1. Kill or Cure

2. 1. To examine the role of psychological medicine continuing the process of ‘doctoring the nation’ that we looked at in relation to eugenics 2. To examine the role of psychological medicine in defining the ‘normal’ family as a central feature of post-war life 3. To examine the role of psychological medicine in a liberation of the individual

3.  Early optimism of asylum had faded  Problems of growing size (1000+), overcrowding, incurablity  Cost in face of rising broader demands of welfare  In lead up to WWII answers via eugenics

4.  Disillusion of doctors with asylum medicine  Desire to reach out to the milder cases who may be easier to cure  Rise of outpatient treatment, clinics, and child guidance services  Development of new psychotherapies  Interest too in prevention – promotion of ‘mental health’ and ‘mental hygiene’  But problems of resource, limited expertise, and reticence to talk about problems  Needs moment of crisis to push make mental health a national problem

8.  Political extremism, economic irrationality, and violence of war in mid- century encourages serious consideration of human psychology  Focuses attention on how to make democratic subjects  Evident in pre-war writing about extremism, Nazism, and political violence  Democracy a result and necessary condition for mental health

9.  Fear of mass mental breakdown via air attack following Guernica  Psychological strength (morale), prevention from collapse, and treatment likely to be keys to war  Need for the state to act, and willingness to resource expansion of psychological medicine to whole population

10.  Importance of freedom to release aggressive impulses in play as child: implications for child- rearing and education  Importance of security in first years (evidence of what happens without this to camp children and evacuees): encourages the attachment theory of John Bowlby and Donald Winnicott on dangers of maternal deprivation

11.  Via BBC radio and child-rearing literature reaches into family home (Donald Winnicott and John Bowlby)  Post-war withdrawal of support from nurseries  Progressive pedagogy in schools

12.  Model of the wartime bombsite  A space for children (under supervision) to explore, make things from junk, and to develop as children

13.  Through psychological advice holds possibility of designing an ideal environment for the child: safe, suited to the way the child sees the world, bringing the outside world into the protected realm of the family home

14.  Encourages/facilitates what we see as a classic era of family life: increasingly focused on home; home-bound mother; new expectations of fatherhood; smaller families  But historically this era of the ‘nuclear family’ is not the norm but a rather unique period (Pat Thane)

15.  The pre-war efforts to control and regulate through the imposition of outside controls (eg via eugenics) limited via lack of resources and expertise, and by culture that supports individual liberties  The post-war culture of normative mental health works via advice and internalisation of norms: self- government  Nikolas Rose: an obligation to be free

16.  Defining the family ideal also provides grounds for intervention on grounds of mental health when ‘normal’ family life is absent  This is why the ‘problem family’ is a major subject for concern in this period  Is a target for growing field of social work, but also for family planning to limit problems

17.  Post-war immigration  Breakdown of community with destruction of slums and relocation to high rise buildings  Recognition of persistence of poverty and social problems despite a welfare state  Rising divorce rates and instability of family structure  Close of asylums and move to ‘community care’ places responsibility on families at time of social breakdown

18.  Normative family (and gender roles) challenged by feminism  Challenge from ‘anti- psychiatry’ eg R.D. Laing: family as a cause rather than solution to mental ill health  Challenge from transcultural perspective (and in light of high BME rates in mental health system)

19. 1. Continuities with eugenics in focus on the ‘social problem group/family’ 2. Shift from biological to psychological arguments 3. Limited reach of medicine via clinical sites, and case for preventive strategies instead 4. Demands expansion of expertise (eg social work), but also strategies of education and internalisation of values or manipulation and coercion 5. Yet, is this new doctoring of the nation ultimately a failed project? Rising levels of chronic mental illness (eg anxiety, depression, eating disorders) 6. If so, why? Paradox of diseases of civilisation. Top down causes (expansion of medical gaze or demand led?) 7. And does the post-war project of democratic mental health see new freedoms or a new regime of expectations more deeply pervasive than ever before?