Unfortunate Folk: Essays on Mental Health Treatment, 1863-1992

Published by University of Otago Press

in association with the History Department, University of Otago

PO Box 56/56 Union Street, Dunedin, New Zealand

Fax: 64 3 479 8385

Email: university.press@stonebow.otago.ac.nz

Introduction © Barbara Brookes 2001

Essays © Individual authors 2001

First published 2001

ISBN 1 877276 09 X (Print)

ISBN 978-0-947522-06-3 (Kindle Mobi)

ISBN 978-0-947522-07-0 (EPUB)

ISBN 978-0-947522-08-7 (ePDF)

Published with the assistance of the Alfred & Isobel Reed Trust

as administrated by the Otago Settlers Association

Cover features a photograph by Truby King of Seacliff patient, case 2397:

a 44-year-old married woman (see caption, page 157)

(National Archives, Dunedin Regional Office)

eBook conversion 2017 by meBooks, Wellington, New Zealand

Contents

Title Page

Copyright

Acknowledgements

Abbreviations

Notes on Contributors

Introduction

Part 1: Founding Years in Otago Institutions

1 Dunedin Lunatic Asylum, 1863–1876

Jeremy Bloomfield (1979)

2 Truby King and Seacliff, 1889–1907

Cheryl Caldwell (1984)

3 Taming the Brain Storms

Alexandra Reed (1993)

4 ‘Criminal Lunacy’ 1882–1912

Jane Adams (2000)

5 Ashburn Hall, 1882–1904

Alan Somerville (1996)

6 Seacliff and Ashburn Hall Compared, 1882–1911

Caroline Hubbard (1977)

Part 2: Into the Modern Era in Otago

7 Ashburn Hall, 1905–1947

Judith Clare Medlicott (1972)

8 The Otekaieke Special School for Boys, 1908–1950

Sandy Bardsley (1991)

9 Psychiatry and Seacliff, 1912–1948

Susan Fennell (1981)

10 ‘Unfortunate Folk’: A Study of the Social Context of Committal to Seacliff 1928–1937

Judith Holloway (1991)

11 Cherry Farm, 1952–1992: Social and Economic Forces in the Evolution of Mental Health Care in Otago

Jeff Kavanagh (1996)

Part 3: Some New Zealand Perspectives

12 Scientific Pastors: The Professionalisation of Psychiatry in New Zealand 1877–1920

Matthew Philp (1996)

13 ‘Production not Reproduction’: The Problem of Mental Defect in New Zealand 1920–1935

Stephen Robertson (1989)

14 Women Psychiatrists in New Zealand, 1900–1990: An Oral History

Paula Cody (1996)

15 A Separate World? The Social Position of the Mentally Ill, 1945–1955

Susannah Grant (1998)

Notes

Index

Acknowledgements

Much of the history recorded here has been made possible because access was granted to sensitive records. We are grateful to Healthcare Otago, who granted students access to the Seacliff and Cherry Farm files and to the Medical Director of Ashburn Hall who similarly granted access. We would also like to thank the staff of the Medical Library, University of Otago, and the Department of Preventive and Social Medicine, for granting students access to their valuable collection of fifth-year medical theses.

The Healthcare Otago files are now held at the Dunedin Branch of National Archives and we are grateful to the staff there for their assistance. We also wish to record our thanks to the staff of the Hocken Library and the Central Otago University Library for the help they invariably give to History research students. Some of the essays have made use of oral testimony and we would like to thank all those who made their time available to students. We are grateful to Jane Adams for her meticulous work checking and standardising the footnotes.

Barbara Brookes and Jane Thomson have had different roles in the production of this volume. One of Barbara’s research interests is the history of medicine and her own work and interest in the field has acted as a catalyst for students. She has supervised a number of the students whose work appears here and she has been delighted in the way students have enthusiastically responded to the challenge of writing about the history of mental health. Jane’s role has been that of editor, reducing 20,000 word essays down to chapter size. Barbara and Jane wish to record the pleasure involved in their collaboration on this volume and their thanks to History Department at the University of Otago for making this possible.

