Abstract
At a meeting of the Royal Society of Medicine in November 1958, the psychiatrist Michael Shepherd and a group of colleagues observed that most of the previous work on the epidemiological aspects of mental disorder had been focused on institutionalised patients where the population had been ‘conveniently circumscribed for the purposes of investigation’. Research, therefore, had been concerned predominantly with major psychiatric disorder. In order to obtain further knowledge about mental illness, Shepherd argued that there was a need for systematic study of the minor psychiatric disorders and their prevalence in the community.1 Shepherd, a well-respected Professor of Psychiatry, established the General Practice Research Unit at the Institute of Psychiatry in London during the late 1950s. The aim of this unit was to study, by epidemiological methods, ‘the causes, nature, extent and distribution of extra-mural mental disorder in the setting of general practice, where, under the conditions of the British National Health Service, information is obtainable about the health of the bulk of the population’.2 In stating this aim, Shepherd and his colleagues were articulating a view widely expressed by those working in general practice during the post-war period: that family doctors fulfilled a unique role in medicine and should be more widely involved in epidemiological research.
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Michael Shepherd, Michael Fisher, Lilli Stein and W. I. N. Kessel, ‘Psychiatric morbidity in an urban group practice’, Proceedings of the Royal Society of Medicine (1959), 52, 269–74, on 265.
Greg Wilkinson, ‘The General Practice Research Unit at the Institute of Psychiatry’, Psychological Medicine (1989), 19, 787–90, on 787.
David Hannay, ‘Undergraduate medical education and general practice’, in Irvine Loudon, John Horder and Charles Webster (eds), General Practice under the National Health Service 1948–1997 (Oxford, Oxford University Press, 1998) pp. 165–81, on p. 167.
John Howe, ‘Research in general practice: Perspectives and themes’, in Irvine Loudon, John Horder and Charles Webster (eds), General Practice Under the National Health Service 1948–1997 (Oxford, Oxford University Press, 1998), pp. 146–64 on p. 147.
Elianne Riska, ‘The rise and fall of Type A man’, Social Science and Medicine (2000), 51, 1665–74, on 1665.
Allan V. Horwitz, ‘How an age of anxiety became an age of depression’, The Milbank Quarterly (2010), 88 (1), 112–38, on 120.
Horwitz, ‘How an age of anxiety’, 130. See also David Healy, The Antidepressant Era (Cambridge, MA, Harvard University Press, 1997) and
David Healy, Let Them Eat Prozac: The Unhealthy Relationship between the Pharmaceutical Industry and Depression (New York, New York University Press, 2004).
See also Christopher Callahan and German E. Berrios, Reinventing Depression: A History of the Treatment of Depression in Primary Care 1940–2004 (Oxford, Oxford University Press, 2005). For an account of anxiety in the preceding period,
see Andrea Tone, The Age of Anxiety: A History of America’s Turbulent Affair with Tranquilizers (New York, Basic Books, 2009).
Mark Jackson, The Age of Stress: Science and the Search for Stability (Oxford, Oxford University Press, 2013), p. 141. See also Tone’s Age of Anxiety. Tone describes the new chapter in what W. H. Auden had declared the ‘Age of Anxiety’, in which post-war America became ‘suffused with atomic anxiety’, pp. 93–4. The age of anxiety and the emergence of the concept of ‘stress’ is also discussed at length in Rhodri Hayward, The Transformation of the Psyche in British Primary Care 1880–1970 (London, Bloomsbury, 2014), Chapter 3.
See Jackson, The Age of Stress, p. 160. For Alexander and Dunbar, see H. Weiner, ‘The concept of psychosomatic medicine’, in E. R. Wallace IV and J. Gack (eds), History of Psychiatry and Medical Psychology (New York, Springer, 2008), pp. 485–516.
Eileen Janes Yeo, ‘The social survey in social perspective’, in Martin Bulmer, Kevin Bales and Kathryn Kish Sklar (eds), The Social Survey in Historical Perspective 1880–1940 (Cambridge, Cambridge University Press, 2011), pp. 49–65, on p. 49.
Seebohm Rowntree, Poverty: A Study of Town Life (London, Macmillan and Co, 1908 edition), pp. vii–viii.
W. P. D. Logan and Eileen M. Brooke, The Survey of Sickness 1943–1952: Studies on Medical and Population Subjects No. 12 (London, HMSO, 1957), p. 11.
Michael Shepherd, Psychiatric Illness in General Practice (Oxford, Oxford University Press, 1981 Second Edition), p. 11.
W. P. D. Logan and A. A. Cushion, General Register Office Studies on Medical and Population Subjects, No. 14, Morbidity Statistics from General Practice, Volume 1 (London, HMSO, 1958), p. 34.
