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Introduction

The Open University — Mon, 11 Apr 2011 11:47:49 GMT

This unit is from our archive and it is an adapted extract from Understanding Health and Social Care (K100) which is no longer in presentation. if you wish to study formally at The Open University, you may wish to explore the courses we offer in this curriculum area.

In this unit we consider some of the issues raised by Howard Mitchell who has made a special study of Lennox Castle Hospital, about ten miles from Glasgow at Lennoxtown. His study is the subject of the video clips that accompany this block. Lennox Castle Hospital belongs to the period of the 1920s and 1930s when separate provision for people with learning difficulties was being developed following the 1913 Mental Deficiency Act.

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Learning outcomes

The Open University — Mon, 11 Apr 2011 11:47:49 GMT

After studying this unit you should be able to:

use Goffman’s model of ‘the total institution’ to organise and explain information that has been observed and recorded;
describe the development of large-scale institutions in the nineteenth century which were designed to segregate, control and in some cases, cure, their inmates.

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1.1 Finding out about Lennox Castle

The Open University — Mon, 11 Apr 2011 11:47:49 GMT

Lennox Castle was typical of large institutions built by local authorities in the 1930s and was the largest in the UK. At the time it opened it was considered to be 100 years ahead of its time by specialists visiting from the USA. Since then Lennox Castle has become well known as an example of a particular type of provision characterised by its isolation and by a certain notoriety among members of the public and nursing profession.

Lennox Castle represented a large investment by the Corporation of Glasgow, who bought the land and built the hospital. But only 60 years after it was opened it was scheduled for closure. There was a need to capture and record life there before it, and the people associated with it, disappeared. But how did Howard Mitchell go about his research, and what did he find? You'll find out by watching the video: ‘Lennox Castle Hospital: a hidden history’.

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Video: Lennox Castle Hospital: a hidden history (part 1)

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Activity 1 Lennox Castle Hospital: what kind of an institution?

1 hour 0 minutes

Watch the video ‘Lennox Castle Hospital: a hidden history’. Don't worry if you feel you need to watch it through more than once. All of the files in total last about 30 minutes. Watching a video when you're learning is different from watching for entertainment. You can use every bit or parts of it. You should make it work for you so pause or watch sections again as much as you want to.

While you watch note down any words which come into your head about what kind of place Lennox Castle Hospital might have been to live or work in.

Discussion

Comment

I don't know what words occurred to you, but what I noted down were adjectives like:

'safe’	‘cruel’
‘isolated’	‘boring’
‘frightening’	‘caring’
‘cold’ (in the winter)	‘oppressive’
‘dangerous’	‘inhuman’
‘peculiar’	'stultifying’
‘extraordinary’	‘depressing’
‘controlling’

Someone who read this material suggested nouns like, ‘friends and enemies’, ‘sharing’, ‘trust and distrust’, ‘fear’, ‘punishments and rewards’.

I didn't seem to come up with many positive words even though I saw people laughing and smiling about things they remembered. The story on the video evokes a mixture of emotions and it's difficult to know if people who lived and worked there share the same feelings about the place. Someone like James Lappin sounds quite resigned to life at the hospital, making the best of what he's had. When Colin Sproul talks about his work as a nurse, he's both bitter and realistic when he recalls the system he had to work with. There's something rather similar in both their attitudes. Margaret Scally remembers good times at the hospital, at work, but she leaves us with no illusions, she's pleased not to be there any longer. And Howard Mitchell, how does he come over? How well did you feel he coped with having been a nurse and with what he now knows as a researcher?

The hospital and the system it represents appear to be something of an enigma. But perhaps it's too easy to see it as extraordinary and isolated. Whatever our reactions, we need to be able to explain what we saw and to draw conclusions from it.

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1.2 Explaining what we find out

The Open University — Mon, 11 Apr 2011 11:47:49 GMT

How do we make sense of what we saw? The video tells the story of the hospital in dramatic tones: we hear about a riot, escapes, punishment and drug treatment regimes. But we also hear about football matches, dances and friendships. Even so, they are only part of the story of 60 years and many hundreds of people's lives. We saw several volumes of detailed records. What can be learnt from so much information? How can Howard Mitchell begin to organise all these facts and accounts?

One way of beginning is by drawing out some common themes from all the available evidence – the written and recorded data. Perhaps fortunately for us, we've only got the video to draw on, so let's start with that.

Social scientist Erving Goffman wrote, an important paper in 1961, ‘On the characteristics of the total instituion’. His model of the ‘total institution’ may be usefully related to Lennox Castle Hospital. In the paper he outlines four characteristics of institutional life:

Batch living – where people are treated as a homogeneous group without the opportunity for personal choice. Activity is undertaken en masse. Rules and regulations dominate and residents are watched over by staff.
Binary management – where the two worlds of residents and staff are seen to be totally separate and staff wield power over residents by maintaining distance between them.
The inmate role – where people who come to live in institutions are stripped of their former roles, made to break with the past, lose their personal identity and become an inmate.
The institutional perspective – over time the inmate may come to accept the loss of self and the power of the institution, taking on roles which reinforce its existence.

'Goffman also suggests that ‘total institutions’ are ‘symbolised by the barrier to social intercourse with the outside world and to departure that is often built right into the physical plant, such as locked doors, high walls, barbed wire, cliffs, water, forests or moors’ (‘On the characteristics of the total institution).

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Lennox Castle Hospital main building and aerial view of the whole site

Activity 2 Lennox Castle: a ‘total institution’?

0 hours 30 minutes

Taking each of Goffman's four characteristics note down some examples from what you saw in the video against each. How helpful is Goffman's model do you think? Does it fit completely onto the picture of Lennox Castle?

At this point you may feel you need to watch the video again, particularly if you only watched it through once for Activity 1.

