State controlled care of the insane in Britain at the start of the twentieth century is often described as conservative because the emphasis was on certification and institutionalization for rate-aided patients. However, Britain cannot be considered as a whole because the laws governing mental health care were different in Scotland and England. Toward the end of the nineteenth century Scotland had temporary care for noncertifiable mental cases and community guardianship schemes for nonviolent cases of insanity. In 1894 Dr. John Carswell wrote that the General Board of Lunacy had “permitted the use of one male and one female ward in Barnhill Parochial Hospital for the treatment of doubtful and temporary non-certified cases.” In England borderline conditions were not acknowledged and prophylaxis and outpatient facilities were rare. This situation was the exact opposite of the psychiatric practice developing in Germany. The main protagonists in this chapter explored these German developments for their own clinical practice. Dr. Helen Boyle (1869–1957) and Dr. Isabel Hutton (1887–1960) traveled extensively in Europe and the United States in search of new ideas and good practices in an effort to improve the treatment of acute, temporary, and noncertifiable mental disorders in England.

The Law, Psychiatric Clinics, and the Treatment of Noncertifi able Mental Disorders

Under the 1890 and 1891 Lunacy Acts for England and Wales there was no possibility of treatment in a public asylum without certification; hospitals admitting mental patients had to be approved and registered by the regulating authority and nursing homes were not allowed to take mental cases. Dispensaries were new to the nineteenth century and a few asylums and general hospitals had them for mental disorders, but they were rare outside London. St. Thomas’s and the Charing Cross Hospital had clinics for mental disorders. In 1890 Dr. L. S. Forbes Winslow opened a charitable outpatient clinic in Euston Road, London for the mentally disordered poor, which was known as the British Hospital for Nervous Disorders.

The decades around 1900 were a crucial period in the making of the various national systems of health services, as well as the formation of the modern medical and social sciences. The field of psychiatry and mental health care can be understood as located at the intersection of these spheres. Here, concepts, practices, and institutions emerged that marked responses to the challenges posed by urbanization, industrialization, and the formation of the nation-state. Psychiatry had a considerable impact on the modes of perception and evaluation, and on the patterns of action toward contemporary social concerns and political issues. These psychiatric responses were locally distinctive, and yet at the same time they established, in part, influential models with an international impact.

This volume addresses two important topics of late nineteenth- and early twentieth-century history. The essays deal with the transformation of psychiatry into one of the most contested and influential modern sciences; and they link this focus to broader issues of international relations and transfers of concepts, practices, personnel, as well as funds in a context of rising internationalism and nationalism.

For instance, an orientation toward new career opportunities in the United States by European physicians in the context of innovative and flexible institutional structures and systems of funding may be documented for the 1920s; yet this orientation has found almost no attention in the historiography of psychiatry.