Care and Treatment of the Mentally Ill in North Wales, 1800-2000 (review)

This book is a welcome addition to the ever-expanding field of mental-health studies that has recently drawn renewed strength from historians focusing on hitherto understudied areas (C. Coleborne and D. MacKinnon on Australia, C. Philo and R. Houston on Scotland, W. Ernst on India, S. Swartz and H. Deacon on South Africa, etc.). Although Pamela Michael's study is primarily a history of the North Wales psychiatric institution in Denbigh, she successfully places a close reading of the institution's development within the context of a wider history of Wales. In chapters on the Denbigh Hospital during World Wars I and II, and in chapter 13 on the asylum post-1960, she convincingly demonstrates the effects of events in the extrainstitutional contexts of Wales and Europe on the social organization and administrative outlook of the Denbigh Hospital. Michael also attempts to write a rounded history of that institution by integrating the life histories and perspectives of patients and staff with those of medical officials, administrators, and government officials.

Michael's book is as chronologically ambitious as it is historiographically and analytically understated. At several points she opens up important space in which to engage with the current debates in the field—but instead of filling that space with her own historical analysis, she chooses rather to delve back into more institutional detail. This reluctance partly reflects Michael's intention to "document and describe changes and events" so as to allow readers to form their own perspectives (p. 2)—yet, despite this implied objectivity, she presents a relatively clear "neo-Whig" approach in the introduction and the conclusion of her book that approximates that of Gerald Grob's work on madness in the United States. For Michael, the birth and articulation of the asylum concept was, on the whole, a major humanitarian response to madness—one that can be critically assessed in some of its details, but that nevertheless "embodied genuine attempts to address the needs of patients" (p. 215). Her decision to "weigh-in" in this fashion on the older humanitarian-versus-social-control debates of the 1970s and early 1980s limits the sophistication of her analysis of the fascinating historical details that she chronicles.

For example, Michael's perceptive consideration of how Wales differed from Ireland and England (in the gendered nature of industrial development, and in the relative absence of a private mad-trade, respectively) could have led to an equally cogent analysis of how the persistence of traditional family forms of care intersected with the rise of the asylum. In other words, her findings have great potential for contributing to the current discussion about the "decentering" of the Victorian asylum. But once Michael starts the story of the Denbigh Asylum, she stops considering what is in her own view (in chapters 1 and 2) a major and enduring alternative to institutional care.

To take another example, it is clear from Michael's chapter "1874–1914" that infrastructure inefficiencies in the asylum—tremendous overcrowding, the heavy use of "soft" forms of mechanical restraint and of seclusion, and the resort to workhouses—did not make Denbigh an especially happy place for many patients (as well as staff). Although it is likely that most of the asylum's workers were doing their best under very trying circumstances to "relieve the sufferings of its patients" (p. 2), this does not preclude the historian from a more critical assessment of the social, political, and economic relations that created this unfortunate state of affairs.

This book is well researched and pioneering, and it opens up many avenues for reconsidering the history of mental health in Wales and elsewhere. It ought to stimulate Michael, and other researchers, to delve more deeply into the important issues that the book surveys.