E. R. Bransby, ‘The extent of mental illness in England and Wales’, Health Trends (1974), 6, 56–9, on 57.
A. Ryle, ‘The neuroses in a general practice population’, Journal of the College of General Practitioners (1960), 3, 313–28, on 315.
See also R. E. Perth, ‘Psychosomatic problems in general practice’, Journal of the College of General Practitioners, Research Newsletter (1957), 4, 295–331. Perth suggested that 40 per cent of the population were at risk.
The shift from asylum-based care to community treatment has been well documented. See, for example, Andrew Scull Decarceration; Community Treatment and the Deviant –a Radical View (Cambridge, Polity 1994);
Edward Shorter, A History of Psychiatry: From the Era of the Asylum to the Age of Prozac (New York, John Wiley, 1997);
and also covered in Ali Haggett, Desperate Housewives: Neuroses and the Domestic Environment 1945–1970 (London, Pickering and Chatto, 2012).
R. E. Kendell, ‘The classification of depressions: A review of contemporary confusion’, British Journal of Psychiatry (1976), 129, 15–28, on 15.
Brian Cooper, John Fry and Graham Kalton, ‘A longitudinal study of psychiatric morbidity in a general practice population’, British Journal of Preventive and Social Medicine (1969), 23, 210–17, on 212.
Keeve Brodman, Albert J. Erdmann and Harold G. Wolff, Cornell Medical Index: Health Questionnaire (New York, Cornell University Medical College, 1949), p. 2.
For full descriptions of these screening tools, see D. Goldberg, The Detection of Psychiatric Illness by Questionnaire (Oxford, Oxford University Press, 1972).
Ian McDowell and Claire Newell, Measuring Health: a Guide to Rating Scales and Questionnaires (Oxford, Oxford University Press, 1996), p. 178.
See for example Aaron Lask, Asthma: Attitude and Milieu (London, Tavistock, 1966).
C. A. H. Watts, Depressive Disorders in the Community (Bristol, John Wright, 1966), pp. 50–1.
John Fry, ‘The management of psychosomatic disorders in general practice’, The Practitioner (1957), 177, 554–63, on 554.
See James L. Halliday, ‘The rising incidence of psychosomatic illness’, British Medical Journal, 2 July 1938, 11–14; James L. Halliday, ‘Epidemiology and the psychosomatic affections: A study in social medicine’, Lancet, 10 August 1946, 185–9; and J. L. Halliday, Psychosocial Medicine: A Study of the Sick Society (London, William Heinemann, 1948). For a full account of Halliday’s use of national insurance claims as ‘psychological documents’, see Hayward, The Transformation of the Psyche, Chapter 3, ‘Social consciences’.
Rhodri Hayward, ‘Enduring emotions: James L. Halliday and the invention of the psychosocial’, Isis (2009), 100, 827–38, on 835.
See Roy Porter, ‘Diseases of civilization’ in W. F. Bynum and R. Porter (eds), Companion Encyclopedia of the History of Medicine (London, Routledge, 1993), pp. 585–600.
H. Weiner, ‘The concept of psychosomatic medicine’, in E. R. Wallace IV and J. Gach (eds), History of Psychiatry and Medial Pathology (New York, Springer, 2008), pp. 485–516.
See also H. Flanders Dunbar, Synopsis of Psychosomatic Diagnosis and Treatment (St Lois, MO: CV Mosby Co., 1948).
Weiner, ‘The concept of psychosomatic medicine’, p. 504. See also F. Alexander, Psychosomatic Medicine: Its Principles and Applications (New York, W. W. Norton and Co., 1950).
Edgar Jones, ‘“The gut war”: functional somatic disorders in the UK during the Second World War’, History of the Human Sciences (2012), 25 (5), 30–48, on 34.
Edgar Jones and Simon Wessely, ‘Hearts, guts and minds: Somatisation in the military from 1900’, Journal of Psychosomatic Research (2004), 56, 425–29, on 429.
Philip Hopkins, ‘The general practitioner and the psychosomatic approach’, in Desmond O’Neil (ed.), Modern Trends in Psychosomatic Medicine (London, Butterworths, 1955), pp. 4–28, on p. 4.
David Hannay, ‘Undergraduate medical education and general practice’, in Irvine Loudon, John Horder and Charles Webster (eds), General Practice under the National Health Service, 1948–1997 (London, Clarenden Press, 1998), pp. 165–81, on p. 167.
D. W. Hall, ‘Vocational training for general practice’, Health Trends (1973), 5, 80–82, on 80.
Pereira Gray, ‘Postgraduate training’, p. 185. For developments in general practice within the context of the organisation of the NHS, see Geoffrey Rivett, From Cradle to Grave: Fifty Years of the NHS (London, King’s Fund, 1997), pp. 80–92.
