Considering Uncertainty in the History of Psychiatry

Pressing historians to embrace expressions of uncertainty and critique in twentieth-century psychiatry, Sarah Phelan makes a case for studying overlooked historical figures within psychiatric history.

This essay draws upon my PhD research into the papers of the Scottish psychiatrist Thomas Ferguson Rodger (1907-1978), held at the University of Glasgow Archives, to signal new avenues for histories of uncertainty, scepticism and reform from within mainstream mental health care. It considers how attending to instances of ambivalence and criticism found within orthodox psychiatry can help to lift its monolithic façade. Thomas Ferguson Rodger was first Professor of Psychological Medicine at the University of Glasgow from 1948-1973, with his department based at the Southern General Hospital. There he advocated an ‘eclectic’ psychiatry which incorporated physical methods such as electroconvulsive therapy (ECT) and psychiatric medications with an adapted form of psychoanalytic psychotherapy (Phelan 2017, 88).  

Professor Rodger giving his lecture ‘Some Observations on Mental Health Services in Scotland under the National Health Services Act’ to the Medical Institute of Kiev, 1955.
Image Credit: University of Glasgow Archives & Special Collections: MS Morgan H/1/2.

Rodger’s post-war career encompassed an important period of transformation as traditional asylum-based psychiatry was challenged by emergent general hospital- and community-based psychiatry. Rodger’s eclectic psychiatry was a pragmatic solution fitting for this transitional phase; it allowed him to negotiate between different therapeutic approaches utilised within general hospital psychiatry and was underpinned by an awareness of the then inadequate scientific understanding of psychiatry’s methods (Phelan 2017, 88).

Although Rodger occupied a prominent place in the psychiatry of his day, until my research both he and his archive have received limited historical attention (Phelan 2018). Rodger’s place within the history of psychiatry has not followed the same trajectory as his more conspicuous contemporaries. His mentor David Henderson co-authored the much re-issued Textbook of Psychiatry: for Students and Practitioners (1927). Rodger never aspired to match the literary and philosophical insight of his famous student, R. D. Laing, or the strength of Laing’s challenge to institutional psychiatry. Instead, Rodger characterised himself as largely typical of his psychiatric peers and therefore, superficially, he is less immediately demanding of historical attention. Additionally, he published little and is thus not particularly visible within the medical journals to which historians might turn.

As I researched the Rodger archive a distinctive pattern emerged. Rodger’s enthusiasm and confidence in new developments (whether that be novel psychoanalytic insights in the 1930s or the advent of physical therapies in 1950s) was often followed by a sharp disappointment in, or admission of, the limitations of these new techniques (Phelan 2017, 94). While such incongruity can be confusing for the researcher, this essay suggests that alongside theoretical shifts and therapeutic innovation, uncertainty is an aspect of psychiatric practice equally worthy of historical investigation. Reading into these recurring instances of doubt and inconsistency can be revealing of the profession, its attitudes and approaches. Taking Rodger’s papers as a preserve of psychiatric uncertainty tells of the epistemological instability underlying his post-war eclectic psychiatry, as well as his self-critical sensibility about his profession.

Uncertainty and critique in post-war psychiatry

Rodger was acutely aware of mainstream psychiatry’s shortcomings. While not immune to optimism in new physical therapies, he often betrayed a critical sensibility about the precariousness of his profession (Phelan 2017, 92-94). On 25 January 1956 during his address as Chair to the Medical Section of the British Psychological Association, he assessed psychiatrists as follows:

Why we hold a particular point of view and attach our loyalties to one group rather than another is not clear to anyone of us, although we tend to think it is because we are right and the others are wrong. An accident of training, a difference in personality, and we find ourselves in this school or that. Differences are perhaps more in ourselves than in the facts we choose to study (Rodger 1957, 5-6).

Rodger was sensitive to the arbitrariness of disciplinary loyalties; whether a psychiatrist ended up a physicalist or a psychoanalytic sympathiser was decided more by idiosyncrasies of character and determining educational experiences than any underlying truth. For Rodger, his eclecticism allowed him to incorporate ‘growing knowledge’ (Thomas Ferguson Rodger papers, 1) into his psychiatry, but it did not conclusively explain mental illness nor offer a guaranteed remedy. Eclecticism was serviceable until a more desirable Kuhnian revolution occurred (Phelan 2017, 93):

“It can happen […] that a system of thought which satisfies the requirements at a particular stage in the development of a subject such as psychiatry becomes outmoded and inadequate when new facts have to be taken into account. It is at this stage that eclecticism becomes justifiable with the likelihood that it will later be replaced by a new unified system of ideas capable of expressing the acquisitions of knowledge which disturbed our previous mode of thinking” (Thomas Ferguson Rodger Papers, 1).