All names in this volume, except those that were available in the public realm at the time, have been fictionalised to preserve confidentiality. We have made every effort to provide accurate information about the illustrations used and apologise for any errors or omissions.

Abbreviations

Notes on Contributors

Although not all contributors replied to a request to tell us briefly what they are doing now, enough did to illustrate the variety of careers to which history research can lead.

Jane Adams completed her History Honours degree in 2000, and aims to complete her Law degree in 2001. After that, she hopes to travel widely, and to also undertake further History study. Her work on ‘criminal lunacy’ arose out of her desire to combine into one topic her interests in psychiatric history, gender studies, and criminal law.

Sandy Bardsley finished her Honours dissertation at Otago in 1991, then headed to the University of North Carolina at Chapel Hill for MA and PhD work in medieval history. She received her PhD in 1999 and now teaches history at Emory & Henry College in Virginia, USA.

Paula Cody completed her Masters thesis in 1996 and now works as a freelance historian and researcher in Dunedin. She believes the mental health field is a dynamic and relevant topic which interests those outside the academic arena because of its pertinence to people’s lives, and because of society’s increasing interest in mental well-being – shown by the way New Zealand has embraced self-help books, therapy and drug régimes, and the investigation by various government departments into the causes of psychological problems.

Sue Fennell returned to Britain for six years on completion of her degree, where she lived and worked in London, She is now married with two young sons and lives in Wellington. She has retained an interest in medical history through collaborative research into an aspect of medical education at Otago and hopes to complete her Masters thesis on this subject when her sons occupy a little less of her time.

Susannah Grant wrote her History Honours dissertation in 1998. She is currently researching Sir George Grey’s governorship of New Zealand 1845–1853 for a doctoral thesis at the University of Otago. She enjoys cooking, children and travel with her husband Shaun.

Judith Holloway completed her BA (Hons) dissertation in 1991. She thinks she was attracted to the field of mental health because she had always been somewhat suspicious of ‘normality’ – of what society condones and what it condemns. After four years’ travelling and working in Asia and Europe, Judith returned to Dunedin in 1999. She is currently employed by the Hocken Library, University of Otago, as well as studying towards a qualification in Japanese.

Caroline Hubbard completed her History Honours dissertation in 1977. Since then she has travelled the world several times, lived in France and England and pursued a career in the New Zealand Public Service. Her history degree provided a good training in how to analyse issues and think beyond the obvious.

Jeff Kavanagh spent a year working in the History Department as a Research Assistant on the Caversham project, before travelling to Korea and Japan where he spent two years working as an English teacher. He now lives and works in London as an Assistant Project Manager for a non-profit Economic and Regional Analysis company.

Judy Medlicott (née Billing) completed her MA dissertation while teaching in 1971. Since then she has raised two daughters, travelled extensively, and returned to secondary teaching in 1982. She is currently HOD History at New Plymouth Girls High School.

Matt Philp wrote his History Honours dissertation in 1991. After seeing a bit of the world he came home to train as a journalist, and for the past four years has written for the New Zealand Listener magazine, with the odd soapy foray into television scriptwriting. His history degree was excellent preparation for the former, but hasn’t as yet been crucial to the goings-on at Shortland Street.

Alex Reed completed her History Honours dissertation in 1993 and, after a short stint working in Auckland, has been based in London. Having worked in film production and research for five years there, she is now travelling again and trying to re-employ her writing skills to record her adventures.

Stephen Robertson wrote his History Honours dissertation in 1989. Since that time he has completed a PhD in American history and gender history at Rutgers University, held postdoctoral fellowships at the American Bar Foundation in Chicago and George Mason University in Fairfax, Virginia, and taught for a semester at Massey University. He is now a lecturer in the Department of History at the University of Sydney, completing a book entitled Sexuality through the Prism of Age: Modernity, Legal Culture and Sexual Violence in New York City, 1880–1950, and enjoying life in the sun with his partner Delwyn and his daughter Cleo. His 1989 dissertation topic was chosen because he wanted to write about the history of sexuality (about which little had been written in New Zealand at that time), and his search for sources led him to the intersection between mental health and sexuality.

