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PhD title + abstr

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PhD title + abstr

  1. 1. John Stephen Adams BSc (Open), MA(Cambridge), MA (Leicester), MPhil (Leicester) ‘Challenge and Change in a Cinderella Service’: A History of Fulbourn Hospital, Cambridgeshire, 1953 – 1995 Thesis submitted for the degree of Doctor of Philosophy of The Open University, in the Faculty of Health & Social Care Date of submission: 2009
  2. 2. © John Adams Abstract This study of Fulbourn Hospital uses oral history and documentary sources to explore the models of mental illness and the therapeutic practices associated with them in one provincial English psychiatric hospital during the second half of the twentieth century. The appointment in 1953 of a new Medical Superintendent from the Maudsley Hospital, Dr David Clark, set in train a process of change which transformed the hospital through the implementation of a social model of psychiatry. This period was ended by the appointment of the leading biological psychiatrist, Professor Sir Martin Roth, as the University of Cambridge’s first Professor of Psychiatry in 1976. The subsequent years saw the appointment of psychiatrists who shared support for a medical model of psychiatry. Attention then turned to the development of care in the community through the establishment of group homes and community mental health teams. The implementation of sectorisation proved to be controversial, as did the increasing role afforded to general managers. It is concluded that many of the elements of the social model introduced by Dr Clark became absorbed into the working practices of the nursing staff, after they had been abandoned by the psychiatrists working in the hospital. This study therefore illustrates the process through which professional boundaries shifted in response to changing models of practice. 2
  3. 3. Contents Chapter 1: Introduction 8 Chapter 2: The History of Mental Health Care: A Review of the Literature 15 Chapter 3: Research Methodology 48 Chapter 4: The New Superintendent 86 Chapter 5: Winds of Change 122 Chapter 6: Hereward House and Westerlands: The Creation of a ‘Therapeutic Community Proper’ 157 Chapter 7: ‘Social Therapy’ in Practice 203 Chapter 8: Nursing Reforms at Fulbourn 237 Chapter 9: The Critics of the Fulbourn Regime 265 Chapter 10: Reaching Out from the Institution 303 Chapter 11: Conclusion 346 Appendix 1:[Removed] 361 Appendix 2: Brief biographies of oral history interviewees 365 Bibliography 369 Tables Table 1: Chronological list of oral history material (Ch. 3) 75 Table 2: Work groups of patients 1954 and 1961 (Ch. 4) 115 Table 3: Percentage of work groups discharged (Ch. 4) 116 Table 4: Diagnoses of patients (Ch. 6) 161 3
  4. 4. Table 5: Individual treatments for ‘disturbed ward’ patients (Ch. 6) 161 Table 6: Themes and practices in the therapeutic community wards (Ch. 6) 178 Table 7: Occupation of patients in Hereward House on 2 February 1969 (Ch. 6) 187 Table 8: Admissions, re-admissions and patient numbers for Street and other acute wards (Ch. 7) 211 Table 9: Mental Health Act 1959 (Ch. 7) 218 Table 10: Diagnoses of patients admitted to ‘Swift ward’ (Ch. 7) 219 Table 11: Ward links, from 1966 (Ch. 8) 239 Abbreviations AWA Asylum Workers’ Association CPN Community Psychiatric Nurse DICT Deep Insulin Coma Therapy DPM Diploma in Psychological Medicine DSM Diagnostic & Statistical Manual of Mental Disorders ECT Electro-Convulsive Therapy FRCP Fellow of the Royal College of Physicians 4
  5. 5. GNC General Nursing Council GP General Practitioner GPI General Paralysis of the Insane ICD International Classification of Diseases LREC Local Research Ethics Committee MPA Medico-Psychological Association MRCP Member of the Royal College of Physicians MRCPsych Member of the Royal College of Psychiatrists NAWU National Asylum Workers’ Union NHS National Health Service RMN Registered Mental Nurse SRN State Registered Nurse WHO World Health Organisation Illustrations Illustrations removed for copyright reasons. 5
  6. 6. Dedication To Gwen Adams and Anna Adams. Acknowledgements A doctoral study employing oral history as one of its main sources necessarily relies upon the active assistance of many people, but responsibility for any errors, and for the interpretations drawn from source material, remains mine alone. 6
  7. 7. The initial debt is owed to my colleague Nick Smithson, who first encouraged me to embark on this journey of discovery, putting his own historical resources at my disposal and introducing me to Dr David Clark. This study could not have been undertaken without the assistance of the twenty-six other individuals who agreed to be interviewed. They were unfailingly helpful and hospitable, despite the demands that I was making upon their personal schedules. Librarians and archivists have provided much valuable help and advice. At the Open University, Professor Pam Shakespeare facilitated the transformation of a personal enthusiasm into a project proposal. Dr Sheena Rolph and Professor Dorothy Atkinson supervised the study in a wholly supportive manner, and I am very grateful to them for their judicious balance of critical appraisal and positive encouragement, sustained over the last six years. Professor Joanna Bornat and Dr Tessa Muncey generously agreed to act as critical readers for final drafts of the study. Finally, this thesis is dedicated to my mother and to my wife, who have lived with my enthusiasm for the history of some of the less fashionable corners of the health and social services for over two decades. 7