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Summary: Many people like to perceive themselves as better than previous generations: more knowledgeable, moral, tolerant and humane. Values associated with these aspects of ourselves may affect how we understand our professional forebears. In the early 20th century, some psychiatrists adopted new biomedical theories, including focal sepsis and eugenics, which resulted in inestimable harm. Detrimental clinical practices arose and were perpetuated in the context of societal values, medical ethics and other forces within and outside the medical profession. Historical understanding of the processes by which these things took place may help inform debate concerning current and future challenges of providing psychiatric care. The methods by which psychiatrists consider their predecessors may also have a bearing on how psychiatrists of the future will perceive us, the psychiatrists of the 2020s. [ABSTRACT FROM AUTHOR]

Background: Trauma is prevalent amongst early psychosis patients and associated with adverse outcomes. Past trials of trauma-focused therapy have focused on chronic patients with psychosis/schizophrenia and comorbid Post-Traumatic Stress Disorder (PTSD). We aimed to determine the feasibility of a large-scale randomized controlled trial (RCT) of an Eye Movement Desensitization and Reprocessing for psychosis (EMDRp) intervention for early psychosis service users. Methods: A single-blind RCT comparing 16 sessions of EMDRp + TAU v. TAU only was conducted. Participants completed baseline, 6-month and 12-month post-randomization assessments. EMDRp and trial assessments were delivered both in-person and remotely due to COVID-19 restrictions. Feasibility outcomes were recruitment and retention, therapy attendance/engagement, adherence to EMDRp treatment protocol, and the 'promise of efficacy' of EMDRp on relevant clinical outcomes. Results: Sixty participants (100% of the recruitment target) received TAU or EMDR + TAU. 83% completed at least one follow-up assessment, with 74% at 6-month and 70% at 12-month. 74% of EMDRp + TAU participants received at least eight therapy sessions and 97% rated therapy sessions demonstrated good treatment fidelity. At 6-month, there were signals of promise of efficacy of EMDRp + TAU v. TAU for total psychotic symptoms (PANSS), subjective recovery from psychosis, PTSD symptoms, depression, anxiety, and general health status. Signals of efficacy at 12-month were less pronounced but remained robust for PTSD symptoms and general health status. Conclusions: The trial feasibility criteria were fully met, and EMDRp was associated with promising signals of efficacy on a range of valuable clinical outcomes. A larger-scale, multi-center trial of EMDRp is feasible and warranted. [ABSTRACT FROM AUTHOR]

SUMMARY: In A Plea for the Insane (1918), Lionel Weatherly outlined the inadequacies of the Lunacy Act 1890 and of asylum care in England and Wales, and proposed solutions and ways to bring about improvements. It took courage to persist, but Weatherly was undeterred by controversy or criticism. This article reflects on his book and its context and timing at the end of the First World War, and considers whether we may be inspired to confront current healthcare crises with the same sort of passion and fervour as he did. [ABSTRACT FROM AUTHOR]

Amid extensive press coverage, George Stephen Penny (1885–1964) was tried for murder in 1923. He was found 'guilty but insane' due to 'confusional insanity' associated with malaria which he suffered during World War I. Penny was admitted to Broadmoor Criminal Lunatic Asylum at a time of great public concern about inadequate and cruel care in mental institutions, but he was treated with humanity and respect. Penny's story also reveals much about challenges of psychiatric diagnosis and the relationships between crime, insanity, the public, lawyers and the medical profession. Following discharge from Broadmoor, Penny built himself a life in the community. His pseudonymous memoir, with masterly concealment of his identity and crime, tells his story up to 1925. [ABSTRACT FROM AUTHOR]

Doctor Montagu Lomax was a retired General Practioner, whose service in English lunatic asylums during the First World War inspired him to write The experiences of an asylum doctor: with suggestions for asylum and lunacy law reform. Published in 1921, the book acted as a catalyst for lunacy reform and stimulated improvements in the mental health services in the United Kingdom. Lomax spent the remainder of his retirement campaigning for lunacy reform. He suffered financial and personal hardship following the publication of the book and was castigated by his own profession. On the centenary of the publication of Experiences, this article explores the background and motivation of a remarkable man. [ABSTRACT FROM AUTHOR]

In the 1920s, patients and former patients produced oral and written accounts of their mental hospital experiences. Many aimed to inform the public about the institutions and to improve standards of care, but their views were usually ignored. The assumption that mental disorders affected all aspects of a person's judgement, plus defensive and disparaging attitudes of hospital authorities and formal committees of inquiry, contributed to this. Various other public agendas, financial crises and rising unemployment detracted from the needs of mentally unwell people. Small improvements in care materialized, but lay, professional and institutional cultures generally preserved the status quo. Regarding learning from patients' feedback, some hurdles encountered in the 1920s resonate with challenges in today's National Health Service. [ABSTRACT FROM AUTHOR]