Alan Somerville completed his MA in 1996. Since then, thanks to the introduction provided by his children, he has been drawn deeper and deeper into the world of Playcentre. Why did he want to work on his topic? Although he wasn’t particularly drawn to the field of mental health, he was interested in the pattern of people’s behaviour having unexpected or unintended results; and in seeing how social or economic circumstances might affect their behaviour. This study offered plenty of scope.

Introduction

In July 2000, a member of the local mental health team publicly criticised the fact that overcrowding in inpatient facilities meant that patients admitted to psychiatric wards had to sleep on the floor. The history of mental health care in this province of Otago, and indeed throughout New Zealand, demonstrates that, from time to time, an event will lead to an eruption of public concern about the mentally ill. Yet, for most of the time, the mentally ill take a low profile in the preoccupations of the community. The public preference is for forgetting, as Michel Foucault posited in his pathbreaking Madness and Civilisation, because the fear of madness reflects a deeper fear of self disintegration.

The role of historians is to keep the memory of the past alive, in all its complexity, humanity and inhumanity. Otago province is particularly rich in both Maori and European settlement memories. The gold rushes of the 1860s established Dunedin as a leading commercial centre, and its university and medical school were the first to be founded in New Zealand. The medical school has longstanding relations with many healthcare institutions in the province. Over the years, students in the History Department at the University of Otago, have made a significant contribution to restoring the past of those consigned to a separate world of the mentally ill. They have been able to do so because the rich records of institutions such as the Seacliff Asylum and Ashburn Hall have allowed access to the inner workings of one aspect of New Zealand’s healthcare system. These records also contain captured biographies of people who had no public voice. History relies on access to past records; sensitive use of such sources allows us, among other things, to review the decisions we have made with regard to the care of those who are ill.

A broken mind is baffling in a way that a broken leg is not, hence the study of mental illness offers important challenges to the interpretive craft of the historian. Categories that once mattered, such as ‘insanity of masturbation’, are no longer part of the psychiatric lexicon. Historians drawn to this field are interested in the way illness is socially interpreted, if not socially constructed. These interpretations may differ amongst those concerned: the sufferer, their family, the doctor and the wider society. It is the very mutability of concepts of mental disorder and the variety of responses to it that engage the historical imagination.

One of the students whose work is represented here said of her attraction to the subject of the mentally ill that ‘it stemmed from an interest in social history and more specifically a concern about the exclusion and isolation imposed on people whose illness was largely misunderstood’. Many of the students who have written these chapters had a similar motivation and they have produced a substantial corpus of work which we have edited into chapters for this collection. The research they undertook gave them a unique opportunity to undertake concentrated and scholarly work, of a kind they might rarely get again. Their work is stored away in Dunedin’s Hocken Library, known only to the scholarly community. Like the people about whom they write, their work might be forgotten. Since we are of the view that such excellent research and the subject of mental health should not be consigned to obscurity, we have produced this volume.

The first part of this book explores the foundation institutions established for the care of the mentally ill in Otago in the early days of European settlement. The recognition of lunacy in the province quickly led to cries for intervention by the Provincial Council in the 1860s. Jeremy Bloomfield’s chapter traces the attempt to create provision for those labouring under ‘the dark cloud of insanity’ who initially were grouped together with criminals and vagrants in the local gaol. A group of Provincial Councillors argued that those considered to be mad rather than bad should be ‘objects of tender solicitude’ and thus treated very differently to paupers or prisoners. Such solicitude, however, required funds for proper facilities and one dominant theme throughout this book is the continual battle to obtain scarce resources. While there was a shared recognition between the public and politicians that the lunatic was ill through no fault of his or her own, there always seemed to be more pressing calls upon the public purse. Like most western countries, New Zealand developed parallel and largely independent services for the mentally and physically ill, and the needs of the physically ill often seemed more comprehensible and urgent.

As the Dunedin Lunatic Asylum filled with casualties of the gold rush period, its population reflected that of the Province. Most of the inmates were in their twenties and thirties and three quarters of the men were single labourers or miners. Catholics and the Irish were over-represented in proportion to their prevalence in the population as a whole and perhaps the Presbyterian province’s aversion to drink meant that alcoholism was an unexpectedly high cause of admission.

