Framing mental illness, 1923-1939: The Maudsley hospital and its patients

Abstract

British psychiatric care during the inter-war period has often been characterised in bleak and even punitive terms: an asylum system that required certification for treatment, radical and often risky clinical interventions of no established benefit to patients and a lack of empathy or creativity among doctors. Although the Maudsley Hospital was designed to break the asylum mould, the received view is that a distinctive admissions policy targeted those with a good prognosis, excluding the unruly and chronic. Using random samples drawn from 1924, 1928, 1931, 1935 and 1937-8, this paper explores how changing hypotheses about mental illness influenced the selection and management of Maudsley patients. The largest single diagnosis for in-patients was depression, although 24 per cent had a psychotic disorder. Almost all in-patients resided in Greater London. Only 13 per cent were unskilled workers, 30 per cent being from the professional class. While the key to understanding mental illness was thought to lie in the young, the in-patient population was largely middle-aged. In its operation, the Maudsley did not adhere to the founders' strategic plan but, in the absence of effective treatments, focused on the provision of a changing and varied patient population for its growing army of trainees and researchers.