The Royal College of Psychiatrists' antiquarian book collection originated from the library of psychiatrist Daniel Hack Tuke (1827-1895). A proposal to name the collection after him led us to investigate aspects of his life and work, particularly related to his attitudes concerning race, gender and homosexuality. We juxtaposed his ideas with those of some of his contemporaries. We cannot separate psychiatrists, past or present, from the societal and scientific context that shapes their professional understanding and standards. However, changes in language, knowledge, values and other sociocultural factors over time can affect how we perceive our forebears and how future generations of psychiatrists may perceive us. [ABSTRACT FROM AUTHOR]

Summary: This brief commentary reflects on navigating two dangers of historical research into psychiatry: hagiographic representations of psychiatrists; and accusations of their self-interest and oppression of vulnerable people. [ABSTRACT FROM AUTHOR]

Introduction Much research into psychiatric disorder in Jamaica has investigated psychotic illness but studies of neurotic disorders are lacking. This study investigated psychiatric disorder in a group of mainly urban, lower social class, young adults who had been regular clinic attenders as a physically healthy control group in a cohort study of sickle cell disease. Method The study was cross-sectional in design. Subjects, 44 male and 45 female, were aged 18 to 20 years at the time of the study. The Psychiatric Assessment Schedule was used to determine psychiatric disorder at Index of Definition level 5. Results All subjects approached participated. Rates of psychiatric disorder were 6 (14%) in the male group and 16 (36%) in the female group. There were no psychotic disorders. In the group as a whole, psychiatric disorder was associated with female gender, unemployment, difficulties with social adjustment and number of episodes of physical illness in the 6 months prior to interview. Variables associated with psychiatric distress amongst males included not having a steady relationship, unemployment, criminal activity and difficulties with social adjustment. Variables associated with psychiatric distress amongst females included lack of domestic amenities, not having a mother at home, lack of education, unemployment and social adjustment difficulties. Conclusion Rates of psychiatric disorder were higher than expected, especially for women. Larger studies are indicated to investigate the prevalence of neurotic disorders amongst young people in Jamaica, compared to similar groups in other countries.

Background: Alcohol misuse is common in bipolar disorder and is associated with worse outcomes. A recent study evaluated integrated motivational interviewing and cognitive behavioural therapy for bipolar disorder and alcohol misuse with promising results in terms of the feasibility of delivering the therapy and the acceptability to participants. Aims: Here we present the experiences of the therapists and supervisors from the trial to identify the key challenges in working with this client group and how these might be overcome. Method: Four therapists and two supervisors participated in a focus group. Topic guides for the group were informed by a summary of challenges and obstacles that each therapist had completed at the end of therapy for each individual client. The audio recording of the focus group was transcribed and data were analysed using thematic analysis. Results: We identified five themes: addressing alcohol use versus other problems; impact of bipolar disorder on therapy; importance of avoidance and overcoming it; fine balance in relation to shame and normalising use; and 'talking the talk' versus 'walking the walk'. Conclusions: Findings suggest that clients may be willing to explore motivations for using alcohol even if they are not ready to change their drinking, and they may want help with a range of mental health problems. Emotional and behavioural avoidance may be a key factor in maintaining alcohol use in this client group and therapists should be aware of a possible discrepancy between clients' intentions to reduce misuse and their actual behaviour. [ABSTRACT FROM AUTHOR]

It was the last 6 months of my general practice training, but it changed the course of my life. They shed light on urban and rural life of different social classes, people's expectations for a better world, and how the public perceived the medical profession, asylums and mental disorder. Sans Everything: A Case to Answer by Barbara Robb This book was written by a heroine of mine, Barbara Robb, whose story I learned many years after she died. 16 Hilton C. Improving Psychiatric Care for Older People: Barbara Robb's Campaign 1965-1975. [Extracted from the article]

The government acknowledged scandalously poor care of long‐stay patients in National Health Service (NHS) hospitals in 1969. This followed the Ely Hospital inquiry, which emerged in the aftermath of revelations of abuse at seven hospitals described in Barbara Robb's book Sans Everything: A Case to Answer (1967). Allegations in Sans Everything and at Ely were similar. However, the inquiry committees which investigated, 'disproved' those in Sans Everything and upheld those at Ely. The Ely inquiry became pivotal to NHS policy reform for long‐stay mental illness and mental handicap hospitals, and for giving patients and their families a greater voice if they had concerns about inadequacies. This paper explains the relationship between Sans Everything and 'Ely' and analyses the impact of Robb's work—her high‐profile press campaign, networking, and determination to achieve improvement—which triggered revelations at Ely and elsewhere, and helped shape the course and constructive outcome of the Ely inquiry. [ABSTRACT FROM AUTHOR]