By the late 1870s, the initial high cure rate of the Dunedin Asylum was on the wane and the institution was starting to fill up with incurable patients. A bigger asylum was an urgent necessity and, in 1876, with the dissolution of the provinces, the central government backed plans to build a farm asylum, out of Dunedin, at Seacliff. It was to this architecturally ambitious institution built unfortunately on unstable ground, that Frederic Truby King came as Medical Superintendent in 1889. Cheryl Caldwell’s essay examines this period of King’s career, which has been overshadowed by his role as the founder of the Plunket society. King attacked the physical problems of the Seacliff site with vigour and similarly tried to address the inadequate physical care of patients, constantly complaining about overcrowding, altering the diet of the patients away from meat three times a day, redecorating the interior of the asylum and beautifying the grounds.

The tradition of treatment, begun at the Dunedin Asylum, which emphasised comfortable rooms, good food, and plenty of outdoor exercise and employment, was continued by King at Seacliff. The farm allowed greater scope for male employment while women were kept busy indoors with sewing, knitting, laundry and kitchen work. King also endeavoured to classify patients in order to improve treatment, to increase their liberty and to call for early admission. A firm believer in the environmental causes of insanity, King often felt frustrated at how little he could do with the limited resources he had for his patients. His focus then shifted to prevention, which he believed could be achieved by correct feeding and care of infants.

Caldwell argues that King’s ‘two greatest classification successes’ lay in provision for ‘inebriates’ and ‘epileptics’. Alexandra Reed takes the latter group as the focus for her chapter, examining the records of ‘epileptic’ patients in Seacliff from 1880–1915. This was a small group, around 6 per cent of the annual asylum population, distinguished by their youth and the acute nature of their epileptic episodes which suggests that their disability created particular difficulties for families. Contemporary opinion held to the idea of epileptic character traits, which included a tendency towards violence and difficult behaviour. In 1910 the Inspector-General of Mental Hospitals included epilepsy amongst the problems resulting from degenerate heredity. Such views supported the institutionalisation of sufferers in order to prevent them marrying and propagating apparently ‘defective’ children.

Hereditarian views jostled alongside a recognition that epileptics were only insane at intervals and that their basic sanity entitled them to special treatment. Truby King founded Orokonui as a separate facility for sufferers from epilepsy, where they were given individualised care and a greater degree of freedom. A small number of patients benefited from this facility but for most, the prognosis was grim. Over 70 per cent of those admitted to Seacliff for epilepsy never left the asylum and, despite their youth, the mortality rate for epileptics exceeded the average number of asylum deaths. Reed’s postscript suggests that only in the 1930s and 1940s, when new drug therapies became available, did the outlook brighten for this segment of the asylum population.

Jane Adams’ chapter ‘Criminal Lunacy’ examines another small and unique sample of the asylum population: those adjudged to be criminal lunatics or lunatic prisoners. The first group was composed of those discharged or acquitted of a crime on the grounds of insanity. The second group consisted of those in ‘any prison or reformatory or industrial school’ who were certified to be a lunatic by two medical practitioners. In both instances classification of lunatic effectively consigned the person involved to an indeterminate sentence in an asylum. Heated debates took place over where such people should be incarcerated, fuelled by their perceived danger to the wider community.

This chapter demonstrates that the danger criminal lunatics presented to the community was, in fact, negligible. The crimes of women involved vagrancy, drunkenness, indecency, and, in one case, attempted suicide. Male criminal lunatics were more likely to commit violence against others but often they too had been convicted of vagrancy and drunkenness. In general, there was little to distinguish them from the other male asylum residents. The vexed question of whether an individual was mad or simply bad was debated in highly publicised courtroom dramas examined here through the cases of Robert Turner and Lionel Terry. Both spent many years in Seacliff

The quality of life in the asylum was regarded by some criminal lunatics as better than that offered by prisons. A small number of sufferers from mental illness enjoyed the even more attractive surroundings of Ashburn Hall. Alongside the public provision for the mentally ill, New Zealand’s only private asylum, Ashburn Hall, was opened in Dunedin in 1882, the subject of Alan Somerville’s chapter. One of the founders was James Hume, the former energetic lay superintendent of the Dunedin Asylum. Public asylums now required medically trained superintendents, and Hume looked for a new opportunity. In partnership with Dr Edward Alexander, Hume built an asylum with forty bedrooms and began advertising for patients. This private institution, reliant on substantial fees, was able to provide a level of comfort unavailable in the public asylums. The proprietors were also able to send on to Seacliff patients who endangered the hotel-like atmosphere of Ashburn Hall.

