Jonathan Toms's monograph offers an examination of the ‘mental hygiene’ movement in Britain, which combined social work and psychiatry with public health during the twentieth century to promote greater mental – and societal – well-being. Mental hygiene and psychiatric social work have been little studied within modern medical and social history, and this monograph is a welcome development. Beyond analysing the theories of the mental hygiene movement and some of its interactions with educational and medical experimentation and debate, however, it also offers a lively new approach to the stories from psychiatry's past and the ways that we tell them.
At the heart of the book is the importance of the ‘family’ as an organizing principle for mental hygiene, and the various ideas of citizenship, authority, dependence and individual growth that the family could contain. Through this, Toms connects the modern mental hygiene movement of the mid-twentieth century to the moral treatments of the York Retreat in the late eighteenth century, and the efforts of the Charity Organisation Society in the late nineteenth and early twentieth centuries. Moral treatment, he argues, lived on within mental hygiene, albeit by making use of changing, even inverted, models of the family. But this presents an alternative to traditional Foucauldian interpretations of psychiatric knowledge, Toms suggests. He argues for the importance of the ideals of self-government and independence to mental hygiene, as dictated and produced within successful families and their therapeutic substitutes. Negotiating and developing relationships, from those between parent and child to those created and encouraged within therapeutic communities, were key to self-government.
This book is particularly valuable for its inclusion of the history of ‘mental deficiency’ as a central feature of its subject: within mental hygiene and its models of the family, mental deficiency represented a permanent and insurmountable childhood. It also strengthens connections and overlaps between psychiatry and the discipline of psychology, with associated interests in intelligence, personality, educational development and emotional response. Critiques of mental hygiene from the 1960s onwards, including those from the charity MIND, are also given detailed consideration, and the mental hygiene enterprise as a whole is offered a nuanced history in which its authoritarian and liberating impulses can coexist.
Our guide to this new territory is W. David Wills, a psychiatric social worker and educationalist of the mid-twentieth century. Wills received his training in the USA in the 1920s before returning to England to specialize in child guidance, running the experimental Hawkspur camp and then Reynolds House for delinquent young men. Extracts from Wills's diaries and letters are interspersed throughout the book, offering imaginative and often amusing expositions of the theories and events under discussion. His correspondence with colleagues, former residents of Hawkspur, and specialist journals and newspapers offers tantalizing glimpses into the personal relationships that flowed into and out of the mental hygiene movement: the disagreements, the successes and the disappointments. Wills's near-constant background presence also aids the emphasis on continuities and connections, particularly as the seemingly disruptive campaigns of the second half of the century against much psychiatric practice returned questions of morality and medicine forcefully to the foreground.
Contributions from Wills's archives are not always a smooth fit, however, and are at times at risk of disrupting the flow of the whole. These, along with the many short sections into which the chapters are divided, make it difficult at times to follow the broader points being made. The language and style of writing can also feel jarring in places, as Toms boldly challenges ‘the habitual disavowal, in contemporary Foucauldian academic work, of any tone that can be labelled sentimental or frivolous' (ix). Nevertheless, the unusual form and content provide a welcome reminder of the often fragmentary, exploratory and uncertain nature of historical knowledge, particularly in the field of mental health and its sciences. Even Wills's unexpected reflections upon an ingrown toenail and his own possible narcissism give a flavour of the individual personalities and preoccupations that lie behind socio-medical innovation.
Overall, this is a useful contribution to our growing knowledge of the disciplines of psychology, psychiatry, and social work in the twentieth century. It introduces new archival material and little-known individuals, and makes an intriguing case for new ways of understanding concepts of mental health in the recent past. Although its unconventional style may prove divisive, it is a welcome addition to the field.
