11 - Postscript: Findings and Speculations

Summary

The history of St Andrew's Hospital as examined in previous chapters reveals a strong institutional ‘storyline’ and provides a case example for a wider theme: the rise and fall of the asylum/psychiatric hospital. It has been placed in the contexts of local and national developments in mental health care, drawing particularly upon public statements concerning the hospital and the more private medical observations of its patients. Such information is more extensive and accessible compared with that offering intimate details of hospital life or glimpses of patients when considered essentially as people rather than as cases. It does not guarantee accuracy or objectivity and must remain only a guide to understanding what, over two centuries, could be construed as forms of mental health care. Any sense of social relationships or hospital routine which emerges is impressionistic, though that conveyed is based upon written records, the sometimes contradictory recollections of people working at the hospital or closely connected with it, and of patients’ reported experiences. This postscript offers a more personal view of the history of the asylum/hospital in relation to other research and considers briefly what has replaced ‘St Andrew’s’, in terms of services for patients and a new role for some of the former buildings.

At the risk of oversimplification, nineteenth-century asylums have been generally depicted as hierarchical, male-dominated, isolated communities, offering forms of care ranging from custody to cure and involving processes of control. These expanding places for madness became sites of professional power, in which illnesses and therefore patients were segregated and categorised with relatively little success in managed communities offering limited therapy and lots of work. Studies of asylum administration, admission and discharge procedures and institutional connections have tested these broad narratives without resolving more contentious issues. Until recently there has been less research on such features in twentieth-century hospitals, although the ‘war neuroses’, controversial physical and pharmaceutical treatments, patients’ rights and the debate surrounding de-institutionalisation and community care have attracted considerable attention.

All these features were evident in Norfolk but some can be highlighted, beginning with broad observations. The transformation from asylum to psychiatric hospital suggests a medical approach to mental illness but it is rather less clear how and when this became predominant.