He acknowledged the psychiatrist’s imperfect perspective (Phelan 2017, 93): ‘the problems facing us are complex, their nature is not revealed to us and we cannot know beforehand to which approach they will yield’ (Rodger 1957, 5). Drawing attention to the unknown aetiology of mental illness, and therefore to the corresponding instability of contemporary therapeutics (Phelan 2017, 88), Rodger emerges as a critic from within orthodox psychiatry.

Reform from within mainstream psychiatry

In contrast with more assertively political anti-psychiatric writing, Rodger’s critique of psychiatry’s unstable claims to expertise was unpresuming in tone. Nonetheless, Rodger was associated with attempts to rehabilitate his discipline. In a 1966 article, he underlined that the future establishment of a Royal College of Psychiatrists, a task with which he was involved prior to the college receiving its charter in 1971 (Turner et al. 2015, 607), was a key opportunity to revolutionise psychiatry, stating:

“What we must do now is to agree on what sort of psychiatry the college is to represent. If we change our name alone we shall have changed nothing. It is psychiatry that is to be transformed” (Rodger 1966, 8).

The exploration of orthodox clinicians such as Rodger grappling with the limitations of orthodox practice opens up new avenues for histories of professional reform in psychiatry. Attending to Rodger’s wavering faith in psychiatry invites future exploration of where he stood in relation to both ‘classic anti-psychiatry and the critiques of psychiatry by [other] psychiatrists’ (Turner et al. 2015, 623). Pat Bracken and Philip Thomas write that, ‘although there have always been voices within psychiatry that have challenged the assumptions of the status quo, at certain times these have become more organised and coherent than others’ (2010, 219). Further investigation of Rodger as one of psychiatry’s perennial critics might ascertain whether his moderate strain of critique was shared by his British contemporaries, therefore painting a fuller picture of mid-twentieth-century psychiatric discontent that never reached formal organisation or a clamorous pitch.

Indeed, Rodger’s remarks were a manifestation of enduring difficulties with the presiding psychiatric framework (Bracken and Thomas 2010, 219). Although Bracken and Thomas deem their present-day challenge ‘a much more humble project than the critical psychiatry of the sixties and seventies’ (2010, 227), an exploration of Rodger’s critique of his profession suggests that, alongside the daring manifestos of R. D. Laing and others, there was a more moderate historical precursor seeking to change things from within.

Making a case for middle-ground figures

This essay hopes to nudge historians of psychiatry towards an unlikelier and quieter kind of historical figure; beyond the heroic ‘Great Men’ of psychiatry, there are less strident, less publicly visible clinicians, such as Rodger, who reward closer study. Considering the post-war period through an unassuming figure such as Rodger has rendered accessible the struggles and contradictions of twentieth-century psychiatry, struggles that might have been obscured if attending to a more complacent or self-congratulatory practitioner (Phelan 2021, para. 8).

Such an approach contributes to a broader interest in uncertainty in the field of medical humanities.[1] Recent scholarship has energised research in this area, by foregrounding the centrality of uncertainty to medical practice and training, and historical research. For instance, in their discussion of how the ‘humanities’ can help medical students learn about ‘professional clinical complexity and uncertainty’ (2022, 325), Neepa Thacker, Jennifer Wallis and Jo Winning write that for medical practitioners who are increasingly treating ‘chronic illness’, engaging with patient stories and acknowledging ‘clinical uncertainty’ is key to capably negotiating ‘complex medical journeys in partnership with their patients’ (2022, 332).

Janet Weston, meanwhile, entwines ‘uncertainty’ and ‘imagination’ as vital constituents of historical investigation (2023, 8) when archival evidence is rich is some areas but lacking in others (2023, 13). Weston describes historical recovery and reconstruction as follows: ‘Researching and writing about the past draws together knowledge and the unknowable, certainty and ambiguity, facts and speculation’ (2023, 21). In approaching the Rodger archive with a similar sensitivity to uncertainty, his papers present an unexpectedly porous psychiatric perspective, within which different debates about mental illness are played out, and in which different voices, including those of his patients, break through.          


