
Petty Tyranny and Soulless Discipline?
Patients, policy and practice in public mental hospitals in England, 1918–1930
Claire Hilton (Author)
High expectations for a better world followed the First World War. Many changes took place aligned with ‘progress’, but in England the poorest benefited little from them. This was all too evident in the nation’s public mental hospitals. Patients were their raison d’ȇtre, yet their experiences show that they sat at the foot of the country’s priorities.
Petty Tyranny and Soulless Discipline? places patients at its centre to explore their daily lives, including their admission, care, treatment, discharge and after-care, or death. These narratives, drawn from a range of primary sources, are contextualised in an historical analysis of how and why a mixture of stagnating and changing knowledge, attitudes and ideals affected patients’ experiences. The Lunacy Act 1890 underpinned life in the mental hospitals by setting out their organisation, regulation and funding. A variety of professionals, campaigners for reform, central government departments, local authorities, trades unions and voluntary organisations, often with competing agendas, influenced what happened to patients. There was also new medical knowledge, from Britain and beyond. This book weaves these strands into a coherent whole, to reveal the complexity of mental health provision in the past and enable reflection that might inform debate today.
List of figures
List of tables
List of abbreviations
Preface
Foreword
Acknowledgements
1 Introduction: historical context and methodological considerations
2 Outside to inside: public experience and understanding, and into the mental hospital
3 Certified under the Lunacy Act: patients’ daily life in hospital, and after
4 Challenges for the mental hospital doctors: medical knowledge and treating patients
5 Regulatory culture: structure and staff
6 Reform
7 Epilogue: reflections then and now
References
Index
DOI: 10.14324/111.9781800088610
Number of illustrations: 16
Publication date: 01 July 2025
PDF ISBN: 9781800088610
EPUB ISBN: 9781800088627
Read Online ISBN: 9781800088610
Hardback ISBN: 9781800088597
Paperback ISBN: 9781800088603
Claire Hilton (Author) 
Claire Hilton is an Honorary Research Fellow at Birkbeck, University of London, and Honorary Archivist at the Royal College of Psychiatrists.
‘[A] wonderful book … I would commend it to you as do others.’
Linda Bryant, CEO, Together for Mental Wellbeing
‘Dr Hilton’s comparison of psychiatric care in the 1920s and the 2020s is, by turns, elegant, stunning, salutary and chilling. Throughout, she reminds us of the dangers of what Rob Behrens has dubbed “bunker-ism”. This excellent book is the beginning of an antidote, if not cure, for this common affliction.’
Nicol Ferrier, Newcastle University
‘A groundbreaking and sobering read, which has seismic implications for the field of mental health care in the future. It should be compulsory reading for clinicians and providers of mental health services.’
Jane Warner, Plymouth University

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