Discussion

I don't know what you decided to enter under the four headings but here are a few examples which I felt fitted Goffman's model very well:

Batch living. From what James, Margaret and Colin told us there was regimentation and a feeling that lives were lived out in very public conditions. Margaret mentioned the way clothes were handed out and Colin can still recite menus from nearly 60 years before. The detailed records of so much of people's lives suggest a public accountability concerned to establish that formal rules about behaviour and treatment were to be maintained whatever the cost to human dignity and individuality. Management of behaviour through drugs might also be viewed in this way.
Binary management. Although we heard how staff lived on the hospital grounds and were subject to rigid supervision of their social lives there was plenty of evidence of the kind of separation which enabled staff to use physical and other powers over patients. Records were a form of control which were not open to patients to amend or contest and personal lives were subject to close scrutiny and observation. There were other separations within the hospital. The nursing staff had less power and access to information in comparison with the medical staff. Not so much a binary system perhaps, rather a hierarchy of divisions with the patients very much at the bottom.
The inmate role. People like James and Margaret were very young when they first came into hospital. They learned how to grow up as inmates and seemed to have become skilled at living as patients at Lennox Castle. The inmate role was created from a range of what would have seemed extraordinary practices if anyone had attempted to impose them on people outside the hospital. Disability resulted in what sound like conditions more appropriate for prisons or military barracks. Reality seems to have been stood on its head: cruelties are defined as right and appropriate and defenceless people are defined as dangerous and immoral. Contacts with the outside world were strictly limited and regimented as the ‘Regulations regarding the visiting of patients’ (see next screen) make clear.
The institutional perspective. This was perhaps less obvious from the video. Margaret Scally has moved out of the hospital and is obviously pleased to be able to distance herself physically and emotionally from the place. She also suggests that she never completely accepted the regime. Though she never ran away she says she wanted to. James Lappin comes over as someone who is more accepting and unquestioning of rules which meant that he and his girlfriend were never free to meet on their own.

Goffman's definition of a total institution might have been based on Lennox Castle. The hospital's layout, its grounds and its distance from most people's homes in Glasgow and further afield helped to contain everyone who lived and worked there. Everything seemed to be catered for. We heard about ‘escapes’ so presumably there was a feeling of barriers with the outside world that people tried to break through, and there were the less visible barriers maintained between the hospital and nearby Lennoxtown which at one stage prevented local people from working there. But this physical separation was only a backdrop for the kind of life which develops in an institution like Lennox Castle. Goffman argues that separation from the world outside enforced by bizarre rules, secrecy, punishments and loss of individual identity, isolated inmates and staff from accepted standards of rationality and ethics in the world ‘outside’, leading to what Howard Mitchell describes as an ‘impenetrable and cruel’ community.

Elsewhere Goffman also mentions solidarity among inmates and the development of communal activities. We didn't hear too much about these from the video. Perhaps the riot might be an example of communal resistance, and presumably the football and other sporting activities generated their own group experience. Although a total institution like Lennox Castle might seem like one community from the outside there were clearly times and occasions when, from the inside, it felt as if it contained several different communities.

Goffman has been criticised for drawing conclusions about institutions from a study of only one hospital and for devising a model which focuses on similarities while not allowing for variations within and between hospitals (Jones and Fowles, 1984, pp. 9–26). But as a sociological model the ‘total institution’ is only a tool to help us organise and identify key features in any context or set of relationships.

Over the years, practices at Lennox Castle Hospital changed. Mixed villas became a feature of life in the 1980s, a far cry from the strict segregation of Colin Sproul and James Lappin's early years at the hospital. Facilities later included a cafe and shopping area. Sports continued to play a big part in hospital life for both patients and staff. The hospital film shows and dances continued as television was introduced to the villas. Other changes came with the ending of domestic work for patients, to be replaced by education and training, preparation for life outside the hospital. Some element of privacy and individualisation was introduced as cubicles broke up the long rows of hospital beds in the villas and people were allowed to wear their own clothes.

Despite these changes the hospital remains isolated physically and with a distinctive layout determining a way of life and set of care practices which might be seen as normal to the people who live and work there, but far from normal as far as life outside is concerned. Goffman made his observations while he was ‘assistant to the athletic director’ at one hospital (Jones and Fowles, 1984, p. 23). He had no nursing or administrative experience of hospital life so perhaps he remained very much an outsider while he made his observations. Howard Mitchell tried to combine having been a nurse at Lennox Castle with being a researcher. How did this background contribute to his investigations?

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1.3 Regulations on visiting patients in Lennox Castle, c.1950

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1.4 On being an insider and a researcher

The Open University — Mon, 11 Apr 2011 11:47:49 GMT

The two roles of practitioner and researcher are not always easy to combine. Sometimes it's difficult to detach yourself from situations and stand back when you know you've been a part of practice which you've begun to see differently. On the other hand, being an insider can bring some advantages. How did Howard Mitchell deal with these two roles?

Click on 'View document' below to read Howard Mitchell's piece on 'The inside researcher'

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Activity 3 Weighing up the advantages and disadvantages of being an insider

0 hours 20 minutes

Click on the link above and read through Howard Mitchell's piece 'The inside researcher'; and as you do, note the advantages and disadvantages that he writes about. How far do you feel he succeeded? Is the video a balanced account or does it feel biased to you in any way? Perhaps it wasn't biased enough for you?

Discussion

Advantages: Howard Mitchell mentions his commitment to the hospital, his knowledge of learning disabilities and its history, his contacts with people who could tell him their stories, his local and hospital connections, professional trust, his ability to communicate with people with learning difficulties.

Disadvantages: he was concerned not to upset people who trusted him; he may not have asked enough questions and people assumed he knew things; patients may have deferred to him.

As to bias, Howard explains how he tried not to take on too much medical knowledge of the residents. He deliberately chose not to read their case notes: ‘I felt it would be going behind their backs’. The result is that we know nothing about why Margaret and James came to be diagnosed as needing to be detained at Lennox Castle beyond what they told us themselves. But, if people with learning difficulties are to be treated on the same terms as other people in society, then perhaps this is all that we as outsiders should know.

Of course one difference for Howard Mitchell is that he was researching the past. Had he been researching Lennox Castle today he might have found it more difficult to stand back and not intervene or comment on what he heard.

Key points

Whatever emotions are evoked by the stories we heard in the video, we still need to be able to understand what we saw.
Using Goffman's model of ‘the total institution’ is one way to organise and explain what is observed and recorded.
Models themselves are only a tool to be used critically to identify variations as well as what fits.
The ways of life which were described provide a starting point for discussions of what are acceptable and normal ways of behaving towards other people.
Being an insider researcher can have advantages but there are issues of confidentiality and a need to be able to reflect on your part in what you are researching.

Institutions such as Lennox Castle Hospital were typical of a particular period in the history of social care. How did these institutions emerge and what can we learn from that history today? To find out we're going to go back even further into the past.

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2.1 Institutions and segregation

The Open University — Mon, 11 Apr 2011 11:47:49 GMT

In this section I'll be compressing most of the history of legislation and provision which came to form the basis of health and social care over the last two centuries into quite a small space! You may want to find out more about particular aspects and developments. If you do, then you'll find the list of references to books and articles at the end of the unit useful.

