Civilian Lunatic Asylums During the First World War: A Study of Austerity on London's Fringe (Mental Health in Historical Perspective)

"This open access book explores the history of asylums and their civilian patients during the First World War, focusing on the effects of wartime austerity and deprivation on the provision of care. While a substantial body of literature on 'shell shock' exists, this study uncovers the mental wellbeing of civilians during the war. It provides the first comprehensive account of wartime asylums in London, challenging the commonly held view that changes in psychiatric care for civilians post-war were linked mainly to soldiers' experiences and treatment. Drawing extensively on archival and published sources, this book examines the impact of medical, scientific, political, cultural and social change on civilian asylums. It compares four asylums in London, each distinct in terms of their priorities and the diversity of their patients. Revealing the histories of the 100,000 civilian patients who were institutionalised during the First World War, this book offers new insights into decision-making and prioritisation of healthcare in times of austerity, and the myriad factors which inform this" -- provided by the publisher Foreword Preface Acknowledgments Contents Abbreviations List of Figures List of Tables 1 Introduction: Civilians, Lunacy and the First World War Historiography of the Asylums From Broad Theories and Generalisations to Specifics and Diversity Shell Shock: Historiography and Change Placing the Patients Centre Stage Standards of Care and How to Measure Them The Language of the Asylums Other Methodological Considerations 2 Infrastructure: Rules, Walls, Obstacles and Opportunities Introduction The Lunacy Act 1890: “Red Tapism”, Admissions, Finance, Reform and Change The Board of Control, Asylum Leadership and Their Challenges Special Care? Service Patients and Other Groups Creating Military Hospitals from Asylums Reconstruction Conclusions 3 Certified Insane: Concepts and Practices Introduction: Lily’s Story Air Raids and Other War Stresses in the Community Understanding Mental Disorders: Classification Researching Mental Conditions GPI: Clinical Challenge, Research and Cautious Responses to Innovation Nature and Nurture: Biological, Social and Psychological Treatments: Moral and Medical, Restraint and Seclusion Recovery, Convalescence and Discharge Conclusions 4 Personnel: Staffing the Asylums and Serving the Colours Introduction The Staff on the Asylum Front Line Hierarchies Gender, Status and Staff Education Medical Staff: Doctors and Dilemmas Serving the Colours Towards the End of the War Conclusions 5 Food, Farm and Fuel: An Inequitable Supply Chain Introduction The National Food Context Asylum Diets: Supply and Demand Asylum Diets and Nutritional Understanding Communal Eating for Patients and Staff Food Distribution in the Asylums Asylum Farms Fuel Conclusions 6 Patients and Their Daily Life Introduction Seeking the Patients’ View In-Patient Life Clothing Cleanliness Night Times Patients’ Links with People Outside Patients at Work Conclusions 7 Difficult Diseases: Tuberculosis and Other Infections Introduction: Elsie and Mohammed Death Rates and Post-mortems Tuberculosis Tuberculosis at Claybury and Hanwell: Case Studies Other Infections: Dysentery, Typhoid and Influenza Conclusions 8 Accidents, Injuries, Escapes and Suicides Introduction: A Culture of Kindness or Harm? Abuse in the Asylums: Allegations and Outcomes Broken Bones and Cauliflower Ears: Facts and Fictions Escapes Suicides Conclusions 9 Shackles and Chains: Some Concluding Thoughts Then and Now Leadership: Attitudes and Standards Patients, Outcomes and Austerity Making Change Final Word Index