The Tavistock Clinic was founded in London under the leadership of Dr Hugh Crichton-Miller (1877–1959), initially to explore the traumatic effects of First World War shellshock victims. Its vision was extended to provide systematic major psychotherapy on the basis of concepts inspired by psychoanalytic theory, for patients suffering from psychoneuroses and allied disorders. See H. Dicks, Fifty Years of the Tavistock Clinic (London, Routledge and Kegan Paul, 1970).
Patrick S. Byrne and Barrie E. L. Long, Doctors Talking to Patients: A Study of the Verbal Behaviour of General Practitioners Consulting in their Surgeries (London, HMSO, 1976), pp. 8, 9.
Stephen Taylor, Good General Practice: A Report of a Survey by Stephen Taylor, Nufffield Provincial Hospitals Trust (London, Oxford University Press, 1954). See for example pp. 417, 430, 431. Lord Stephen Taylor of Harlow, who was a doctor and former Labour Member of Parliament, became influential in the development of general practice and published regularly about social and political issues that affected health.
F. J. A. Huygen, Family Medicine: The Medical Life History of Families (Nijmegen, The Netherlands, Dekker and Ven de Vegt, 1978), p.11. For a British example of a similar theoretical approach,
see Robert Kellner, Family Ill-Health: An Investigation in General Practice (London, Tavistock Publications, 1963).
Marinker, ‘Changing concepts of illness’, p. 80. A more radical critique of the family was of course also put forward by R. D. Laing and A. Esterson in Sanity, Madness and the Family (London, Tavistock, 1964) in which the authors argued that ‘the family is the unit of illness: not the individual, but the family’, p. 23.
Richard Moore, Leeches to Lasers: Sketches of a Medical Family (Killala, Ireland, Morrigan, 2002), pp. 218–9.
David Pilgrim, Key Concepts in Mental Health (London, Sage, second edition, 2009), p. 176.
For figures and analysis of suicide in England and Wales, see Kyla Thomas and David Gunnell, ‘Suicide in England and Wales 1861–2007: A timetrends analysis’, International Journal of Epidemiology (2010), 39, 1464–75.
F. A. Whitlock, ‘Suicide in England and Wales 1959–63, Part 2: London’, Psychological Medicine (1973), 3, 411–20, on 411.
Norman Kreitman, Vera Carstairs and John Duffy, ‘Association of age and social class with suicide among men in Great Britain’, Journal of Epidemiology and Community Health (1991), 45, 195–202, on 195.
F. A. Whitlock, ‘Suicide in England and Wales 1959–63, Part 1: the county boroughs’, Psychological Medicine (1973), 3, 350–65, on 361, 362.
See for example, Phyillis Chesler, Women and Madness (London, Allen Lane, 1974).
George W. Brown and Tirril Harris, Social Origins of Depression: A Study of Psychiatric Disorder in Women (London, Tavistock, paperback edition, 1979), p. 279.
James Y. Nazroo, Angela C. Edwards and George W. Brown, ‘Gender differences in the prevalence of depression: Artefact, alternative disorders, biology or roles?’, Sociology of Health and Illness (1998), 20 (3), 312–30, on 324.
See Christopher Tennant and Paul Bebbington, ‘The social causation of depression: A critique of the work of Brown and colleagues’, Psychological Medicine (1978), 8, 565–75.
See Walter Gove, ‘The relationship between sex roles, marital status and mental illness’, Social Forces (1972), 51, 34–44. For debate about Gove’s work, see Haggett, Desperate Housewives, pp. 107–8.
Bruce P. Dohrenwend and Barbara Snell Dohrenwend, ‘Sex differences and psychiatric disorders’, American Journal of Sociology, (1976), 81, 1447–54, on 1452.
Monica E. Brisco, ‘Why do people go to the doctor? Sex differences in the correlates of GP consultation’, Social Science and Medicine (1987), 25, 5, 507–13, on 511.
Derek L. Phillips and Bernard E. Segal, ‘Sexual status and psychiatric symptoms’, American Sociological Review (1969), 34 (1), 58–72, on 60.
Lynda W. Warren, ‘Male intolerance of depression: A review with implications for psychotherapy’, Clinical Psychology Review (1983), 3, 147–56, on 149.
Barbara Ehrenreich, The Hearts of Men: American Dreams and the Flight from Commitment (New York, Anchor Press/Doubleday, 1984), pp. 82–4.
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Haggett, A. (2015). Psychological Illness and General Practice. In: A History of Male Psychological Disorders in Britain, 1945–1980. Mental Health in Historical Perspective. Palgrave Macmillan, London. https://doi.org/10.1057/9781137448880_2
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