At one time, poverty, madness, disability and criminality were thought of as unchangeable God-given or demonic states. In the late eighteenth and early nineteenth centuries institutional care emerged as these conditions came to be viewed as treatable. Because it was believed that people could be improved in some way by being set apart from influences which were seen as damaging (like poor families, disease and lack of education) prisons, hospitals and asylums were designed with highly regimented and controlling regimes. Indeed earlier provision for adults and children with learning difficulties focused specifically on education and training programmes. An ethic of work was fundamental to many of these systems of care–work was seen as improving and at the same time providing for inmates’ and patients’ keep. Institutions also had the function of protecting other people whom, it was thought, might be at risk from contact with poor, mad, disabled or law-breaking members of society.

Previously, people with mental illness had been subjected to degrading practices, often being treated as public spectacles to be ridiculed and terrorised. Many of the nineteenth century reformers wanted to offer more humane treatment yet at the same time they were keen to provide opportunities for the medical profession to experiment with and treat more cases. Charles Dickens, writing in 1841, portrays Barnaby Rudge as someone with learning difficulties. His words are uncritical, but at the same time serve to distance his readers from his main character's humanity. They illustrate the dilemma he faced in writing about such a subject at that time:

Startling as his aspect was, the features were good, and there was something even plaintive in his wan and haggard aspect. But the absence of a soul is far more terrible in a living man than a dead one, and in this unfortunate being its noblest powers were wanting.
(Dickens, 1841, p. 28)

Reformers like Lord Shaftesbury supported those doctors who believed in removing chains and adopting a more caring regime, such as that developed at the Retreat in York which had been opened by Quakers as early as 1796. However while Shaftesbury was arguing for a more enlightened philosophy of care he also referred to ‘patients’, ‘hospitals’ and ‘doctors’. A new language designating conditions which had been thought of in ‘moral’ terms emerged as people came to be classified as ‘insane’, ‘imbeciles’ and ‘idiots’ which at the time were seen as scientific terms. With the new language came new courses of treatment, including bathing, mild sedative drugs, poultices and enemas. One system and language of care was thus substituted by another, more medical one (Nolan, 1993, pp. 33–5). This change in the words used to describe different conditions and disabilities marks a shift in attitudes and care practice.

Bethlehem Hospital, London, women's gallery, 1860

The 1845 Lunacy Act and the Lunacy (Scotland) Act of 1857 required the counties or local authorities to build and maintain asylums. These new environments were seen as providing the basis for reforming difficult behaviours or treating illnesses. They provided a total environment of treatment, support and work for their inmates. The institutions, the treatment regimes and the segregation, it was believed, would contribute to some kind of cure. And of course, because they were so segregated, the general public had little opportunity to witness what went on within. This encouraged a belief that they were curative or at least therapeutic in some way.

The Retreat near York, from an early 19th century engraving

Within the asylums, doctors’ powers tended to be unquestioned and were supported by public fears whipped up by contemporary newspaper reports. Indeed, in England and Wales the number of people certified as ‘lunatics’ doubled between 1844 and 1860, leading some people at the time to question the reliability of such assessments. Were publicity and social panic having an effect on judgements (Nolan, 1993, p. 33)? The growth in the numbers also had its effect on the operation of care within the institution as ‘cure and treatment’ could easily become ‘control and punishment’.

A distinctive feature of the asylums was their size. Many asylum buildings were remarkable in terms of architecture and layout. While the first asylums, like the Retreat at York, were meant for only 30 patients, by 1900 buildings came to average over 800. Colney Hatch, the Middlesex asylum which opened in 1851, was from the start designed for 1,000 patients. Its frontage was nearly one-third of a mile long (Alaszewski, 1986, p. 8).

These early institutions developed out of Elizabethan Poor Law provision where those whose families could not care for them or who were unable to provide for themselves were supported out of local parish funds in workhouses and small institutions.

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2.2 1 Social Darwinism and eugenics

The Open University — Mon, 11 Apr 2011 11:47:49 GMT

Nineteenth century reformers combined their new medical diagnoses with a concern to tackle what they saw as the social causes of cruelty and incapacity. Two theories dominated: social Darwinism and eugenics.

Social Darwinism drew on Darwin's ideas of natural selection and emphasised the contribution of the fittest and most superior individuals to the survival of the human species. The social Darwinists, who included some of the most prominent thinkers of their time, believed that social ‘engineering’ or the control or manipulation and improvement of social conditions would do away with, or weaken, the effect of nature's shaping forces. The result would be uncontrolled breeding and weakening of the genetic pool and hence the deterioration of the race and swamping of the higher types within society. Eugenicists took these ideas further, arguing that those who were weaker, ‘degenerate’ or ‘defective’ in some way should not be allowed to breed or interbreed at all as their offspring would inevitably degrade the quality of the race. Poverty, ignorance, mental defectiveness as well as lack of moral values were seen as evidence that British society needed to purify its genetic stock and deal with what were seen as poisonous environments in the slums and factories. Great emphasis was placed on parenthood and procreation.

The influence of the eugenics movement in this country was strong and had a particularly pernicious effect on the care of children with learning difficulties. Ideas based on notions of racial purity led to demands for compulsory sterilisation of young people with learning difficulties and the application of a condemnatory morality which saw unmarried mothers locked away in mental handicap institutions. Their custodial care came largely to be accepted by the medical and educational establishments and their situation largely invisible to wider society (Hendrick, 1994, p. 92).

These ideas sustained segregation as a form of provision of care: segregation from society and segregation of the sexes within institutions (Williams, 1989, pp. 160–1).

Child with learning disability from the nineteenth century, MENCAP archive

Eugenicist ideas flourished well into the twentieth century and, some argue, are still alive today, with concern about reproduction a persistent thread as these quotes and the cuttings opposite demonstrate:

The unnatural and increasingly rapid growth of the feeble-minded classes, coupled with a steady restriction among all the thrifty, energetic and superior stocks constitutes a race danger. I feel that the source from which the stream of madness is fed should be cut off and sealed up before another year has passed.
(Churchill, a proponent of forcible sterilisation, in a private letter to Prime Minister Asquith at the time of the Royal Commission on the Care and Control of the Feeble-Minded, 1904, quoted in Ponting, 1992, p. 23)

[It is] not the very severe cases which are the most dangerous: it is the mild cases, which are capable of being well veneered, so as to look, for a time at any rate, almost normal, against which there is most need to protect society.
(Mary Dendy, proponent of segregation, writing in 1910, quoted in Jackson, 1996, p. 166)

Let us assume that we could segregate as a separate community all the families in the country containing mental defectives of the primary amentia type. We should find that we had collected among them a most interesting social group. It would include everyone who has extensive practical experience of social service would readily admit, a much larger proportion of insane persons, epileptics, paupers, criminals (especially recidivists), unemployables, habitual slum dwellers, prostitutes, inebriates and other social inefficients than would a group of families not containing mental defectives. The overwhelming majority of the families thus collected will belong to a section of the community which we propose to term the ‘social problem’ or ‘subnormal group’ … If we are to prevent the racial disaster of mental deficiency we must deal not only with the mentally defective persons but with the whole subnormal group from which the majority of them come … The relative fertility of this (subnormal) group is greater than that of normal persons.
[While dementia means being ‘out of one's mind’ amentia was used as another word for ‘mental deficiency’ or a lack of mind.]
(Report of the Wood Committee on Mental Deficiency, 1929, quoted in Ryan and Thomas, 1987, p. 108)

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2.2.2 Treatment regimes

The Open University — Mon, 11 Apr 2011 11:47:49 GMT

As well as asylums which housed people with mental illness and learning difficulties there was a turn towards a style of mass provision generally.

