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‘Breathe’ by Joanna Crane

Questions about ‘mental health’ and ‘mental illness’ loom large amid many media discussions about the health and well-being of the population and society. Those individuals understood as suffering from some form of mental distress or unhappiness might be offered, or may seek, help from a variety of sources, including psychologists, psychiatrists, mental health nurses, social workers, counsellors and psychotherapists. All these professionals might become involved in the provision of care or treatment. They might be employed within state-run hospitals or clinics, or they might provide private treatment for those willing and able to pay. This chapter will suggest that our awareness of the contemporary scene of mental health and illness can be aided by understanding where its ideas and practices have come from.

This chapter presents a history of ‘psychiatry’, with the word used as shorthand for the development of a set of ideas and practices that deal with what came to be defined as ‘mental illness’. While the emergence of psychiatry was largely led by those who saw themselves as working within a medical specialism, many other interest groups and forces have shaped the development of the various institutions and practices surrounding the world of mental illness. Since any history limited to a single chapter can only tell part of the story, the focus here is on how that history needs to be understood as shaped by contradictory forces: power and control versus care and concern.

Indeed, it can reasonably be claimed that there are two contrasting versions of the history of psychiatry. The first might be called ‘the progressive view’ of the development of a dedicated field of practice that specialised in the treatment of ‘mental’ illness. It recognised areas of human suffering and misery that could be amenable to cure or alleviation if the right treatments were discovered and made available. The second, more critical view, is the anti-psychiatry perspective, which suggests that the profession of psychiatry and the surrounding notions of mental illness and health developed as important tools of a culture that has sought to marginalise and control those individuals whose behaviour deviates from the norm and might pose a threat to the social order.

Anti-psychiatry A term used to describe a broad coalition of people and ideas who have opposed the theories and practices of psychiatry.

The focus here is on the emergence of psychiatry within Great Britain, but it should be noted that its early development was embedded in European endeavours, with North American practices becoming important later on. It is certainly the case that psychiatry, now global in its reach, was very much a western enterprise. It is also important to be aware that, as this chapter deals with historical matters, it draws on language (e.g. ‘lunacy’ and ‘mad’) that would be considered offensive if used in the present day. These terms are preserved here, since there is uncertainty about how accurately they could be translated into modern language. Nowadays the term ‘mad’ tends to be equated with something like psychosis, where a person loses touch with reality, whereas in the past it has been used more generally to refer to states of mental turmoil.

Psychosis A psychiatric term that refers to an individual’s state of mind that is ‘out of touch’ with reality. The individual has no understanding that they are in this state. Typical symptoms include hallucinations (hearing, smelling or seeing things that are not there) and delusions (believing something to be true that others deem impossible).

This chapter aims to:

 demonstrate how the field of psychiatry has been shaped through its development as a medical speciality, but also by the emergence of a psychological outlook that theorised a ‘mind’ that could become disordered and, therefore, could be subject to psychological treatment

 show that wider issues of social policy and criminal justice have also left their mark on the field of psychiatry

 highlight the considerable public debate surrounding the field, and the influence of popular opinion

 explore the increasing scope of psychiatry, which now covers all areas of life (from cradle to grave) and an ever-growing array of disorders.