The private asylum offered families an alternative to home care when the behaviour of relatives became embarrassing, and committal to Ashburn Hall held less of a stigma than committal to Seacliff. Patients were able to maintain their individuality in the small asylum in a way that was difficult in the much larger public facilities. Treatments, however, were much the same, with an emphasis on order and outdoor work. Cure was equated with conventional behaviour. One patient, allowed out on trial, thanked the superintendent ‘very sincerely for teaching me to follow the example of the proverbial parrot’.

A comparison between public and private provision is at the core of Caroline Hubbard’s study of Seacliff and Ashburn Hall between 1882 and 1911. As would be expected, class was the main differential in the patient populations, but there were others. ‘Heredity’, a loose and large category for admissions at both institutions, included a number of ‘congenital idiots and imbeciles’ at Seacliff which were absent from Ashburn Hall. The proprietors of the private asylum, reliant on a reputation for cure in order to maintain custom, were clearly selective in their admission policies, a luxury denied the public institution.

Hubbard’s study takes issue with the idea that the siting of Seacliff and Ashburn some distance out of Dunedin was indicative of stigma. She argues that beliefs in the curative effects of fresh air and outside employment were much more important. Contacts with the community were clearly regarded as important for patients, with patients visiting town and townsfolk visiting Seacliff to provide entertainments. ‘Clearly,’ she argues, ‘asylum patients were generally regarded in the community as poor unfortunates to be pitied, rather than beasts or deviants to be kept locked away.’

The second part of this volume examines modern developments in Otago. The dawn of the twentieth century saw little new in treatments for the mentally ill but the initial optimism that asylums, by offering a retreat from the world, would accelerate cure faded with the increasing percentage of long-stay patients. Technological innovations, transforming urban life in New Zealand, impacted on the asylum. Electric light was installed at Ashburn Hall in 1907 and telephones soon became a necessity. Significant change in the governance of Ashburn Hall came in 1916, as Judith Medlicott traces, when one owner left his shares to be divided among the University of Otago, the Mayor and Councillors of Dunedin, and the King Edward Technical School. Dr A.H. Falconer, medical superintendent from 1926 until 1947, recruited able staff, built closer links with the Medical School, and persuaded the new Labour Government that patients at Ashburn Hall should receive hospital benefits under the 1938 Social Security Act. The private asylum could now rely on a measure of public support. From the late 1940s, like the public asylums, Ashburn Hall would introduce new methods of treatment, and have an increasingly important role in medical education and the mental health system. This more recent history has yet to be written.

Sandy Bardsley’s chapter examining Otekaieke Special School for Boys examines an institution of a very different type from Ashburn Hall or Seacliff. The school was not a place specifically for care or cure but an institution for training. These were not sufferers from occasional ‘brain storms’ but boys whose lives were to be marked by the judgement that they were ‘mentally retarded’ or ‘feebleminded’. The educational solution to the problem of those who did not learn in the conventional classroom was to isolate them and teach them useful skills in a separate residential institution. Bardsley’s chapter reveals that social circumstances, particularly unstable family backgrounds, played an important role in who was sent to Otekaieke.

Along with toothbrush drill and physical training, boys were taught reading and arithmetic. Idleness was not permitted and staff encouraged highly disciplined behaviour. Staff expectations of obedience were imbibed by older boys, some of whom exercised tyranny over the younger residents. Boys rebelled against the regime, and against bullying by older children, by absconding. The educational aim of the school, and the desire that it should lead to useful employment, appears not to have been fulfilled at least for the 30 per cent in Bardsley’s study sample, who went directly to other institutions, including mental hospitals.