Development of special schools for disabled children began in 1750 when the first private schools for blind and deaf children were opened in Britain. The earliest public institution, run on a charitable basis, the London Asylum for the ‘support and education of the deaf and dumb children of the poor’, was opened in Bermondsey, south London, in 1792. By the end of the nineteenth century, separate schools for blind, deaf, physically disabled and learning disabled children were common, though the extent to which they were educational rather than custodial was much debated. Poor Law children were similarly treated to segregated and reforming regimes. They might be fostered or ‘boarded out’ but were just as likely to be housed in district schools, ‘barrack schools’ or to be placed in voluntary society homes run by organisations such as Dr Barnardo's and the National Children's Home (Hendrick, 1994, pp. 76–8). Barnardo spoke for many reformers when he argued that if the children of the poor, whether or not they had parents, ‘can be removed from their surroundings early enough, and can be kept sufficiently long under training, heredity counts for little, environment counts for everything’ (quoted in Hendrick, 1994, p. 79). Today we might see these attitudes as rooted in the nineteenth century ethic of work and individual self-improvement.

Long description

Dumbie House where Thomas Braidwood established the first school for deaf children, ‘Braidwood's Academy for The Deaf and Dumb’ in 1760. Photograph taken in 1935

It has been argued that institutional care increasingly came to be used by working class families who, under pressure from the effects of long working hours for most members of the family and urban overcrowding, found it less possible to care for people at home than in earlier, pre-industrial times and that factory work provided fewer opportunities for people with learning difficulties. As home and work became more separate, so care and support became less possible (Ignatieff, 1983). Wright argues that if family members were given over to asylum care this was not necessarily because parents and others had a medicalised understanding. Lay explanations of learning disability were more likely to be linked to growing children's inability to contribute to the household economy and especially to their apparent inability to benefit from education (Wright, 1996, p. 131). This theory fits well with James Lappin's explanation of why his father handed him over to hospital care.

Warren Towers School for the Deaf, Newmarket, 1939

While Wright's suggestion is an interesting one it needs to be borne in mind that care in the community and by families continued to be the dominant form of care throughout the period when institutions flourished. Many parents resisted pressure to put their children into institutions, as Ida Taylor, born in 1921 with cerebral palsy recalls:

They wanted to send me to a mental place and lock me up. They kept coming to our house when I was about six or seven years old to ask me and my mum questions. They asked me easy things like me name and how many days in the week and about money and that. Me and me mum got upset because I didn't want to go away and she didn't want them to take me. They said I should be in a mental place and that worried us a lot. What stopped it was that me mum took me to our doctor. He stopped those men coming round and told them I was no more mental than fly! They'd been on at us for about five years and it had made me mum ill with worry thinking I was going to be locked up.
(Quoted in Humphries and Gordon, 1992, p. 16)

Arguments that institutional solutions suited a society in which working class families had fewer resources to support their disabled relatives does not explain why institutional solutions were also taken up by wealthier middle and upper-class families who resorted to the private asylums. Though the treatment of poor children in the workhouse was satirised by Charles Dickens in his novel Oliver Twist there was no parallel popular exposure of the treatment of those who were considered ‘insane’ or ‘imbeciles’. Those, both staff and patients, who protested about conditions in the nineteenth century asylums, like John Perceval and his Alleged Lunatics’ Friend Association which was founded with the backing and help of lawyers, were isolated. They lacked the powers of resistance to what had come to be seen as a normal and acceptable way to treat certain groups of people judged to be in need of care and protection.

We've mentioned the impact of the 1845 and 1857 (Scotland) Lunacy Acts. These Acts made no distinction between people with a mental illness and people with learning difficulties. Separate provision for people with learning difficulties only came later with the 1913 Mental Deficiency Act, as we heard on the video. Until then only a tiny minority of people certified as ‘idiots’ lived in specialist ‘idiot asylums’ the rest lived in workhouses, prisons and lunatic asylums (Gladstone, 1996, p. 140).

The proportion of people living in mental hospitals peaked in the 1930s and began to decline in the 1950s. In contrast, the peak for numbers of people with learning difficulties in institutions came in the 1960s after the 1959 Mental Health Act which gave more emphasis to community care. Their numbers actually trebled between 1924 and 1954 to reach nearly 60,000 (Alaszewski, 1986, p. 15). The influence of institutional care persisted long and powerfully, as we've seen from the history of Lennox Castle Hospital.

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2.2.4 Activity: segregation today

The Open University — Mon, 11 Apr 2011 11:47:49 GMT

Activity 4 What about segregation today?

0 hours 5 minutes

Just pause for a moment and think about who gets segregated in society today, where, and why. Write down any groups of people you can think of.

Discussion

I thought of people convicted of criminal behaviour serving prison sentences, some people with learning difficulties, disabled children at special schools, young offenders, asylum seekers, illegal immigrants, people who are unable to pay their debts or who have been convicted of fraud, children in care or boarding schools, homeless people in night shelters and hostels, women who are victims of domestic violence who live in refuges, frail older people in nursing homes and residential care. I also thought of people detained under the Mental Health Act because they are diagnosed by doctors as being a danger to themselves or to others, and people detained under Section 47 of the 1948 National Assistance Act because they are neglecting themselves.

These days they may not be so great in number and the buildings they live in may be less imposing, but have all the reasons for segregation changed so very much?

So far we've discussed asylums and large-scale institutions simply in terms of the policies which gave rise to them and the philosophies which supported them, both inside and out. But these institutions were also places of employment. How did the job of nursing develop under such conditions?

Key points

The nineteenth century saw the development of large-scale institutions designed to segregate, control and in some cases, cure, their inmates.
The philosophy of institutional care meant that people from most sections of society tended to be catered for, from the youngest to the oldest, although care at home in the community was still the most likely form of care.
Social Darwinism and eugenics were influential philosophies which, together with an increase in the power of the medical professions, led to policies which segregated particular groups from society and which also imposed sexual segregation within institutions to prevent interbreeding.
Policies of segregation still operate today and affect certain individuals and groups within society.

