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Whatever the motivations of those who planned and built the asylums across many countries in Europe and North America, there can be no doubting their popularity, as their populations greatly outgrew the intended numbers. The hopes of providing peace, rest and pleasant interaction with purposeful staff were dashed by overcrowding and understaffing. Asylums largely came to deserve their characterisation as dismal prisons, or warehouses for those who were unable to look after themselves or who were rejected by their families and communities (Scull, 1996). This all lent support to those who pointed to the coercive and controlling nature of the psychiatric enterprise itself. Just as the more subtle and psychological model of moral insanity failed to survive amid the storm of a hostile press, moral treatment also failed within the wholly underfunded new asylums. This failure pushed psychiatry back to a more despondent understanding of mental disorder, one based on assumptions of inherited weakness (Scull, 1996).

Asylum populations began to fall in the middle of the twentieth century, peaking in England in 1954 and falling rapidly after that (Tooth and Brooke, 1961). The reasons for this fall have been contested (Rogers and Pilgrim, 2014). Some have argued that the development of drug therapies (particularly the phenothiazines) allowed more people to live without confinement (e.g. Gelder, Mayou and Cowen, 2001). Others suggest that the development of the welfare state in the post-war period allowed families and communities to care for dependent people at home (Rogers and Pilgrim, 2014).

There was also a series of critiques of psychiatry that gained momentum from the 1950s through to the 1960s. In addition to Foucault’s view of the significant role played by psychiatry in enforcing particular ways of being (as discussed in Section 1), some psychiatrists drew attention to meaning that might be found within apparent ravings of those judged to be ill (e.g. Laing, 1965). Others drew attention to the negative impact of the asylum environment itself (e.g. Goffman, 1961), and the potentially harmful effect of receiving such a stigmatised label (Scheff, 1966). Some questioned the logical impossibility of the idea that the mind could be regarded as suffering from a disease (Szasz, 1970). The critiques of psychiatry were also taking place within the profession itself as the effectiveness of the asylums was questioned (Brown and Wing, 1962).

Whatever the reason, by the 1980s the decline of the asylum population meant that the upkeep of these old-fashioned, and expensive-to-maintain buildings was a drain on resources. The government of the day therefore accelerated the closure of the asylums with its overt policy of ‘community care’ (Audit Commission, 1986). This policy promoted a shift of resources across a range of health and social care services, away from long-term institutional care and towards the support of people in their homes and communities. In some respects, this was nothing revolutionary; as will be described in Chapter 4, the post-war period witnessed an expansion of the diagnostic categories of mental disorder, which meant that mental illness was viewed as something prevalent across wider social groups. Thus, efforts were made to make services available to more people. While this book will discuss a number of initiatives in detail, an important dimension of all of them was the rise of child guidance clinics (Stewart, 2012). These may be the most remarkable sign of a government belief in the significance of mental health to the overall good of society. Monitoring children and treating poor mental health was considered to be an overall social good. These developments can be viewed through the different lenses of the contested perspectives – either as progressive developments that provided support for a greater range of difficulties, or as sinister means of control and manipulation. A significant move was attempted by the introduction of the Mental Health Act 1959 (in England and Wales). It sought to fully incorporate psychiatric services within the newly emerged National Health Service and the associated arms of an enhanced welfare state.