SOME BACKGROUND FACTORS IN RECENT ENGLISH PSYCHIATRIC PROGRESS

The factors outlined herein—a 19th century tradition of moral psychiatry, a history of social legislation, the activities of lay reformers and the development of a nationalised health scheme—have all made significant contributions to the current developments in English psychiatry, characterized by therapeutic communities, open-door hospitals, day centers, industrial rehabilitation units and aftercare programmes. From as early as the 1930's British hospital psychiatry has progressively moved away from a custodial position towards the development of an atmosphere conducive to the development of therapeutic communities and giving effect to procedures conceived in the late 18th century. More and more, attention has been directed towards good hospital-community relations, the betterment of aftercare, and in general the establishment of a preventive psychiatry where patients can be admitted early and treated rapidly. Examination of the factors discussed herein suggests that not only did a fertile soil exist for the growth of these ideas and practices but that an effective machinery for carrying out such programmes has been made available. It is of especial interest that most of these developments were being introduced before the advent of tranquilizers which have been credited for the increasing permissiveness and humanity of hospital policies(45).

Much as the developments in the days of Tuke were part of a larger social picture, so too the current changes in medical and psychiatric care are part of an increasingly liberal political and social policy which has provided much social welfare legislation (15). It is suggested that an examination of such factors is necessary in evaluating the development and success of current experiments in psychiatry which have not developed de novo or from some preformulated theoretical position but stem from a long history of social and legislative reform and have been fostered as an aspect of a nationally organised health scheme.