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2.2.5 The emergence of asylum professionals

The Open University — Mon, 11 Apr 2011 11:47:49 GMT

Asylums and institutions were not only sites of care and control, they were also places where people worked as staff and developed professional expertise. The people who worked there also experienced segregation, professionally speaking. In this section we take a brief look at the development of caring professions in the institutions.

Low status patients, frequently paupers, with low status illnesses and conditions, such as mental illness, mental frailty or mental handicap, provided no prestige to doctors and other staff who worked with them. These socially stigmatising conditions meant that asylum doctors in mid-nineteenth century England occupied a lower social and professional status than doctors who worked in general hospitals. They could not, for example, offer their services to the large public charities or other bodies. They could not become consultants. Assistant medical officers in the asylums were paid at a lower rate, had to live in, had to delay marriage and had few opportunities for research or professional development. Since doctors at the large general and teaching hospitals did not see people with mental illness, there was also a tendency towards segregation of knowledge and professional skills (Hurt, 1988, p. 115).

If the medical staff were regarded as low in status, the attendants, as asylum nurses were still being called until well after the Second World War, who looked after the patients were very much lower, both within the institutions and within nursing generally. Though the Medico-Psychological Association (MPA), the asylum doctors’ own organisation, was ostensibly in support of training and education for attendants, with several members running their own evening classes during the mid to late nineteenth century, there was concern that successful nurses might challenge the position of doctors. However, by 1899 over a hundred asylums were taking part in a training scheme which led to an examination and certification. Attendants who took part were almost exclusively from the public asylums and were supervised and trained by doctors. This was in contrast with general nurses who, led by such pioneers as Florence Nightingale, had set up training schools which were controlled by nurses. Few private institutions trained their own attendants. Nursing had its own professional organisation by 1887 with the establishment of the British Nursing Association. But asylum nurses were excluded from membership on the grounds that they did not have appropriate experience and were also socially inferior.

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2.2.6 Skills for the attendants

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In the box below are the examination questions for attendants sitting the MPA's Diploma in 1893. Candidates were charged 2s 6d (approximately one tenth of an average weekly wage) and resits cost one shilling. Remember that at this stage, before the 1913 Mental Deficiency Act, asylums included many people with learning difficulties as well as those who were regarded as mentally ill.

Examination for attendants on the insane (1893)

Mention the causes of lung disease.
By what channels is the refuse or waste matter of the body drained from the circulation?
What symptoms would lead you to suspect that a patient is losing weight?
What symptoms would lead you to suspect that a patient is gaining weight?
1. What is a sensory nerve?
2. What is a motor nerve?
Name the special senses.
1. What is a drawsheet?
2. Explain how you would use it.
3. What are its advantages?
1. What observations would you make regarding the passage of urine and
2. the appearance of the urine?
1. Why is occupation important in the treatment of the insane?
2. What rules should be observed in promoting the occupation of patients?
1. What patients are most likely to escape?
2. What circumstances would make you suspicious?
3. How would you guard against escape?
1. In what way should attendants conduct themselves towards patients?
2. What do you understand by ‘showing a good example’?
1. What are the risks in treating cases in private houses compared with asylums?
2. What precautions would you take?
What are the difficulties with relatives in private houses, and how would you endeavour to meet them?

(Quoted in Nolan, 1993, p. 67)

Activity 5 Skills for the attendants

0 hours 5 minutes

Look at the exam questions in the box. What does it seem that the attendants’ main tasks might have been and what key skills did they need?

Discussion

The first part of the paper, up to question 4, focuses on physical health or changes in the condition of patients. Then questions 5 and 6 might possibly be described as rudimentary physiology. These are followed by a question which seems to be more about control and security. There doesn't seem to be much about communication, or emotional or spiritual care, and there's only question 9 to suggest that the attendants or nurses might also need to know how to divert or stimulate patients mentally.

Question 13 is interesting for what it reveals about contact with patients' relatives. It seems to suggest that only staff working in the community were likely to have to explain themselves to patients' families about the treatment being provided.

The tasks might be summarised as: diagnosis, treatment, containment and protection.

As to study skills, this paper seems quite demanding in terms of the verbal and writing skills it expects in such a low status occupation. Just for your information it's perhaps worth adding that the written paper was followed by a practical part, held two or three days later. Both parts of the exam were marked by the attendants’ own superintendent and an external assessor who was also an asylum superintendent.

In 1920 the newly formed General Nursing Council agreed that those who held the MPA's Certificate and those who had gained the newly established Certificate for Nurses in Mental Subnormality, could be eligible to be admitted to the supplementary Register (Nolan, 1993, pp. 60–81). When Colin Sproul became an attendant at Lennox Castle he and his colleagues took the Royal Medico-Psychological Association examination to obtain a certificate in ‘mental deficiency nursing’. This was a lesser qualification, with State Registered Nurses (SRNs) occupying higher status.

Colin Sproul was to become a shop steward later in his career. Trade unionism among the asylum nurses made a number of attempts to get off the ground in the nineteenth century as attendants tried to break free from the discipline and harshness of the medical hierarchy running the asylums. The basis for successful organisation came with the National Asylum Workers' Union, set up in 1910. This was to change its name in 1931 to the Mental Hospitals and Institutional Workers' Union amalgamating with the Hospitals and Welfare Services Union in 1946 to form the Confederation of Health Service Employees (COHSE). In 1993 COHSE joined with two other public service unions, NUPE and NALGO, to form the giant union UNISON.

Colin Sproul's nursing certificate, 1939

Institutions varied and it would be inaccurate to portray them all, and all their staff, as insensitive custodians. However this particular form of provision had some dominant characteristics which meant that, as far as the general public was concerned, it was something to be avoided. Why were institutions perceived in this way?

We've looked at Goffman's characteristics of life in institutions and we've seen that, although they were never the main form of care, institutions dominated the landscape and language of care provision. What was the nature of their domination and what did it mean for the reputation which they had in society generally?

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2.2.7 Resistance to institutions

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Click on 'View document' below to read R. A. Parker's piece 'The persistent image'.

View document

Activity 6 Resistance to institutions

0 hours 30 minutes

Read R. A. Parker's peice 'The persistent image. As you read it through note down an example for each of what Parker suggests are the ‘four forms of reinforcement’ of attitudes towards institutional care during the nineteenth and twentieth centuries. Think back to the video. Does what you saw support Parker's argument?