[1] For example, at the 2023 Congress of the Northern Network of Medical Humanities (NNMHR), different manifestations of uncertainty were explored from different critical perspectives. Panels addressed ‘Arts-Based and Creative Research Methods in Uncertain Times’ and ‘Care and Uncertainty’

Sarah Phelan is an independent researcher. From 2013 to 2018, she undertook a PhD in Medical Humanities at the Medical Humanities Research Centre at the University of Glasgow, funded by a Lord Kelvin Adam Smith PhD scholarship. Sarah has published articles in History of Psychiatry, History of the Human Sciences and Cultural Geographies. She is an artist-participant on the recent Writing the Asylum project, funded by the University of Glasgow and the Wellcome Trust. She can be found on twitter @sarah_m_phelan.

References

A.M.S. 1978. “Obituary: Professor T. Ferguson Rodger.” The College Courant 30, no. 61: 39.

Bracken, Pat and Philip Thomas. 2010. “From Szasz to Foucault: On the Role of Critical Psychiatry.” Philosophy, Psychiatry, & Psychology 17, no. 3: https://muse.jhu.edu/article/405314/pdf.

Henderson, David Kennedy and Robert Dick Gillespie. 1927. Textbook of Psychiatry: for Students and Practitioners. London: Oxford University Press.

Laing, Ronald David. 2010[1960]. The Divided Self: An Existential Study in Sanity and Madness. London: Penguin Classics.

Phelan, Sarah Mary. 2018. “Reconstructing a Twentieth-Century Scottish Psychiatrist: Thomas Ferguson Rodger, ‘Wartime Psychiatry’, ‘Eclecticism’, and ‘Mad Dreaming’.” PhD diss., University of Glasgow, http://theses.gla.ac.uk/id/eprint/30740.

Phelan, Sarah. 2017. “Reconstructing the Eclectic Psychiatry of Thomas Ferguson Rodger.” History of Psychiatry 28, no. 1: 87–100. https://doi.org/10.1177/0957154X16674892.

Phelan, Sarah. 2021. “‘Too Principled, Too Honest’– Thomas Ferguson Rodger, Professor of Psychological Medicine.” ‘SSSA in 70 Objects’. Accessed 24 September 2021, https://libraryblogs.is.ed.ac.uk/sssa/object17/.

Rodger, Thomas Ferguson. 1957. “The Other Man’s Point of View.” British Journal of Medical Psychology 30, no. 1: 3-8. https://doi.org/10.1111/j.2044-8341.1957.tb01937.x

Rodger, Thomas Ferguson. 1966. “The Role of the Psychiatrist.” The British Journal of Psychiatry 112, no. 482: 1-8. https://pubmed.ncbi.nlm.nih.gov/5908100/.

Thacker, Neepa, Jennifer Wallis and Jo Winning. 2022. “‘Capable of Being in Uncertainties’: Applied Medical Humanities in Undergraduate Medical Education.” Medical Humanities 48, no. 3: 325-334. https://doi.org/10.1136/medhum-2020-012127.

Timbury, Gerald. 1978. “Obituary: Thomas Ferguson Rodger.” The Bulletin of the Royal College of Psychiatrists 2, no.10: 169–170. https://doi.org/10.1192/S0140078900003345.

Turner, John, Rhodri Hayward, Katherine Angel, Bill Fulford, John Hall, Chris Millard, and Mathew Thomson. 2015. “The History of Mental Health Services in Modern England: Practitioner Memories and the Direction of Future Research.” Medical History 59, no. 4: 599-624. https://doi.org/10.1017/mdh.2015.48.

Weston, Janet. 2023. Looking after Miss Alexander: Care, Mental Capacity, and the Court of Protection in Mid-Twentieth-Century England. Montreal and Kingston; London; Chicago:  McGill-Queen’s University Press.

Archival Sources

Notes for a draft lecture or address titled ‘Eclectic psychiatry’ [MS and TS]. c.1950s-1960s. GB 248 DC 081/4/5/9, Thomas Ferguson Rodger Papers, 1907-1978. University of Glasgow Archives and Special Collections.

Claridge, Gordon. Interviewed by Sarah Phelan. Transcript. School of Scottish Studies Archives, University of Edinburgh, 30th January 2015.  

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