The founding of Otekaieke was one of the significant changes which took took place outside of the mental hospitals, with the establishment of special facilities for ‘mentally defective’ children. From the 1920s onwards, psychiatric outpatient clinics were developed at general hospitals. Inside the public mental hospitals Susan Fennell argues that a transformation occurred between 1912 and 1948, with the development of more active treatment. Fennell notes the role Seacliff played in medical training over this period and the continual difficulties in staffing the hospital. Poor conditions made it difficult to attract the nursing staff needed to provide adequate care for the patients in the overcrowded hospitals.

The First World War had a significant impact on treatment as the numbers of men suffering from war neuroses brought a new sympathy towards sufferers from mental illness. The success of the ‘talking cure’ in treating soldiers led to a new optimism about psychiatric treatment. New physical treatments were also employed such as insulin coma therapy in the 1930s and electro-convulsive therapy in the 1940s. Doctors welcomed any new treatment that held out a promise of improvement for patients. In 1945 surgical intervention in the form of pre-frontal leucotomy appeared to offer another solution to some patients’ problems, although it was never adopted on a large scale. Poor staff-patient ratios and a long-stay patient population inclined medical personnel to seize on the promise of new physical therapies with enthusiasm.

Judith Holloway’s essay concentrates on the ‘unfortunate folk’ admitted to Seacliff during the years of the Great Depression. Rather than focussing on treatments, she explores the way ideals of femininity and masculinity shaped entry to the asylum and experiences within it. The identity of women with the domestic sphere was such that forty-four of the fifty-two women admitted to Seacliff in Holloway’s study were recorded as being ‘domestics’. As she notes, ‘this could mean they were paid servants or housewives, but either way confined to a home, whether their own or someone else’s.’ Holloway’s deft analysis of cases suggests many mentally distressed women felt that they had failed at homemaking. For some the asylum offered respite from ‘onerous domestic duties, and often indigence’.

The Depression made it particularly hard for men to live up to their role as breadwinners. One man, out of work for two years prior to his committal, expressed his lack of identity by saying he believed his ‘heart had gone missing’. Both single women and men were over-represented in the asylum population but the latter more dramatically. Nearly all the single men in this study were committed to Seacliff via the police; many were itinerant labourers who had been drinking excessively. Older men were admitted for senility, while nearly a quarter of all male admissions between 1928 and 1937 were labelled ‘feebleminded’, ‘imbecilic’ and ‘idiotic’. Holloway concludes that, for both men and women, mental breakdown was often accompanied by a crisis in gender roles, a likelihood exacerbated by a period of economic difficulty.

Jeff Kavanagh’s chapter examines the social and economic forces which shaped Cherry Farm, begun in 1952 as a ‘therapeutic community’ to replace Seacliff. His essay takes us beyond the era of the large mental hospital to the new world of community care. He notes the irony that, by the time of its completion in 1969, Cherry Farm’s time was already past as new treatments, changing ideas, and, most urgently, fiscal imperatives promoted the concept of community care over that of institutions. The pace of relocation of services back into Dunedin heightened in 1965 when the former chest hospital at Wakari was converted to a psychiatric unit. By 1966 that unit handled over 400 patients a year who averaged a stay of twenty days each. Attempts to relocate patients from Cherry Farm into the community were less successful, however, because patients were ill-prepared for discharge and lacked support in the community.

Concern about the separation of mental hospitals from other health services led, in the late 1960s, to the decision by central government to devolve responsibility for such services to local hospital boards. This decision accelerated the move to community care, in the hope that it would be a cost-saving measure. In fact, as experts pointed out, community care was unlikely to cost less and it would prove to be as difficult to make adequate provision for care in the community as it was in hospitals. One of the important impediments to a high standard of care was the fact that New Zealand was still dogged by the shortage of qualified staff, which had created difficulties for the psychiatric service from the outset.