Discussion

Comment

Parker's ‘four forms of reinforcement’ are:

‘The deliberate cultivation of a repellent image’: he suggests that this followed from the implementation of the Poor Law and its philosophy of deterrence and oppression which permeated institutional provision from the start.
‘Reported cases of abuse of inmates’: he mentions scandals as well as routine cruelties.
‘Enforced association and routine of institutional life’: he quotes Townsend (1962) and a warehousing approach to care which forced people to live in an ‘artificial’ community in which they lost their own individuality.
‘Compulsion’: he mentions the practice of certification and lack of understanding of the differences between mental handicap and mental illness. Certification under the Mental Deficiency Act of 1913 placed on local authorities the responsibility to ensure that all adults and children considered ‘mentally defective’ should be identified by a specially appointed Executive Officer and examined and certified by a doctor. A patient's certification was reviewed every five years before a committee, but was rarely revoked.

How did you see these ‘four forms of reinforcement’ in relation to Lennox Castle? Was its image ‘repellent’? Margaret Scally and James Lappin seemed to have mixed feelings about the place. As an ex-inmate perhaps Margaret is more forthright in her critical expressions. Howard Mitchell describes its dubious reputation within the wider community but seems to see both positive and negative sides to its past.

What about abuse and scandals? Well we did hear about behaviour which by today's standards might be regarded as unsatisfactory and unacceptable in relation to patients.

‘Enforced association’ sounds like Goffman's description of the total institution. Margaret, Colin and James's accounts are full of references to people being regimented in groups and having opportunities for individuality suppressed.

Compulsion and detention was certainly a feature of Lennox Castle's care regime. We heard about the young men who were detained there as an alternative to prison and it certainly seemed as if James and Margaret had not had much choice until recently about where they might live, despite the ending of certification in 1959.

Parker was writing at a time (1988) when all forms of institutional care, including residential care, were under review. His hope, expressed at the end of the chapter, is that, given time, memories of past abuses would fade and that a new, more positive view of collective forms of provision might emerge coupled with more enlightened and sympathetic practice.

Key points

Institutional care tended to be provided for those who had a low status in society, either from poverty or disability.
The staff also occupied a low status within the hierarchy of their professions.
Low status, ‘repellent image’, association with the Poor Law and a philosophy of deterrence and oppression meant that as far as the general public was concerned institutional care was regarded with fear and horror.

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2.2.8 Campaigns for change

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Here we consider where some of the pressure for change was coming from in the earlier part of the twentieth century. Throughout the period of institutional domination there were, as we've seen from the early 1800s, voices which called out for change. Some contrasted the treatment of the sick and disabled poor with their richer counterparts in the private asylums. Others protested at the general inhumanity of regimented, mass care. Patients and their relatives had mixed experiences to draw on, but few felt confident enough to speak out in public against abuse or to suggest alternative forms of care. Shame was also a powerful deterrent to speaking out. Relatives were often unwilling to admit that a relative was an inmate of an institution. When change came it was as a result of action taken by people who were, for a variety of reasons, more powerfully situated. One source was the increasing professionalisation of those involved in the care of poorer and more dependent people in society.

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2.2.9 Professionalisation

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Care of frail older people provides an example. Many were cared for in the old Poor Law infirmaries which had become the responsibility of local authorities by the early decades of the twentieth century. These tended to be considered, by patients, doctors and nurses alike, as very much second class to voluntary aided hospitals (Timmins, 1996, p. 106). Nevertheless, even within the voluntary hospitals older people often fared least well, living for years on ‘back wards’ allocated for the ‘chronic sick’. Many of these wards existed well into the 1950s and became the subject of exposures and critical comment, particularly following the efforts of Dr Marjorie Warren who campaigned among the medical profession for the recognition of geriatric medicine as a speciality. She wrote in 1946:

It is surprising that the medical profession has been so long in awakening to its responsibilities towards the chronic sick and the aged, and that the country at large should have been content to do so little for this section of the community. Today, owing to the ageing of the population, the general shortage of nurses and domestic help … and the fact that more women are employed … the problem has reached enormous dimensions …To all who have studied the subject it is obvious that the specialised care and treatment of these folk is of great economic importance and calls for immediate attention.
(Quoted in Evers, 1993, p. 320)

Marjorie Warren targeted doctors who she felt neglected older people in the infirmaries because they were poor and suffering from conditions requiring lengthy treatment for which often there was no cure. The first Chair of Geriatric Medicine was set up in the late 1960s in Glasgow, a few years after Marjorie Warren's death (Evers, 1993, p. 323).

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2.2.10 Civil liberties campaigns

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Another source of change came from changing attitudes in the area of civil liberties. The Mental Deficiency Act of 1913 had defined categories of mental deficiency on social grounds with the result that many men, women and children had been locked up for years without any diagnosis relating to mental deficiency. The pressure group, the National Council for Civil Liberties (now known as Liberty) began campaigning in 1947 for a change in the Act. The NCCL's campaign included the identification of 850 ‘mental deficiency’ cases, for example Kathleen Bradley who had been detained for 20 years. At the age of 19, recovering from rheumatic fever, her local authority had been unable to find anyone to look after her. Though she had been in the top class at her school and had no record of being a delinquent she had been certified as a ‘mental defective’. A campaign to release her included questions in Parliament and appeals to the Board of Control. She was released in 1955.

Cover of 50,000 Outside the Law, pamphlet on the treatment of mental health patients, National Council for Civil Liberties, 1951.

The success of the NCCL's campaign and the realisation that there were probably approaching 6,000 similar cases led to the setting up of a Royal Commission in 1957. The Royal Commission was followed fairly swiftly by the 1959 Mental Health Act which abolished the 1913 Act and introduced Mental Health Review Tribunals. These had to include at least one non-professional member. The NCCL led teams of volunteers to act for patients at tribunals and by 1958 1,800 people had been released, with others following later (Dyson, 1994, pp. 33–35). Though the NCCL had identified injustice with some success, certification was replaced by compulsory detention defined in various sections of the 1959 and successive Mental Health Acts, a practice which came to be known as being ‘on section’ or ‘sectioning’ which is still in force today. The old Mental Deficiency Act's powers were curbed by the 1959 Act but people previously classified ‘feeble minded’ were reclassified as ‘severely subnormal’ and were still compulsorily detained.

