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History of Psychiatry Podcast Series

Rab Houston was born in Hamilton, Scotland, lived in India and Ghana and was educated at the Edinburgh Academy and St Andrews University before spending six years at Cambridge University as a research student (Peterhouse) and research fellow (Clare College). He has worked at the University of St Andrews since 1983 and is Professor of Modern History, specialising in British social history. He is a fellow of both the Royal Historical Society and the Royal Society of Edinburgh (Scotland’s national academy), and a member of the Academia Europaea. He is married to a senior university manager and lives in Edinburgh. In his spare time he likes any form of active meditation.http://www.st-andrews.ac.uk/history/staff/rabhouston.html https://arts.st-andrews.ac.uk/psychhist/

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2.1 Melancholy And Mania The Main Classifications

In this block of podcasts I’m going to look again at the language used to describe mental problems, the ways lay and professional people identified them in the past, and the possible confusions that lie in wait for us in history, when both culture and the material world were very different from the present day. Nowadays we are faced with a sometimes bewildering array of mental conditions and syndromes. By contrast, medical classifications in the past were often remarkably basic. The spectrum of mental illness could be encompassed by just two words: mania and melancholy.

9mins

2 Aug 2016

Rank #1

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14. Being an Asylum Patient 1: Cardiff Asylum regulations, 1919

In this podcast and the next four, I’m going to look at what patients made of entering and being in what we call mental hospitals and what were known until 1930 as lunatic asylums. The podcasts are about life in the institutions which dominated care of the insane and mentally impaired from the mid-nineteenth to the late twentieth century. The first extract shows why we seldom hear the voice of those who were institutionalised: asylums were highly regulated and authoritarian, not only for patients, but also for staff. The regulations show how closed many public asylums were. This was the day-to-day existence of about 100,000 asylum inmates in a British population of 36 million; by 1900 there were over 100 asylums whose average size was nearly 1,000. The average length of stay ran to several years because asylums increasingly filled up with chronic cases.IMAGE: Psychiatric patient, 19th century. Credit: KING'S COLLEGE LONDON/SCIENCE PHOTO LIBRARY / UIG, Rights Managed / For Educational Use Only

12mins

17 Oct 2017

Rank #2

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2.4 Madness, Witchcraft, And Religion

Early modern Europe saw an unprecedented craze for hunting, prosecuting, and executing witches, tens of thousands of whom were burned. It was widely believed witches could manipulate evil forces to do harm to people and property. Were the witches of the sixteenth and seventeenth century the mad people of the nineteenth and twentieth century? Image of the week: James VI, Daemonologie (1603 edition)Full Bibliographic Record: Wellcome Library Catalogue L0078964Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 http://creativecommons.org/licenses/by/4.0/

14mins

23 Aug 2016

Rank #3

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Understanding Mental Health: conditions, caring, and contexts - Prof. Uta Frith

Autism is a neuro-developmental disorder with a prevalence of about one in 100 births. Although we assume that this disorder has always been with us, and Rab Houston and I identified a case from the 18th century, it was not given a label until the 1940s. Hans Asperger, a Viennese pediatrician, and Leo Kanner, an American child psychiatrist, both used the label ‘autistic’ to characterise the condition. It took another thirty years until it was understood that it was not rare, but there was a whole spectrum of autistic conditions, all sharing the core symptoms of impaired social communication and repetitive and restricted behaviours. To explain these symptoms I mention two proposals: the ‘Theory of mind’ account, explaining the communication impairment; the ‘Weak central coherence account’, explaining the focus on detail.Uta Frith is Emeritus Professor of Cognitive Development at UCL’s Institute of Cognitive Neuroscience.

25mins

24 Apr 2018

Rank #4

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2.2 Mind And Body

One of the themes of these podcasts is that the boundaries between medicine and other disciplines in the past were much less clear cut than nowadays and the way knowledge was organised was also quite different. One of the most famous contributors is the seventeenth century French philosopher Renée Descartes and in today’s podcast I want to explain briefly his theory that the mind (what he called the ‘rational soul’) was distinct from the body.