Historical evidence can be useful to inform debate about current dilemmas in health service policy. However, concepts of historical analysis may be problematic for doctors, for whom a model of 'history' is often based on clinical history-taking: a clinical history aims to explain the present, whereas a historical analysis aims to elucidate the past. This article discusses and illustrates these concepts, and highlights potential pitfalls of poor historical methodology. It also provides pointers about researching the history of psychiatry in the UK and how to contribute historical evidence to health service policy debates today. Declaration of interest: None. [ABSTRACT FROM AUTHOR]

Background: Comorbid anxiety is common in bipolar disorder (BD) and associated with worse clinical outcomes including increased suicidality. Despite effective psychological treatments for anxiety, research into treating anxiety in BD is underdeveloped. This paper describes a novel psychological intervention to address anxiety in context of bipolar disorder (AIBD).Methods: Adults with BD and clinically significant anxiety symptoms were randomized to AIBD plus treatment as usual (TAU) or TAU alone. AIBD offered 10 sessions of psychological therapy using a formulation-based approach. Feasibility and acceptability were evaluated through recruitment, retention, therapy attendance, alliance, fidelity, and qualitative feedback. Clinical outcomes were assessed at baseline, 16, 48, and 80 weeks: interim assessments of relapse at 32 and 64 weeks.Results: Seventy-two participants were recruited with 88% retention to 16 weeks and 74% to 80 weeks (similar between arms). Therapy participants attended x ¯ 7.7 (SD 2.8) sessions. Therapeutic alliance and therapy fidelity were acceptable. Qualitative interviews indicated that participants valued integrated support for anxiety with BD and coping strategies. Some suggested a longer intervention period. Clinical outcomes were not significantly different between arms up to 80 weeks follow-up.Conclusions: AIBD is feasible and acceptable but lack of impact on clinical outcomes indicates that adaptations are required. These are discussed in relation to qualitative feedback and recent literature published since the trial completed. [ABSTRACT FROM AUTHOR]

Russell Barton was one of the 96 London medical student volunteers who went to Belsen concentration camp in Germany, 2 weeks after its liberation in 1945, to help survivors. Barton later became a psychiatrist. In 1968, he wrote about the medical students’ experiences and his understanding of Belsen based on his time there, in an invited article in Purnell’s History of the Second World War. He perceived parallels between the regimes controlling Belsen and National Health Service psychiatric hospitals, noted similar harmful psychological consequences for those held within and commented that the public appeared to turn a blind eye to both. His article outraged readers. While some of his interpretations of Belsen were incorrect, his experience there connected intimately with his passion and persistence to provide humane and dignified treatment and care for patients and to improve hospital facilities. Later, Holocaust deniers cited his article. This article seeks to provide an informed review and analysis of the controversy. Abbreviations National Health Service (NHS)AEGIS (Aid for the Elderly in Government Institutions)United States of America (USA) [ABSTRACT FROM AUTHOR]

Clinical knowledge and experience, and demographic changes, indicated the need to ensure provision of adequate ‘psychogeriatric’ services to provide treatment for mentally ill older people (generally over 65 years). Various factors influenced the provision of these services, including politics, economics and stereotypical negative attitudes towards older people. Clinicians successfully led service developments, often unsupported by central government and local health authorities, despite benefits being noted in the localities where services were established. In 1989, services were available to most of the population of England and the Department of Health officially recognised psychogeriatrics as a medical specialty. [ABSTRACT FROM AUTHOR]

Demographic trends, and older people over 65 years disproportionately occupying beds in psychiatric hospitals, pointed to their increasing clinical needs. Clinical work with older people often required different skills from work with younger people. 'General psychiatrists', nominally working with adults of all ages, usually had little interest in working with older people. By 1977, it was clear to clinical leaders in the field of psychogeriatrics that official recognition of their specialty by the government was essential to ensure service development. Official recognition would provide the means to collect data to identify gaps in services, to obtain information on the implementation of government guidance and to advocate for resources, including ensuring high quality training posts for doctors wanting to specialise in the field. Doctors have traditionally taken the lead in creating new medical specialties, and psychogeriatrics was no exception. However, support fluctuated towards the specialty from the leadership of the Royal College of Psychiatrists. Health service leaders who did not undertake work with older people, were incredulous that others wished to do so. Negotiations between the Royal College of Psychiatrists and the Department of Health and Social Security about recognising psychogeriatrics were convoluted and prolonged. Recognition was achieved in 1989, following intervention by the Royal College of Physicians of London. [ABSTRACT FROM AUTHOR]