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2.2.11 Scandals, treatments and cost saving

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In the 1960s critics of the quality of care for older people, such as Peter Townsend, The Last Refuge (1962), and Barbara Robb, Sans Everything (1967), added their voices to growing criticisms of institutional care, not only for older people but for users of mental health services and people with learning difficulties too. Government had already begun to take account of its responsibilities for the dire state and cost of many of these institutions and in a famous speech in 1961 Enoch Powell, the then Minister of Health, spoke in damning terms:

There they stand, isolated, majestic, imperious, brooded over by the gigantic water tower and chimney combined, rising unmistakable and daunting out of the countryside–the asylums which our forefathers built with such immense solidity.
(Quoted in Timmins, 1996, p. 211)

Powell set up a 10-year plan but little was achieved at that stage. Successive governments inherited the scandals and, without a convincing or funded alternative, his words did little more than start a process of change. The campaigns of the 1950s and 1960s led by voluntary organisations, academics and some professionals, as well as by patients and their families, fuelled a general move away from institutional care which was given statutory support in the 1990 NHS and Community Care Act. There were other changes too. The introduction of drug treatment from the 1950s offered the possibility of non-custodial care and ideas about the origins and development of conditions began to change too. More psychological and psychotherapeutic as opposed to physiological theories took over, and ideas about correcting or treating behaviour began to lose their force (Parker, 'The persistent image').

Institutions were never the major providers of care in the UK; a range of other types of provision coexisted so that those in institutional care were always a minority of those receiving care. But institutions have tended to be the lynch pin as such terms as ‘preventive care’, ‘after care’, ‘care after discharge’ suggest. All these ‘other’ forms of provision relate back somewhere to institutional care. As Parker suggests, institutions always dominated the landscape of care provision. The training they provided to nursing and medical staff, their care regimes and their position as a last resort, meant that they constituted a powerful source of authority and control in the lives of people who, for whatever reason, came within their confines.

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2.2.12 Activity: living through change

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Living through changes

1908 – Royal Commission on the Care and Control of the Feeble-Minded
1910 – James Lappin born
1913 – Mental Deficiency Act (England and Scotland)
1915 – Colin Sproul born
1914–18 – First World War
1925 – James goes into Royal Scottish National Institution at Larbert
1927 – Mental Deficiency Act
1929 – Report of the Mental Deficiency Committee (Wood Committee); recommended expansion of institutional provision for ‘mental defectives’
1937 – Colin joins the staff at Lennox Castle Hospital
1938 – James enters Lennox Castle Hospital
1939 – Outbreak of Second World War
1939 – Colin Sproul qualifies as a mental deficiency nurse
1942 – Colin marries and moves onto the Oval shortly afterwards
1945 – Labour government
1946 – National Health Service Act
1947 – National Council for Civil Liberties campaign begins
1951 – Conservative government
1952 – Margaret Scally born
1952 – The drug Chlorpromazine (Largactil) introduced
1956 – Riot at Lennox Castle
1957 – Report of the Royal Commission on the Law Relating to Mental Illness and Deficiency (The Percy Report)
1958 – Margaret is admitted to Waverley Park Home
1959 – Mental Health Act 1959
1961 – Enoch Powell's ‘water tower’ speech
1962 – Peter Townsend's Last Refuge published
1964 – Labour government
1967 – Barbara Robb's Sans Everything published
1960s (late) – Employment of patients as domestics on the wards at Lennox Castle ends
1968 – Margaret is moved to Lennox Castle Hospital
1969 – Ely report identifies cruelty and cover-up at the Ely mental hospital in Cardiff; first of a decade of several similar inquiries at Farleigh, Whittingham, South Ockenden and Normansfield
1971 – Better Services for the Mentally Handicapped, White Paper issued by the Department of Health
1972 – ‘Our Life’, first national conference of people with learning difficulties
1975 – Non-contributory Invalidity Pension introduced for all patients, at £3.00 a week
1975 – Colin retires
1979 – Committee of Enquiry into Mental Handicap Nursing and Care (the Jay Committee) stresses the importance of individual care rather than groups or classes of care
1979 – Conservative government
1981–Association of Carers founded
1986 – Report by the Audit Commission, Making a Reality of Community Care
1988 – Community Care: Agenda for Action (Griffiths Report)–did not extend officially to Scotland
1988 – Residential Care: A Positive Choice (Wagner Report)–did not extend officially to Scotland
1989 – Caring for People, White Paper issued by Department of Health–includes Scotland
1990 – National Health Service and Community Care Act (includes Scotland)
1991 – Margaret moves into the community 1
997–James is living at Lennox Castle 1997–Colin is living in Lennoxtown
1997 – Labour government
2000 – James Lappin moves to live in the community in Glasgow
2002 – In April, Lennox Castle Hospital closed down
2002 – Colin Sproul still living in Lennoxtown

Activity 7 Living through change

0 hours 15 minutes

Colin Sproul and James Lappin were both in their eighties when they were interviewed for the video. Margaret Scally was 44. In the box above there's a time line which integrates dates and events in their lives. I've also included some key political events which could be significant. Read it through and, as you do, note down any questions it raises for you about the lives of Colin, James and Margaret.

Colin Sproul, 1997

Long description

Margaret Scally in Glasgow, 1997

Long description

Colin Sproul (second from left) and colleagues, 1938

Long description

Margaret Scally at the Special Olympics

Long description

James Lappin at Lennox Castle Hospital, 1997

Long description

James Lappin back in Glasgow on a visit

Long description

Discussion

One of the first questions I wanted to ask is how was it that James Lappin could have spent nearly 37 years, getting on for half of his life, in Lennox Castle since the 1959 Mental Health Act which emphasised community treatment and which led to many people being freed from the label of ‘certification’? I wondered how long it took for legislation and the effect of reports to change care practices at Lennox Castle. I wondered whether, had James Lappin only been born a few years earlier, he would have been certified and put into hospital at all. There didn't seem to be much detail to fill in for Colin and Margaret's lives. I wondered whether the time line would have looked different had they had an opportunity on the video to discuss the changes which were important to them, like friends they'd known, different jobs they'd done and family events.

The timeline in the box above brings together various bits of information, from making the video, from books and other publications, and from this unit. You might have wondered about the different types of facts you were presented with. Some were spoken on the video while others were simply dates of events. Did you wonder how these different kinds of evidence compared with one another?

Key points

As far as individuals are concerned, key Acts, reports and other innovations may have little immediate impact on the quality of life – institutions can be slow to change.
Until very recently the policy and practice of institutional life has dominated the lives of people who are seen to need care.
When change came it was due to a number of influences: cost reduction, professionalisation of the staff, civil liberties campaigns, scandals and exposures, introduction of new drugs and treatments.

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References

The Open University — Mon, 11 Apr 2011 11:47:49 GMT

Alaszewski, A. (1986) Institutional Care and the Mentally Handicapped: The Mental Handicap Hospital, Croom Helm, London.

Atkinson, D. (1997) An Auto/biographical Approach to Learning Disability Research, Ashgate, Aldershot.

