Rhodri Hayward’s The Transformation of the Psyche in British Primary Care, 1800–1970 provides an illuminating insight into the development of psychological models of selfhood that are relatively central to modern debates about medicine and health. It explores the historical connections formed between health, identity and personal history, investigates shifting conceptions of the psyche in modern Britain and probes into the changing interactions between doctors and patients as researchers constantly reconfigured the concept of psychological distress. In adopting this approach, Hayward provides an important contribution to a growing body of historical research into the development of modern psychological thought and its influence in individual, social and political domains.
In his first chapter, Hayward makes a subtle but important point that complicates standard interpretations of turn-of-the-century psychological thought. He maintains that the unconscious was understood in diverse ways as it became fashioned by a plethora of expert and lay individuals from the late eighteenth century onwards. In adopting this line of argument, Hayward makes a convincing case for reconsidering commonly accepted narratives of the Freudian discovery of the unconscious and the First World War as important watersheds. On the contrary, the unconscious emerges from Hayward’s analysis as a contested, somewhat uncertain, space that became known through the activities of French hypnotists, the support of individuals in Britain including Frederic and Arthur Myers and a growing interest among health reformers. Yet psychological concepts took on diverse meanings. For occultists, the unconscious extended beyond the body as opposed to being firmly enclosed in the physical space of the body.
Hayward proceeds by positing that the new psychology was in many ways born through the intimate administrative workings of schemes such as the Workmen’s Compensation Act. Insurance compensation is, perhaps, a somewhat mundane site in which to locate developing ideas of an unconscious self, lacking the inherent glamour of the First World War or industrial modernity as wellsprings of psychological modernity. Nonetheless, as Hayward maintains, the extensive patient-record-keeping that came along with issuing sickness certificates led to the production of a wealth of psychological data, allowing for a new analysis of biographical medicine that helped psychological thought secure a foothold in psychiatric and general practice. In the 1930s, James Halliday made effective use of patient records to track what he saw as the shifting psychological makeup of British society in a transitional period marked by economic downturn and widespread neuroses.
In his third chapter, Hayward demonstrates that the interwar period witnessed a rapid infiltration of psychological thought in government strategies; a development that formed part of a growing desire to assess the psychic state of the British population in an era tinged with deep socio-political anxiety and a foreboding sense of national social crisis. In this period, new epidemiological models emerged that added complexity to explanations of disease aetiology that focused almost exclusively on the bacteriological. Instead, psychologists sought to link the onset of physical complaints such as rheumatism to psychological disturbance. Hayward refers to the problem of the middle-class housewife, a suburban neurotic, as a mentally troubled case study whose psychological analysis reflected an increasing turn towards transforming the private inner state of individuals into a public object of government. In turn, inner life, once psychologically assessed and pathologised, could be targeted as an object of both individual and social reform. As Hayward discusses, the psychological reform of individuals provided a basis for considering social reconstruction.
Nonetheless, those observing the mental well-being of the general public soon turned into objects of surveillance themselves. Hayward’s fourth chapter argues that a mid-century desire to incorporate psychotherapeutic methods into general practice raised concern about whether general practitioners were in fact in a fit psychological state themselves to adequately use the force of their personality to address patient needs. If medical record-keeping had once provided a resource for socio-medical analysis, it now seemed plausible that those producing the records were in need of psychological assessment and personal reform. Hayward expands upon this intriguing theme by examining mounting mid-century concern about the personal influence of the physician in contributing to a patient’s illness. To achieve this he examines various problematic questions. By constantly formulating new diagnoses and pathologising emotional and physical conditions, were doctors and psychologists encourage patients to consider themselves as ill? Does the emotional state of the physician influence his or her interaction with the patient? Is the power of medical influence and suggestion in itself productive of neuroses, psychological complaints and physical conditions? And how can an exemplary physician, conscious of the power of his interventions and insulated from the patient, be moulded? Hayward’s concluding chapter explores the development of the placebo and its relationship with psychotherapeutic methods, adding insight into the ongoing role of psychotherapeutic models in an era marked by growing popularity in prescribing pharmaceutical remedies for mental illness.
In The Transformation of the Psyche in British Primary Care 1880–1970, Hayward offers an illuminating study that deepens historical understandings of the multiple functions of psychological thought the emergence of new understandings of the self and how concepts of the unconscious underpinned certain therapeutic regimes, affecting how many general practitioners performed their therapeutic role. Hayward’s study, an important contribution to a growing body of research on twentieth-century psychology, is condense but meticulously researched, thoughtfully crafted and well-presented.
