and internalisation of values or manipulation and coercion

5. Yet, is this new doctoring of the nation ultimately a failed project? Rising levels of chronic mental illness (eg anxiety, depression, eating disorders)

6. If so, why? Paradox of diseases of civilisation. Top down causes (expansion of medical gaze or demand led?)

7. And does the post-war project of democratic mental health see new freedoms or a new regime of expectations more deeply pervasive than ever before?