Binney, M. (1995) ‘Introduction’ in Philips, E. Mind Over Matter: A Study of the Country's Threatened Mental Asylums, SAVE Britain's Heritage, pp. 1–8.

Booth, T. and Booth, W. (1994) Parenting Under Pressure: Mothers and Fathers with Learning Difficulties, Open University Press, Buckingham.

Burch, K. (2001) Community Care, 4 October 2001, http:// www.community-care.co.uk/cc_archivedetails.asp [accessed 30 May 2002].

Cox, C. and Pearson, M. (1995) Made to Care: The Case for Residential and Village Communities for People with a Mental Handicap, RESCARE, Stockport.

Dickens, C. (1858) Barnaby Rudge: A Tale of the Riots of Eighty, Chapman and Hall, London.

Dyson, B. (1994) Liberty in Britain 1934–1991, Civil Liberties Trust, London.

Emerson, E., Cullen, C, Hatton, C. and Cross, B. (1996) Residential Provision for People with Learning Disabilities: Summary Report, Hester Adrian Research Centre, Manchester.

Evers, H. (1993) ‘The development of geriatric medicine’ in Johnson, J. and Slater, R. (eds) Ageing and Later Life, Sage, London.

Fido, R. and Potts, M. (1989) ‘“It's not true what was written down!”: experiences of life in a mental handicap institution’ Oral History, Vol. 17, No. 2, pp. 31–34.

Gladstone, D. (1996) ‘The changing dynamic of institutional care’ in Digby, A. and Wright, D. (eds) From Idiocy to Mental Deficiency, Routledge, London.

Gluck, S.B. and Patai, D. (eds) (1991) Women's Words: The Feminist Practice of Oral History, Routledge, London.

Goddard, J. (1996) Mixed Feelings: Littlemore Hospital–An Oral History Project, Oxfordshire County Council Leisure & Arts.

Goodley, D. (1996) ‘Tales of hidden lives: a critical examination of life history research with people who have learning difficulties’, Disability and Society, Vol. 11, No. 3, pp. 333–8.

Hendrick, H. (1994) Child Welfare: England 1872–1969, Routledge, London.

Humphries, S. and Gordon, P. (1992) Out of Sight: The Experience of Disability 1900–1950, Northcote House, Plymouth.

Hurt, J.S. (1988) Outside the Mainstream: A History of Special Education, Batsford, London.

Ignatieff, M. (1983) ‘Total institutions and working classes: a review essay’, History Workshop Journal, Spring 1983, pp. 167–73.

Jackson, M. (1996) ‘Institutional provision for the feeble-minded in Edwardian England: Sandlebridge and the scientific morality of permanent care’, in Digby, A. and Wright, D. (eds) From Idiocy to Mental Deficiency, Routledge, London.

Jackson, M. (1997) ‘Images from the past: using photographs’ in Atkinson, D., Jackson, M. and Walmsley, J. Exploring the History of Learning Disability, BILD (British Institute of Learning Disability), Kidderminster.

Jones, K. and Fowles, A.J. (1984) Ideas on Institutions: Analysing the Literature on Long-term Care and Custody, Routledge & Kegan Paul, London.

Laurent, C. (2001) ‘Children speak out in favour of community care’, Community Care, 31 May 2001, http://www.community-care.co.uk? ccarchuvesdetails [accessed 30 May 2002].

Mitchell, H. (2002) Lennox Castle: the Human History of an Institution, MXM Publications, Edinburgh.

Moody, H.R. (1988) ‘Twenty-five years of life-review’, Journal of Gerontological Social Work, Vol. 12 (3/4), pp. 7–24.

Nolan, P. (1993) A History of Mental Health Nursing, Chapman Hall, London.

Oakley, A. (1981) ‘Interviewing women: a contradiction in terms’ in Roberts, H. (ed.) Doing Feminist Research, Routledge & Kegan Paul, London.

Ponting, C. (1992) ‘Churchill's plan for racial purity’, Guardian, 20 June. Robb, B. (1967) Sans Everything: A Case to Answer, Nelson, London.

Rolph, S. (2002) Guidelines and Advice for Researchers Archiving Data: Legal and Ethical Issues Interviewing People with Learning Difficulties (Confidentiality and Informed Consent) http://www.qualidata. essex.ac.uk/creatingData/guidelineslearningdifficulties.asp [accessed 30 May 2002].

Ryan, J. and Thomas, F. (1987) The Politics of Mental Handicap, Free Association Books, London.

Thompson, P. (1988) The Voice of the Past, Oxford University Press, Oxford.

Timmins, N. (1996) The Five Giants: A Biography of the Welfare State, Fontana, London.

Townsend, P. (1962) The Last Refuge: A Survey of Residential Institutions and Homes for the Aged, Routledge & Kegan Paul, London.

Values into Action (1995) ‘Re-cycling Arguments and Institutions’, Values into Action Newsletter, 81, Summer.

Williams, F. (1989) Social Policy: A Critical Introduction, Polity Press, Cambridge.

Wright, D. (1996) ‘“Childlike in his innocence” Lay attitudes to “idiots” and “imbeciles” in Victorian England’, in Digby, A. and Wright, D. (eds) From Idiocy to Mental Deficiency, Routledge, London.

Wright, D. and Digby, A. (1996) (eds) From Idiocy to Mental Deficiency, Routledge, London.

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Acknowledgements

The Open University — Mon, 11 Apr 2011 11:47:49 GMT

The content acknowledged below is Proprietary (see terms and conditions). This content is made available under a Creative Commons Attribution-NonCommercial-ShareAlike 2.0 Licence

Grateful acknowledgement is made to the following sources for permission to reproduce material in this unit:

Text

'Shot in the arm for former hospitals’, Hampstead and Highgate Express, 7th February 1997; ‘Trouble at Lennox Castle’, Kirkintilloch Herald, January 1956; ‘Lennox Castle riot inquiry’, Kirkintilloch Herald, 1st February 1956.

Illustrations

Page 4: Greater Glasgow Health Board Archive;

Page 6 (top): Mary Evans Picture Library;

Page 6 (bottom): Courtesy Friends’ House Library;

Page 7: MENCAP's Hidden Histories Photo Collection;

Page 8 (top): Marian Van Court (2002) (middle right) Future Generations Homepage. Reproduced by permission of Marian Van Court;

Pabe 8 (middle): By courtesy of Edinburgh City Libraries;

Page 8 (bottom): Barnardo's Photographic and Film Archive;

Page 11 and 14: Colin Sproul;

Page 13: Courtesy Brynmor Jones Library, University of Hull;

Page 14: Margaret Scally;

Page 14(bottom two): James Lappin;

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