7mins

9 Aug 2016

Rank #5

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Understanding Mental Health: conditions, caring, and contexts - Mental Health Nursing, Gerry Hastie

Gerry Hastie trained between 1993-96, when nurse training programmes were changing from being delivered by the Local Health Authority to Higher Education. He has always been a mental health nurse and has worked in care home settings, long term in-patient care settings, acute admissions, addictions and the community.In this podcast he illustrates his personal journey to doing what he does, and what it takes to be a mental health nurse, focusing on values and personal qualities; skills and different remits and the many roles taken on by nurses with patients, their families and colleagues. Nurses are simultaneously therapists, advocates, teachers and researchers who within their own training and skill set but whose work is essential with other professionals. He offers a perspective on what makes nursing unique and how nurses complement the multi-disciplinary team.Finally, Gerry tries to step outside and looks into his profession as an observer and use examples from clinical experience and popular culture to imagine what the public think mental health nurses do.

32mins

20 Mar 2018

Rank #6

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Understanding Mental Health: conditions, caring, and contexts - Prof. Danny Smith

Bipolar disorder is a complex psychiatric disorder of mood and behaviour that has been recognised for thousands of years. It probably affects about 1 in 50 individuals worldwide and is characterised by episodes of depression alternating with episodes of mania. In this podcast we discuss the presentation, diagnosis and treatment of bipolar disorder. We highlight the strengths and limitations of current diagnostic classifications and we consider the need for a multidisciplinary treatment approach that integrates medications (such as lithium) with psychosocial approaches (such as group psychoeducation). We also consider the intriguing link between bipolar disorder and creativity and we conclude with an optimistic discussion of latest research in the field and how this will ultimately lead to improved diagnosis and new treatments in the future.

37mins

30 Mar 2018

Rank #7

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8.5 Mental Health Nursing

Only a small proportion of modern physicians are psychiatrists and they are far outnumbered by nurses and social workers in care systems. The imbalance was even greater in the past, when specialisation of any kind was limited. This podcast looks at who nursed the mentally disordered in the past and how they too became more specialised in the twentieth century. It sets out the qualifications and roles of those who attended the mentally ill or impaired.Image of the week: Nursing Staff. Royal Western Counties Institution, [Idiot Asylum] Star Cross, Devon, late nineteenth centuryFull Bibliographic Record: Wellcome Library Catalogue L0000665 Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 creativecommons.org/licenses/by/4.0/

12mins

24 Jan 2017

Rank #8

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Colonial Psychiatry 1 - What and where?: colonial psychiatry’s origins and characteristics

I have been asked by the Scotland Malawi Mental Health Project to prepare a short series of podcasts to act as a component of the training programme for psychiatrists at the College of Medicine in Malawi. Like much of the less developed world, Malawi has limited resources for specialist psychiatric care: the ratio of psychiatrists per head of population is less than 1% of that in Western Europe. The two series of podcasts already broadcast have been used to help train clinicians and nurses in Anglophone sub-Saharan Africa, including Malawi.The practice of psychiatry in a colonial setting is surprisingly varied. Even within British colonies around the world, those who received psychiatric care, where they were treated, and to what ends was significantly different. Other European colonies were different again.So colonial psychiatry, as practised between the 18th century and the 1940s, 1950s, and 1960s, is a rich and varied topic. I want to narrow it down. I’m going to stick to Anglophone southern and eastern Africa, between the 1880s and 1960s, because that covers the geographical and cultural area in which Malawi is located. Between 1891 and 1964, when it became independent, Malawi was the British Protectorate of Nyasaland.Up to the middle of the nineteenth century the old world shared many of the characteristics we shall encounter in African colonies between the 1880s and 1960s. I’m going to set out 8 key similarities. I then explain what changed in Britain and Ireland over the last two centuries. Finally, I’ll summarise the distinctive experience of southern Africa under colonization, which I’ll explain in detail next time.Image: Eket, Nigeria. Copyright Robin Hammond, Condemned, ( http://www.witnesschange.org )

12mins

23 Jan 2018

Rank #9

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Colonial Psychiatry 3 - How and why?: Ethno-psychiatry and racism

