Conference Report: Health and Welfare in Spaces of Confinement
30 March 2007
Although the title signalled a day focussed on institutional health services, the speakers who gathered for this conference pursued the theme of confinement across a range of physical, psychological and social settings. In the first plenary Paul Gough gave a luminous account of the artist Stanley Spencer’s spell as a medical orderly at Beaufort Military hospital in Bristol during the 1914-18 war. Deftly illustrating the talk with images of the hospital and of Spencer’s murals at the Burghclere chapel, Gough analysed the impact of the hospital’s ‘cells of intimacy’ on the artist’s vision of soldiering, recovery and commemoration. In a pleasing postmodern twist, visiting delegates discovered that the hospital (once the city’s lunatic asylum) was now part of the University itself, and indeed the very building in which we had convened.
The first parallel session discussed sexuality and sexual health. Kath Holden offered a powerful reading of the normative strictures imposed on single women in interwar Britain, as demonstrated in sexual advice literature. David Evans then explored contact tracing in VD clinics, arguing that the confining space of the clinic pressured patients into providing details of sexual partners. Institutional histories of a different sort figured in the second parallel session. Matthew Godsell and Peter Carpenter gave an engrossing account of a short-lived 1960’s experiment in a Bristol hospital for patients with learning disabilities, where a liberal, patient-centred regime antagonised conservative staff and finally collapsed in the glare of the media spotlight. Stephanie Kirby then painted a vivid picture of nursing in the TB sanatorium. Drawing on her now substantial collection of oral histories, Kirby explicated the range of skills, both clinical and emotional, which this challenging environment required of its staff.
In the second plenary Pamela Dale traced the shifting boundary of institutional and community care for vulnerable groups. Illustrating her argument with reference to her work on Devon, Dale showed how the disciplinary techniques of the asylum were increasingly extended beyond its walls by new forms of domiciliary visiting. Yet despite the intention to socialise deviant families, contact with officials also prompted recipients to reframe their expectations of institutional support.
These reflections provided an appropriate introduction to the two afternoon sessions on care of children and the elderly. A highlight of the former was Harry Ferguson’s moving study of the NSPCC’s turn of the century Children’s Shelters. These were the first spaces that acknowledged the abused child, but Ferguson also punctured the ‘myth of rescue’, showing that residents were typically returned eventually to their parents. Meanwhile a couplet of papers by Moira Martin and Robin Means charted the course of medical and residential care for the elderly through the twentieth century, with Martin reaffirming her argument that the Poor Law legacy of therapeutic nihilism needlessly manufactured a class of bedridden, chronic patients. Julia Johnson followed this with an absorbing report of a project that revisits the old peoples’ homes originally analysed by Peter Townsend in his great classic The Last Refuge. The ex-workhouses which scandalised readers in the 1960s may have gone, but Johnson’s team have traced several surviving homes and documented their changes. As might be expected, conditions today are a good deal more humane and comfortable, yet paradoxically the volume of petty regulations which constrain residents has increased. It was a suitably contradictory point on which to conclude a day which had juxtaposed the benign and the repressive aspects of medical and social care.
Martin Gorsky,
London School of Hygiene and Tropical Medicine