Work, Psychiatry and Society c. 1750–2015 ed. by Waltraud Ernst (review)

The role of work in mental illness has a long and varied career. The inability to work is a major disabling characteristic of serious mental disorders, and the capacity to work a sign of mental health. Not surprisingly, therefore, many forms of treatment involved work-related activity as a therapeutic intervention. However, in those situations when large institutions were the sites for treating mental disorders, work as a treatment slipped easily from treatment and the prevention of idleness into a form of servitude that eased the financial burden of institutional care under the guise of therapeutic intervention. The work on asylum farms and light industries making uniforms, shoes, and other goods for the institution provided a much-needed income for institutions that were dependent upon public funding that was always grudging and often inadequate. Modern treatment of mental illness, responding to civil-rights concerns and the advent of better treatments, has moved the locus of treatment from the institution to the community. As a result, work has moved more surely into a form of treatment. A special profession, occupational therapy, with its own professional knowledge and standards, now has jurisdiction over therapeutic work activities in most organized treatment settings.

Work, Psychiatry and Society c. 1750–2015 offers both historical depth and international breadth in covering its topic. The earliest appearance of work as therapy took place in the context of so-called Moral Treatment, which was a product of enlightened practitioners in Britain and France in the late eighteenth and early nineteenth centuries. In this case, the term moral referred to behavior, as in “moral philosophy.” The Tuke family, Quakers at the York Retreat in England, and Philippe Pinel at the Bicêtre and the Salpêtrière hospitals in Paris sought to replace chains and beatings with humane interventions—better diet, cleanly surroundings, and persuasion to counter non-constructive behavior. Included were activities to inculcate good habits and keep patients busy, but work itself as a treatment mode had a rockier course, being well-established only in the early to mid-nineteenth century.

Although the focus of interest regarding work and moral treatment has typically been on Britain and France, this multi-authored work ranges far more widely, covering developments in work as therapy in America, Italy, Russia, Germany, Austria, Ireland, Canada, south Asia, the British West Indies, and Japan. In many cases, the role of work as therapy reflected the colonial past of particular countries. The West Indies and India, for example, modeled their mental health systems on Great Britain, with the added element of rigid class distinctions between colonizers and the colonized. Japan, though starting with reflections of its own historically variable culture, was deeply influenced by the events after World War II, when during the occupation, its institutions were influenced by the United States, and its need for postwar recovery.

Work as therapy has not typically been a subject of academic psychiatric study. As a result, this volume occupies a singular place in the psychiatric literature. Its deep research and convincing argument offer new insights about the history and nature of a neglected feature of modern psychiatric treatment.