In our guest post today, Hazel Morrison provides reflections on her article, ‘Constructing Patient Stories: ‘Dynamic Case Notes and Clinical Encounters at Glasgow’s Gartnavel Mental hospital, 1921-32’ which featured in Medical History 60:1 (2016), 67-86.
My dear Dr. Henderson
Above everything else congratulations on the second edition of your book! … What psychiatry needs is the courage of the case material and the problems shown therein, and less preoccupation with the traditional and formal principles.
Case notes and case histories, argued the doyenne of North American psychiatry – Dr Adolf Meyer - have the power to alter the course of the psychiatric profession. Meyer’s 1929 correspondence to his former student and colleague, Dr David Henderson, pre-empted the paradigmatic shift that would occur in British psychiatry between the two World Wars; as Henderson, at the height of his eminent career, steered patient case taking practices away from former emphases on description of symptoms, classification and brain pathology, and towards the study of individual personality, set within, and reacting to, his or her environment.
My article begins with Henderson’s articulation of his ‘dynamic’, otherwise known as psychobiological, approach to mental health care during the 1920s. The rest of the paper is an examination of the patient case note records produced during his physician superintendence of Glasgow’s Royal Asylum, Gartnavel, 1921-1932. Examination of the staff meeting record lies at the heart of this investigation. Instigated in Britain by Henderson at Gartnavel in 1921, this clinical practice spanned case presentation, patient examination and discussion of plans for treatment. Bringing together a multidisciplinary team of medical practitioners, the aim of the staff meeting was to study the whole person (body and mind) of a patient, reacting and adapting to the experimental stage of the clinical environment, while the patient’s own language and own understanding of illness formed the basis for therapeutic intervention. Recorded verbatim by clinical stenographers, transcripts allow this paper to ‘sit in’ on such meetings. The near uniqueness of these sources enables a new, rarely accessible kind of history to emerge; a history inclusive of patient-psychiatrist dialogues spoken within, and as an essential part of, the clinical encounter:
Dr. Henderson. You have spoken about your spine shifting. Do you believe that your spine is –
Patient. (breaking in) Yes I do. When the change comes on it about knocked me off my mind altogether. I think it was me getting the wind up - it made my nerves worse.”
Rarely can histories look beneath published records to access the clinical conversations, disputes and the situated possibilities for understanding and intervening in patient cases, but here such conversations are laid bare almost verbatim (in ‘real time’). Once the patient was escorted out of the meeting room, debate and discussion of the case continued between Henderson’s staff. Both senior and junior medical staff collaborated within a shared space wherein diverse psychiatric theories – from the most organic to the most psychoanalytic – are brought into dialogue with other branches of medicine, such as presented by staff working in the pathological laboratory or occupation department. Such dialogues almost never make their way into published, official records, as they lay bare the false starts, bold statements and interchanges that speak at cross purposes, before such exchanges were preened and presented at conferences, in papers and medical texts.
Drawing parallels with medical humanities scholarship, my paper endeavours to access a historical space in which methods and concepts, drawn from the humanities and biomedical sciences, mesh and are transformed into new medical knowledges. Situated within spaces, such as those of the staff conference, this project questions the extent to which Henderson’s initiation of multi-disciplinary working practices, which intersect with, and underscore the agency of the individual patient, were productive of case materials that transformed medical teaching and clinical practice in Britain.”
Hazel Morrison
To access Hazel’s article and find out more, please do visit Medical History’s website at https://doi.org/10.1017/mdh.2015.69
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