If you have listened to my series of podcasts on the history of psychiatry in Britain and Ireland you will know that psychiatric relationships are at least partly about power and about the assumptions medical practitioners made concerning those they treated. In the old world, class and sex were important differentiators. In a colonial setting there was an added dimension. Daniel H. Tuke, a British expert on insanity and visiting medical officer at England’s York Retreat, wrote in the Journal of Mental Science for 1857 that ‘the liability to mental disease is greater (other things being equal) in a civilized and thinking people, than in nomadic tribes’. So madness was the price Europeans paid for living in civilization, but transposed to a colonial setting it was the price Africans paid for encountering civilization.Colonial psychiatrists worked to address fundamental issues of social anthropology: How did race affect mind and behaviour? Was it possible to change peoples and cultures? The answer was sadly predictable and the racist ideas I outline provided a rationale for maintaining colonial dependency because they seemed to prove that Africans were unsuited to governing themselves or interacting with the wider world. Their societies had both too many and too few restraints, making them inherently unstable.Image: Juba Central Prison, Sudan, copyright PBS (Robin Hammond, Condemned)( www.witnesschange.org )

10mins

6 Feb 2018

Rank #10

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Understanding Mental Health: conditions, caring, and contexts - Dr Fionnuala Williams

People with learning disability were understood and treated very differently in the past from the present. While attempts were always made to help them, this was against a background of pessimism about their prospects. Much progress has been made in the past half century in positive attitudes towards this group, with closures of the large institutions in which they were often housed and better integration into the community. Nonetheless, challenges remain, including a significantly shorter life expectancy compared with the general population. Dr Fionnuala Williams clarifies misconceptions and enlightens listeners on the definition, causes, and treatments relevant to this diverse population group, where communication is key.

48mins

9 Oct 2018

Rank #11

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8.3 The Dawn Of Psychiatry

This podcast returns to mental medicine. It sets out the forces behind the emergence of psychiatry: the rise of asylums, professional associations, research publications, and specialist training. These concentrated in Victorians times, but psychiatry did not become a fully fledged speciality until the mid-twentieth century.Image of the week: Thomas Smith Clouston, 1840-1915Full Bibliographic Record: Wellcome Library Catalogue V0028676 Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 creativecommons.org/licenses/by/4.0/

10mins

11 Jan 2017

Rank #12

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3. Depression - Hannah Allen

As a young woman in 17th century London, Hannah Allen suffered from severe depression or what was then known as melancholy. She wrote about the pain and despair she experienced. The way she wrote, retrospective but incorporating written fragments from the time of her collapse, and the nature of the temptations to which she was subject, as well as the cures proposed by relations, indicate a narrative of madness and depression as well as bringing out the pervasive religious belief of the age. Concentrated and painful, her frank account accepted that she had been mentally and physically ill; she wrote simply to explain what it had been like. Her writings are a vivid personal account, but they also show a poignant awareness of how her condition affected those around her.IMAGE: [Unknown lady 2] PORTRAIT OF AN UNKNOWN LADY, of the English School 1660-1670 at Lyme Park, Stockport, Cheshire. Credit: Universal Images Group, Rights Managed / For Education Use Only

10mins

11 Jul 2017

Rank #13

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10. A ‘silent madness’. Hugh Blair (1747)

Last week’s extract was a series of diary entries showing how a clergyman sought to help a young woman with learning disabilities. Hearing the voice of the intellectually impaired can be hard for historians, but this week’s podcast does just that. Alice Hill was prevented from marrying, but we know about the case of Hugh Blair because he was married. His brother wanted the marriage annulled on the grounds that Hugh was an ‘idiot’ who did not understand the union he had entered into. An enigmatic figure, I explain how Hugh was in fact autistic: one of the clearest and earliest cases for modern psychologists.IMAGE: James Robertson of Kincraigie; John Dhu (Dow, MacDonald); Jamie Duff by John Kay. Credit: National Portrait Gallery / Universal Images Group, Rights Managed / For Education Use Only

11mins

19 Sep 2017

Rank #14

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Extract 8.1 John Phillip

IMAGE: Head of Military Man by Giovanni Battista Piazzetta, 1682-1754, oil on canvas. Credit: SuperStock/ Universal Images Group, Rights Managed / For Education Use OnlyVoice credit: L. P. Catliff