The third section of this volume moves beyond Otago and presents some New Zealand perspectives on the development of the psychiatric profession, beliefs about mental defect, and the fit between ideas about the mentally ill and the experience of sufferers. Matthew Philp, in charting the professionalisation of psychiatry, traces the move from asylums run by lay administrators to increasing efforts, from the 1860s, to bring them under medical control. This move was promoted by Frederick Skae, the first Inspector-General of Asylums who, like many of the asylum doctors that followed, came with experience from Britain. The work of Otago men, such as Truby King at Seacliff, is seen in relation to what was going on at Porirua, Avondale and the whole network of New Zealand mental hospitals.

The medically trained generation of asylum doctors believed, Philp argues, that insanity was a physical disease, and that their institutions were hospitals where cure could be effected by early admission, classification, proper diet and work. Both medical and moral treatments were necessary to treat physical disorders and to cultivate self-restraint. Mental disease would also be better understood through research, and the creation of a neuropathological laboratory at Ashburn Hall facilitated investigations. Although they sought to enhance the standing of their profession, Asylum Superintendents faced continual problems in securing adequate finance and staff to provide the highest standards of care. Many looked outside the asylum and sought preventative measures through social engineering to ‘stem the tide of social degeneracy’.

Fears of ‘social degeneracy’ are at the heart of Stephen Robertson’s essay on the problem of mental defect from 1920 to 1935, which explores ideas about social engineering. The advent of compulsory schooling, based on an idea of ‘normal’ progress, led to the identification of those unable to meet this standard. Variously labelled ‘idiots’, ‘imbeciles’ or ‘feebleminded’, the fate of these children was subject to fierce debate, fuelled by the eugenics movement. Mental hospitals were no longer regarded as the appropriate place for such children, though just how they should be cared for was unclear. ‘Feebleminded’ girls were regarded as a particular problem because they were thought to be unable to control their sexual behaviour.

The extent of anxiety was such that in 1924 the government appointed a Committee of Inquiry into Mental Defectives and Sexual Offenders. To many of those giving evidence to the Inquiry, segregation and sterilisation seemed obvious solutions to stem the apparent tide of degeneracy. Initiatives such as Children’s Courts derived in part from the recommendations of the Inquiry. A 1928 Mental Defectives Amendment Act created a Eugenics Board and clinics were set up to examine cases and recommend appropriate treatment. Wrangling between the Mental Hospitals and the Education Department, however, led to the demise of the Eugenics Board in the early 1930s. At the same time a deepening economic depression made it clear that mental deficiency was not the cause of poverty, unemployment and other social problems. Public interest in the issue faded in light of more pressing concerns.

Paula Cody’s chapter on women psychiatrists takes a close look at those who entered the speciality in medicine that has proved most receptive to women. Her examination begins with why women initially went into medicine at a time when it was still firmly male dominated and then looks more closely at the particular attractions of psychiatry. Using oral histories conducted with eighteen female psychiatrists, Cody explores their career choice, and the frustrations and rewards they encountered.

In 1946, casual teaching of mental diseases at the University of Otago Medical School was put on a firmer footing when a Department of Psychiatry was established. Women who chose to study psychological medicine often faced a negative reaction from family and medical colleagues when announcing their decision. Within medicine psychiatry was a low status field but those who chose to pursue it preferred, one said, ‘the human side’ to the ‘mechanical side of medicine’. The interviewees suggest that women have a great deal to offer psychiatry and the flexibility of this medical specialty meant it has offered women a profession which can be combined with raising a family. This insight into the views of practitioners reveals the complexity and humanity of individual practitioners, in contrast to the dismissal of individual interests apparent in the previous two chapters.

The final chapter in this collection, Susannah Grant’s ‘A Separate World?’ explores the fluidity between the worlds of madness and reason in mid-twentieth century New Zealand, focussing on the decade from 1945 to 1955. This was a time of optimism for the medical profession because of the new array of physical treatments available and an increased interest in psychotherapy. On the other hand, as portrayed in Janet Frame’s Faces in the Water, conditions within mental hospitals were deplorable and stigma against mental illness remained widespread.

Grant explores the role of mental health workers, politicians, the attitudes of the general public, and of families in responding to mental illness. In doing so she builds a deeply layered picture of relations between the world of sanity and that of madness and the intensity of the effort involved to keep the worlds separate. In effect, she argues, even those who have suffered mental illness collude in the stigma surrounding it by distancing themselves from the world of unreason once they are declared to be well.

