The number of patients resident in many hospitals had begun to decline several years before antipsychotics arrived on the scene. The population of asylums did shrink significantly throughout the 1960s and 1970s, though mental hospitals did not begin to vanish from the scene until the 1980s under Margaret Thatcher. Deinstitutionalisation was no accident. It was a consciously chosen neoliberal policy, pursued relentlessly over many decades. Welfare ‘reform’, in Britain as in the United States, has become a term of art disguising repeated assaults on the social safety net and the demonisation of those dependent upon it. ‘Community care’ in the era of neoliberal politics has turned out to be an Orwellian euphemism masking a nightmare existence for all too many of those afflicted with serious psychoses and for their families.

The themes from this book require extending into other research areas. First, the history of political thought and ideas: psychology itself is an idea, since modern political thought emanated not only from thinking about ‘man’ but also from what the thinker believed himself to be, qua man: that is, his interior religious and/or psychological status. Second is the history of education, where the importance of the German-language tradition (Schleiermacher, Herbart, Froebel) might lead to studying the idea of universal salvation as a founding discourse of modern schooling, and the ‘developer’ as the individual embodiment of social and national progress. Third comes disability history, concerning institutions and asylums, which has encouraged a single reified notion of developmental disability; a critical conceptual history should make it possible to stand outside this. The fourth area is literature. The novel is the classic literary ‘form’ of a linear developmental narrative, but its historical examples reveal it to be a constant subversion rather than reflection of the developmental idea, even in the typical novel of personal formation (Bildungsroman).

Chapter 9 traces the relatively light pre-World War II engagement with mental health issues, with the partial exception of sociology. The postwar expansion of federal research funding, paired with explosive treatment demand for returning veterans, transformed psychology, swelling its ranks with clinicians. Federal largesse underwrote a surprisingly diverse range of projects, with psychologists, psychiatrists, and, to a lesser degree, sociologists as the main beneficiaries. As psychology swelled under its postwar “scientist-practitioner” settlement, sociology remained comparatively small and, by the 1960s, increasingly critical of psychiatry and the country's mental health institutions. Meanwhile, psychiatry had rapidly shed its psychoanalytic character by the 1980s, a response to dried-up funding and the psychopharmacological revolution. The chapter addresses the relative neglect of mental health by economists, up through the 1990s-even as the discipline marched its toolkit through many other social problem domains. The explanation for the anomaly is that mental health, in all its stigmatized irrationality, was a step too far for a discipline committed to the everyday fact, and scholarly application, of reason. With its tight discipline and established policy sway, economists had “no need to chase after scraps from the table served up by NIMH.”

This chapter explores the origins of the mental asylum in the nineteenth century and its governance.