7mins

8 Aug 2017

Rank #15

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9. Protection or control - Alice Hill (1730)

People with learning disabilities were often slow to acquire the ability to read and write – which were not normal skills for many people until the 19th century. We know little of their mental worlds. Those who cared for the intellectually and socially impaired, on the other hand, did record the decisions made on their behalf, both to enable and prevent them acting in ways that might not be in their best interests. The case of Alice Hill, where the issue was whether she should be allowed to marry, shows the fine line between protecting and inhibiting people with learning disabilities, which those close to them have walked over the centuriesIMAGE: Wellcome Library, London, V0030051. Young girl with Down's syndrome, sitting, wearing striped socks. Photograph. By: Joseph Arthur Baldry after: George Edward Shuttleworth. Collection: Iconographic Collections. Library reference no.: ICV No 30534. Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 http://creativecommons.org/licenses/by/4.0/NOTE: We do not know if Alice Hill had Down’s syndrome, but appearance was an important indicator of mental capacity in early modern times and she may well have looked distinctive.

13mins

12 Sep 2017

Rank #16

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15. Being an Asylum Patient 2: Letters from the Royal Edinburgh Hospital, late 19th century

Last week I looked at some regulations from Cardiff District Asylum at the start of the twentieth century. One of their main functions was to restrict communication between patients and the outside world, but it is often difficult to see how patients experienced their lives within institutions. The most abundant records are of what doctors and their staff did to patients. Yet patient letters to the staff or ones they tried to get to outsiders give unique insights into the spectrum of heartfelt attitudes from gratitude to anger and dislike, shown by patients. The uses and abuses of power in the narrow compass of a mental hospital come through very clearly.IMAGE: Wellcome Library, London V0012576. Edinburgh Lunatic Asylum, Scotland. Line engraving by R. Scott after R. Reid. Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 http://creativecommons.org/licenses/by/4.0/

14mins

23 Oct 2017

Rank #17

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8 (ii) Compulsive and delusional behaviour. John Philip (1777) - John Philip’s point of view

This week, we continue the story of John Philip, a humble legal clerk who lived in a world of fantasy, delusion, and obsession. This week, we try to understand his thought processes, and what those around him made of them.IMAGE: Portrait of Robert Fergusson (1750-1774). Painting by Alexander Runciman (1736-1785). Credit: De Agostini Picture Library / Universal Images Group, Rights Managed / For Educational Use Only

10mins

22 Aug 2017

Rank #18

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2. Becoming Insane - George Trosse

We begin our exploration of the voices of the mad with the story of the Rev. George Trosse, an English nonconformist minister, who wrote about his experience of mental illness in his autobiography in the 1650s. Although he realised he was ill, he saw his experiences as a supernatural struggle. Please read or listen to the extracts before listening to the podcast. You will find the written text on the website, or you can listen to them on our soundcloud stream by clicking on the links below. Extract 1 - https://soundcloud.com/user-516743905/george-trosse-extract-1Extract 2 - https://soundcloud.com/user-516743905/george-trosse-extract-2

10mins

4 Jul 2017

Rank #19

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Series Two Introduction

You might recognise my voice from listening to some or all of my previous set of 44 podcasts about the history of psychiatry in Britain since 1500. That series was mostly a medical history, explaining who cared for the mad, where, and how. I talked about asylums, care in the community, medical and lay understandings of the causes of mental problems, changing therapies, and the kinds of mental conditions that existed in the past. Put simply, the series was about what lay and professional people did to help the mad over the last five centuries. But along the way I also tried to bring out what madness was like for sufferers and those around them, explaining the social, economic, scientific, cultural, and political context of welfare provision.The series is still available in its entirety and will be for some time to come. You’ll find a link to it on the main web page. What I’m trying to do with the current series of 26 podcasts is offer a counterpoint, by giving a sense of the lived experience of madness. I want to explore the thoughts and feelings of those who knew they had mental problems, or who others thought disordered, using mainly their own words or, sometimes, descriptions that followed closely what they said and did.

14mins

27 Jun 2017

Rank #20