Presumed Curable: An Illustrated Casebook of Victorian Psychiatric Patients in Bethlem Hospital

Preface; The study of the history of medicine, and especially that of psychiatry, often induces in the modern reader an understandable sense of relief that he or she is living in today's world, and not at any point in the past. Yet the stories of the patients in this book, representatives of many hundreds admitted to Bethlem Hospital in the late Victorian period, will resonate with all who take an interest in mental health care today. In these early years of our own twenty-first century, the fear and stigma associated with major mental illness remain strong. Psychiatrists and professionals in allied disciplines involved in the care and treatment of people with mental health problems still face disorders of uncertain aetiology that devastate the lives of sufferers and their families and for which there are no 'cures'. The advent of effective treatments for mood disorders and the symptoms of psychosis, some fifty years after the events detailed in this book, did of course result in tremendous improvements in prognosis and the alleviation of suffering. The nineteenth-century casebooks of Bethlem Hospital give relatively little information about the physical and chemical treatments applied to individual patients. Of course, the fact that Bethlem's clinical note-takers did not usually consider drug treatments worthy of mention does not mean that these were never employed. It may, however, suggest that the hospital principally relied upon careful maintenance of a therapeutic environment, as glimpsed from time to time in the records, to assist in patients' recovery. It is instructive, and sometimes movingly impressive, to consider what the environment of an institution like Victorian Bethlem could achieve. While writing this book, we have often wondered how different the lives of its patients might have been, had modern drug treatments been available at the time. Cases that would most clearly attract a contemporary diagnosis of schizophrenia, or in which a strong psychotic element accompanied affective disorder - then among the most intractable - would be obvious candidates for recovery today. Twenty-first century medicine might have spared many of the people featured in this book a lifetime of institutionalization. But, just as we should not be too quick to dismiss a treatment regimen that resulted in a claimed recovery rate of up to 50 percent, we should also not complacently assume that we have all the answers today. Development of more effective and acceptable drug treatments for psychosis is an important milestone on a very long and difficult road. Such advances will need to be accompanied by the kind of wholehearted delivery of care aspired to in Bethlem over a century ago if society is to gain the true benefit of everything that has changed for the better in psychiatry in the intervening years.