Ali Haggett. A History of Male Psychological Disorders in Britain, 1945-1980. Houndmills, Basingstoke, Hampshire: Palgrave Macmillan, 2015. xii + 215 pp. $31.00 (cloth), ISBN 978-1-137-44887-3.
Reviewed by Marion Schmidt (Johns Hopkins University)
Published on H-Disability (April, 2016)
Commissioned by Iain C. Hutchison
Women, recent surveys suggest, are more likely than men to be diagnosed with affective mental disorders such as depression and anxiety. Medical professionals, historians, and psychiatry activists have drawn quite different conclusions from these statistics, from pointing to gendered perceptions of mental illness, social factors, or supposed biological differences, issues of under- and overdiagnosis, through to the undue medicalization of women and stigmatization of the mentally ill. University of Exeter historian Allison Haggett argues that men's mental health has been neglected in medical practice. Her History of Male Psychological Disorders in Britain, 1945-1980 focuses on a period when these gender incongruences in medical discourse and practice became particularly evident. Men, Haggett argues, express emotional distress--a term she uses interchangeably with mental or psychological illness--differently to women. Whereas women show “classical” psychiatric or psychological symptoms that lead to a diagnosis of depression or mood disorders, men somatize and display physiological symptoms, such as gastric disorders or back pain. In the United Kingdom, men with such symptoms mainly consulted general practitioners. For a number of reasons, Haggett believes, these predominantly male physicians dismissed or ignored signs of emotional distress in their male patients.
The first chapter situates discourse of psychological illness in the world of British general practitioners. Despite a growing interest in mental illness in the post-World War Two period, debates focused narrowly on a biomedical model that excluded psychosomatic forms and symptoms. Although some practitioners, such as psychoanalyst Michael Balint (1886-1970) advocated for more holistic approaches, their work had relatively little influence. Moreover, general practitioners in this period received little or no education in detecting signs of emotional distress. In their approach to patients, they often reflected contemporary ideals of masculinity or replicated the stigma of mental illness.
The following four chapters use absenteeism from work, alcoholism, and prescription practices as proxies for gauging the extent of emotional distress among “ordinary” British men, and for its neglect in medical discourse and practice. Chapter 2 points to concerns about the effects of (mental) health on economic productivity during and after World War Two. Especially since the 1960s, contemporaries gave great attention to short-term absenteeism from work, and noted that men presented with a high rate of muscular-skeletal or gastric disorders. Yet, Haggett believes that physicians failed to recognize that these symptoms were often a psychosomatic manifestation of emotional distress. Contemporary working class-culture and medical beliefs reinforced a form of masculinity that celebrated the strong male breadwinner and prevented discussions of mental health.
Chapter 3 looks more closely at how this culture of masculinity contributed to perceiving high levels of alcohol consumption as normal, and thus obscured that alcohol was as a form of self-medication men used when facing emotional distress. Chapter 4 examines the patterns of prescription for a range of pharmaceuticals to argue that mental illness in men was more widespread than a superficial look might suggest. Therefore, by the 1970s, women were prescribed typical psycho-pharmaceuticals at almost double the rate for men. Yet Haggett points out that men frequently received medications containing psychotropic agents. These, however, were usually for symptoms considered to be somatic, and thus perceived as typically male conditions. Self-medication with “over the counter medication”--for example, for gastric disorders--also reinforced such gendered preconceptions and consumption patterns. The last chapter deals with mental illness in physicians and in ethnic minorities, arguing that transcultural approaches to mental health were long neglected in the United Kingdom.
Haggett's work is part of the recently growing historiography of psychiatry in the second half of the twentieth century, although she does not engage greatly with the wider scholarship on mental health, gender, or disability. Certainly, given her overall goal of uncovering the hidden history of male emotional distress, the thesis of a specifically male form of somatic psychological disorders makes sense. This concept, however, would have profited from a more nuanced engagement with gender theories beyond a strict male-female dichotomy, and from a more historically situated understanding of terms such as mental illness, disturbance, or psychological disorder. From a disability history perspective, a greater engagement with actor and patient categories in defining emotional distress would have been desirable.
Haggett sometimes appears to medicalize social phenomena such alcoholism, absenteeism, and, indeed, “emotional disturbances” and “male” behavior, even though this goes against her stated goal. Overall, her book works better as a history of the attitudes and practices of British general practitioners than as a history tracing “male psychological disorders” hidden from the male physicians and patients, yet visible to the contemporary female historian. As an analysis of medical discourse, supported by interviews with GPs active during the 1950s, 1960s, and 1970s, a History of Male Psychological Disorders gives detailed insight into the changes GPs faced during this period of great social and medical transformations.
. For a global overview and discussion of potential factors see, for example, the report of the World Health Organization’s Department of Mental Health and Substance Dependence, Gender Disparities in Mental Health (c. 2002), available at http://www.who.int/mental_health/media/en/242.pdf (accessed March 28, 2016).
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Marion Schmidt. Review of Haggett, Ali, A History of Male Psychological Disorders in Britain, 1945-1980.
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