In the 1950s, the population aged over 65 years continued to increase, and older people occupied mental hospital beds disproportionately. A few psychiatrists and geriatricians demonstrated what could be done to improve the wellbeing of mentally unwell older people, who were usually labelled as having irreversible ‘senile dementia’. Martin Roth demonstrated that ‘senile dementia’ comprised five different disorders, some of which were reversible. These findings challenged established teaching and were doubted by colleagues. Despite diagnostic improvements and therapeutic successes, clinical practice changed little. Official reports highlighted the needs, but government commitment to increase and improve services did not materialize. [ABSTRACT FROM AUTHOR]

Attitudes towards autonomy and personal freedom changed in the 1960s in England, but hardly touched the needs of dependent older people. In particular, deeply embedded public and professional attitudes and priorities linked to little change in ‘psychogeriatric’ treatment for those who were mentally unwell. Total beds in psychiatric hospitals decreased, but those remaining were increasingly and disproportionately occupied by older people receiving custodial care, often long term, despite evidence that appropriate treatment could prevent admission and facilitate discharge. Widely publicised scandals of inhumane care of older people in psychiatric hospitals prompted a more responsive government approach to improving services. [ABSTRACT FROM PUBLISHER]

Until around 1979, ‘confused’ or mentally unwell people over 65 years of age tended to be labelled as having ‘senile dementia’. Senile dementia was usually regarded as a single, inevitably hopeless condition, despite gradually accumulating clinical and pathological evidence to the contrary. Specific psychiatric services for mental illness in older people began to emerge in the 1950s, but by 1969 there were fewer than 10 dedicated services nationally. During the 1970s, ‘old age psychiatrists’ established local services and campaigned nationally for them. By 1979, about 100 old age psychiatrists were leading multi-disciplinary teams in half the health districts in England. This paper explores the tortuous development of these new services, focusing on provision for people with dementia. [ABSTRACT FROM PUBLISHER]

The Equality Act 2010 made it unlawful to discriminate in the provision of services on the grounds of age. This legislation is open to interpretation, but it is affecting the way older people's services are defined and provided. Historical evidence indicates that, since the 1940s, apart from psychiatrists working in dedicated old age services, most were unenthusiastic about working with mentally unwell older people and unsupportive of those who chose to do so. A historical analysis might shed light on current dilemmas about 'all age' or 'old age' services and inform decision-making on future mental health services. [ABSTRACT FROM AUTHOR]

J.C. 1844".[2] The Plaque helps counter-balance stereotypical myths that only bad occurred in our past, but also challenges us on what our descendants will question about our contemporary mental health practices. Here, the building was the old Hanwell Asylum, currently St Bernard's Hospital in West London NHS Trust, and the extraordinary was the work Conolly did after appointment as its resident physician in 1839. On 27 May 2022, English Heritage unveiled a "Blue Plaque" celebrating the life and work of Dr John Conolly (1794-1866). [Extracted from the article]

Objective: This study aims to investigate the history of joint geriatric-psychiatric units. For policy making and planning of high-quality clinical service models, clinical and social contexts need to be considered. Longitudinal, contextual information can be provided by historical analyses, including the successes and failures of earlier, similar services. Historical analyses complement clinical, randomised controlled studies and may contribute to ensuring optimum outcomes for future schemes. Methods: Standard historical methodology was used, including searching published sources and institutional and personal archives and conducting a 'witness seminar' and individual oral history interviews. Results: Proposals to create joint units have existed since 1947. Most clinically successful units were led by enthusiastic, dedicated clinicians. Joint units had the potential to provide appropriate assessment and treatment for patients with multiple disorders and education for staff and students. Joint units never became widespread. Conclusions: Reasons for the limited success of joint geriatric-psychiatric units might have included personalities of individuals, administrative boundaries separating geriatrics and medicine, unequal numbers of geriatricians and old-age psychiatrists, varying professional ideologies about the meaning of 'integrated' services, lack of reciprocity for each other's inpatients and lack of government support. Identified stumbling blocks need to be considered when planning joint clinical schemes. If current research indicates benefits of integrated wards for patients and their families, there needs to be ways to ensure that personal factors and fashions of management or government re-prioritisation will not lead to their premature termination. [ABSTRACT FROM AUTHOR]