The first two sections of this book chart how those deemed to be ‘foreigners’ in the world of reason have been treated in one province of New Zealand over the period since the founding of the Dunedin Lunatic Asylum in 1863. Patterns were no doubt similar in the rest of the country, though the concentration of the Maori population in the North Island means they are under-represented here. The studies indicate that families sought the committal of relatives when they could no longer deal with their behaviour and, for most, this was not a decision taken lightly. The asylum, later mental hospital, held out the prospect of cure, and, if that was not forthcoming, a standard of care and surveillance often impossible in people’s homes.

The third section of the book looks at wider patterns, with the creation of a specialty within medicine directed specifically towards treatment of the mentally ill and one that proved particularly attractive to women practitioners. We are also reminded that specific historical circumstances gave rise to fears about social degeneracy in the inter-war period and optimism about treatments in the 1940s and 1950s.

There are certainly moments of inhumanity inside institutions in this story, when the link between sufferers and the sane was unrecognised, such as when the Inspector of the Dunedin Asylum in 1872 wanted separate accommodation for the seven Chinese inmates to protect the Europeans from the ‘leprous Mongolian’; when doctors related the multiple problems and slow recovery of lobotomised patients with ‘extraordinary detachment’; and, at a more basic level when families no longer made the effort to visit their ill relatives. But perhaps the greatest inhumanity operated in the society outside of the institutions, which did not welcome mentally ill people in its midst, at one time wanted to prevent those regarded as ‘feebleminded’ from reproducing, and at most times failed to provide adequate resources for proper care.

These histories of the provision for the mentally ill remind us that women and men have worked to create therapeutic communities even when their efforts were stymied by insufficient resources. If now we regard the word asylum with disdain and certain therapies as barbaric, it is salutary to remember that at a particular historical moment the asylum offered a refuge and surgical procedures appeared to hold out a potential for cure which might be miraculous. The young scholars who have written these chapters took up the challenge of engaging with the world of unreason to examine its often troubling story. They invite us also to enter this world and to share their insights into how it was fashioned by politicians, doctors, patients and their families, and the wider community.

Barbara Brookes

April 2001

PART ONE

Founding Years in Otago Institutions

1. Dunedin Lunatic Asylum

1863–1876

JEREMY H. BLOOMFIELD

Almost until the end of the eighteenth century no large-scale hospitals or institutions existed to care for the ‘lunatic’ on a humane basis. In Bethlem, founded in England in 1547, patients were frequently chained to the walls of prison-like cells. Asylums were run for the profit of the proprietors.¹ Even in early nineteen century Britain, the general situation was little improved. As John Conolly, later to be well-known for his enlightened approach to mental health, described it:

The lunatic was thought to be beyond recovery and beyond amendment …. If he was quiet, he was left to his fancies …. if troublesome he was chained …. The morning brought him no hope, the day no variety, the evening no amusements, the night no rest. Neither the mind nor the body were regarded …. ²

An awareness was growing, however, that the treatment of the insane could be humanised and brought into line with other branches of medical practice.³ Such ideas had been pioneered at the Paris asylum of Saltpetrière. There, in 1793,

in the course of a few days, Pinel released fifty-three maniacs from their chains …. The result was beyond his hopes. Tranquillity and harmony succeeded to tumult and disorder and the whole discipline was marked with a regularity and kindness which had the most favourable effect … rendering even the most furious, more tractable.⁴

Forbidding bloodletting, ducking and every form of violence previously used, Pinel stressed the maintenance of a constant routine and study of the individual patient’s personality.⁵ Work came to be seen as having a therapeutic effect. Pinel’s colleague, Esquirol, was responsible for using a wide range of therapies, from music to mesmerism in his open-minded quest for curative treatment.⁶ He named this ‘moral treatment’, meaning ‘the application of … intelligence and emotions’ to insanity.⁷

Such real concern for the patient first found expression in Britain in the Retreat at York opened by William Tuke in 1796, where a liberal diet, plenty of fresh air and outdoor work, reading, and warm baths were advocated, with minimal restraint.⁸ But perhaps the