History of Psychiatry最新文献

Work as therapy has a place in mental healthcare, but there is disagreement about how and why it might be helpful, and how best to conceptualise or represent those benefits. Over the last 50 years, occupational and industrial therapy sheltered workshops have been key elements in the provision of work activities in psychiatric settings, and community-based horticultural activities and creative craft work have offered additional approaches. Using archival material, interviews, witness seminars and personal reflections, this article charts the birth and initial growth of Restore, a charity providing creative work-based services in Oxfordshire between 1977 and 1988. Although Restore might be understood as a response to national trends in mental healthcare policy and research, its trajectory reflects local contingencies.

Bertram Mandelbrote was Physician Superintendent and Consultant Psychiatrist at Littlemore Hospital in Oxford from 1959 to 1988. A humane pragmatist rather than theoretician, Mandelbrote was known for his facilitating style of leadership and working across organisational boundaries. He created the Phoenix Unit, an innovative admission unit run on therapeutic community lines which became a hub for community outreach. Material drawn from oral histories and witness seminars reflects the remarkably unstructured style of working on the Phoenix Unit and the enduring influence of Mandelbrote and fellow consultant Benn Pomryn's styles of leadership. Practices initiated at Littlemore led to a number of innovative services in Oxfordshire. These innovations place Mandelbrote as a pioneer in social psychiatry and the therapeutic community approach.

This article introduces the four following articles and the Classic Text. They describe the development of a sequence of innovative local mental health services in Oxfordshire, and explore the processes of innovation, led by the humane pragmatism practised by Dr Bertram Mandelbrote, who was Physician Superintendent at Littlemore Hospital in Oxford from 1959 to 1988. The articles describe emerging patterns of therapeutic community practice, and trace the events leading to a set of discrete service developments outside the hospital. Together, they suggest a positive role for chance in these developments, and a focus on the then prevailing national and local regulatory culture. The Classic Text by David Millard provides an overview of the origins of the therapeutic community movement.

This paper uses co-produced historical material to explore the evolution of two innovative mental healthcare institutions that emerged in Oxfordshire in the 1960s. We highlight how the trajectories of both institutions were driven by chance events occurring within social environments, rather than emerging out of evidence or policy initiatives. Both institutions found a role for spontaneity and an openness to chance in the way they worked. We argue that this kind of institutional history would be unlikely today; the paper develops and uses the concept of regulatory culture to explain why. We suggest that the role of regulatory culture has been neglected in the history of psychiatry.

Overcrowding in British mental hospitals was a major service and political concern when the NHS was introduced in 1948. From 1959, a number of projects were initiated locally in Oxfordshire, based from Littlemore Hospital Oxford, to provide alternative accommodation, primarily for long-stay residents. Two NHS hostels were opened and a network of group homes was developed from 1963. These were administered through the hospital League of Friends and supported by the community psychiatric nursing service led by Helmut Leopoldt. From 1977 a separate local charity, Oxfordshire Mind, also provided supported housing for younger patients. These developments can be seen as an early local case study of the provision of non-hospital (supported) accommodation and other forms of support for people with long-term mental health problems.

In the late nineteenth century, the prognosis of late-life melancholia was believed to be poor. The medical casebooks of 40 patients aged 60+years, admitted to two Hospitals for the Insane in New South Wales with melancholia between 1871 and 1905, were examined. Psychosis (87.5%), depressed mood (80%), suicidal behaviour (55%), physical ill health (55%), restlessness (50%) and fears of harm to self (50%) were identified. Main outcomes were discharge (40%) and death (37.5%). Victoria's Kew Hospital patient register for 1872-88 revealed 669 melancholia admissions with 30 aged 60+. Outcomes worsened significantly with age (chi square = 16.19, df = 4, p < 0.005), mainly due to higher mortality. Nineteenth-century late-life melancholia was a severe disorder despite many cases recovering.

This paper, drawing on the published medical literature and unpublished medical record archives, provides an in-depth account of the introduction of malaria therapy for general paralysis of the insane into Australia in 1925-6, at Victoria's Sunbury Hospital for the Insane. This study reveals a complex and ambiguous picture of the practice and therapeutic impact of malaria therapy in this local setting. This research highlights a number of factors which may have contributed to some physicians overestimating malaria therapy's effectiveness. It also shows that other physicians of the era held a more sceptical attitude towards malaria therapy. Finally, this paper discusses the relevance of this history to contemporary psychiatry.