Academic journal article Indian Journal of Psychiatry

The Role of Work in Psychiatry: Historical Reflections

Academic journal article Indian Journal of Psychiatry

The Role of Work in Psychiatry: Historical Reflections

Article excerpt

Byline: Waltraud. Ernst

Until recently, the role of patient work in the history of psychiatry has been a neglected dimension. Yet, in the psychiatric institutions that emerged across the world from the late eighteenth century onwards, work and work therapy were prominent features, culminating in the rise of a specialist profession affiliated to medicine - occupational therapy. This article explores the changing meanings of work within varied medical, social, and political contexts.

In 1751, St. Luke's Hospital for Lunatics was established by philanthropists for the reception of pauper lunatics in London. A few years later, in 1758, its first resident physician, William Beattie (Battie), published his Treatise of Madness, which was to become an authoritative and influential reference work for 18th-century doctors. It has been described as 'the first by a psychiatrist who could draw on his experiences with a large number of patients.'[1] Based on his experience, Beattie insisted that 'management did much more than medicine.'[2] In due course, practitioners began to recommend patient work as an aspect of 'moral treatment.'[3]

Historians' views of work and occupational therapy in psychiatric institutions do not always overlap with practitioners' own perspectives. For a historian, the historical role of patient work in psychiatry is subject to vacillation between therapy and empowerment on the one hand and coercion and punishment on the other hand. In contrast, the present-day occupational therapists and other practitioners allied with psychiatry might not consider the latter features as characteristic of their profession. What does historical research tell us about the development of work therapy in Europe, North America, and South Asia during the course of the last three centuries?

Rest and activity were two of the mainstays of a variety of medical paradigms. In the Greco-Roman tradition, they were part of the six 'nonnaturals,' namely, factors external to the body over which a person had some control. Motion or exercise and rest figured alongside the other five constellations that required balancing out and use in moderation: air and environment, food (diet) and drink, sleep and wakefulness, retention and evacuation, and passions of the mind (emotions). Traditions such as Ayurveda and Chinese Medicine too consider exercise or work as an integral part of medical regimens. The idea of work as therapy is, therefore, not confined to the modern period.

However, from the mid-18th century onward, changes occurred in the social and economic fabric of Western societies. Some of these imbued work more generally with new connotations and accentuated particular meanings in its employment within medical settings. Foremost among these developments was the changing locus of the treatment of the mentally ill. To begin with, patients were confined in relatively small, mostly privately run madhouses, but from the mid-19th century onward, they were increasingly housed in large-scale public lunatic asylums that provided for hundreds or sometimes a couple of thousand inmates. This development was mirrored in British India.[4] Institutionalization on a progressively larger scale was expensive, and an emphasis on motion or work rather than rest became a way of lowering the costs of public institutions. It was during this period that the term 'industry' began to harbor its double meanings of 'processing of raw materials' and of 'industriousness.' Whole families, including women and children from the age of six, spent more time working than they had hitherto done in agricultural employment. In England between 1750 and 1800 annual working hours increased by at least one-fifth.[5]

The idea of work as punishment too flourished, particularly within the prison sector where inmates and those transported to penal colonies like Australia were forced to work. The ideal public institution, whether a lunatic asylum or an orphanage, was a place of industriousness and of economically profitable manufacture or otherwise usefully employed labor; frequently they were. …

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