Rhodri Hayward

The Pursuit of Serenity: Psychological Knowledge and the

Making of the Welfare State

Over recent decades, historians, sociologists and policy

makers have begun to pursue the psyche in earnest. From

histories of fear and empathy to policy initiaties in

education and social welfare, the psyche appears as an elusive

but authoritative entity that will provide the grounds of an

effective politics and reveal the inner meaning of historical

experience. Much has been made of the novelty of these

developments. The rise of the so called ‘happiness agenda’ is

presented by its apostles as a new kind of political

dispensation.1 Similarly historians who have embraced

psychoanalytic and neuropsychological insights in their

writings believe that this has allowed them to escape the

1 Nicola Bacon, Marcia Brophy, Nina Mguni, Geoff Mulgan and Anna

Shandro, The State of Happiness, Can Public Policy shape Wellbeing and Resilience

(London: The Young Foundation, [2009]); Richard Layard, Happiness,

Lessons from a New Science (London: Allen Lane, 2005); Danny Blanchflower

and Andrew Oswald, Well-being over time in Britain and the USA. Warwick

Economic Research Papers no. 616, 2001; R. E. Lane, The Loss of Happiness

in Market Democracies, (London: Yale University Press, 2000); [Office

of National Statistics], Measuring National Wellbeing, National Statistician’s

Reflections on the National Debate on Measuring Wellbeing, (Newport: HMSO, 2011).

1

cultural theorists’ dead-end obsession with discourse and

representation.2 Yet despite the promise and energy associated

with these new approaches, the pursuit of the psyche has been

marked by a certain ambivalence. Although researchers might

celebrate their engagement with psychological life, this

engagement is often perceived as demonstrating the limitations

of their disciplines. Despite the broadly accepted idea that

role and identity is socially constructed, some small aspect

of selfhood remains beyond the scope of sociological or

economic explanation. Thus in the writings of some

contemporary historians on subjectivity, the real essence of

the self is located outside history in, for instance, a

different temporal order of evolutionary adaptation, a

neurobiological affect program or the romantic sublime of the

deep unconscious, which is said to resist the claims of social

determinism and narrative representation.3 In these accounts

historians only effectively deal with subjectivity when they

recognize the inadequacy of their professional methodologies.

The ambivalence inherent in these approaches reflects a

human world portrayed as sharply divided between the flux of

historical experience and a psychic reality containing

elements that remain constant over time.4 This division tends

to be preserved in the stories we tell ourselves about the

growth of psychological understanding in Britain. In the

writings of psychoanalytic enthusiasts and their hostile

critics, the development of a psychodynamic perspective

remains isolated from the changing historical experience of

2

the British population at the start of the twentieth century.

Its growth is depicted instead as a kind of slow enlightenment

in which concepts developed in Central European consulting

rooms are taken up in the United Kingdom through a combination

of missionary efforts, Machiavellian politicking, lurid press

coverage or literary experimentation. 5 Such accounts – which

treat the growth of a psychological consciousness as an

elaborate game of Chinese whispers - have their uses, but they

do little to explain why historical actors may have chosen to

adopt this new vocabulary. Instead they borrow from the logic

of psychotherapy, suggesting that the encounter with

psychoanalysis granted the population the language and

awareness they needed to express their real feelings: feelings

that could not be articulated through the conventional

discourse of Victorian and Edwardian Britain.6

In this chapter I do two things. First, I offer an

alternative account of the growth of psychological

understanding and experience in early twentieth-century

Britain. Instead of attributing its growth to a process of

intellectual enlightenment, I show how this new sensibility

was grounded in certain practical changes in the nation’s

political and economic life. Second, I show how the new kinds

of experience generated by these changes, in turn, created a

novel domain of political action. I examine mid-twentieth-

century psychological welfare schemes - schemes which bear a

superficial similarity to the happiness policies pursued

today. These schemes however were organised around very

3

different concepts and with very different materials.

Whereas twenty-first century political interventions are

structured around ideas of happiness and depression, mid-

twentieth-century schemes were coordinated around the concepts

of anxiety and security. The distinctiveness of these schemes

demonstrates the transience of the psychological categories

used to ground such interventions, and, perhaps more

interestingly, it suggests that the psyche itself may be

continually reconstituted as modes of production and social

organization change. The psychologies used to establish

historical arguments and legitimate political and economic

decisions are themselves constituted through those decisions

and the materials and relationships that arise from them. As

this essay will demonstrate, in mid-twentieth-century Britain

the experience and understanding of anxiety was transformed

through its relationship to schemes of welfare reform.

*

Over the last two decades sociologists and philosophers of

science have begun to turn away from the familiar vision of a

universe populated with fixed and discrete objects to

emphasise the unstable and emergent properties of forces and

matter. Drawing upon a number of philosophical forebears

including Alfred North Whitehead and Gilles Deleuze, they have

argued that physical and psychological phenomena can only be

understood in terms of the contingent networks of tools,

theories and practices that sustain them.7 Instead of taking

4

the objects of scientific analysis (be they subatomic quarks

or psychiatric illnesses) as givens, they have looked at how

these objects are made visible, tangible, and effective. In

the case of psychological phenomena, the constitutive role of

language and social activity is clear. The development of new

psychological concepts changes human experience and thus

produces new phenomena. As the philosopher, Alasdair

Macintyre argues: ‘Psychology is not only the study of human

thinking, feeling, acting and interacting: it has itself –

like other human sciences - brought into being new ways of

thinking, feeling, acting and interacting.’8 When we deploy

psychological concepts such as ‘stress’, ‘intelligence’ or

‘multiple personality disorder’, we are not simply pointing to

pre-existing referents: rather, we constellate certain aspects

of life, creating particular connections and associations, and

thus creating new psychological states.9 These new states,

however, are not sustained by language alone. New categories

and phenomena are embedded in particular forms of practical

action and social organization.10 Through their location in

this extended network, the phenomena obtain a certain

robustness. They have a life of their own and these robust

creations in turn make possible new forms of identity and new

kinds of action. They are, in Kurt Danziger’s words,

‘psychological objects’.11 These psychological objects are

capable of changing the world.

8 Alisdair MacIntyre, “How psychology makes itself true - or false”

in Sigmund Koch and D. E. Leary (eds), A Century of Psychology as Science,

5

This essay looks at the historical transformation of a

particular psychological object - anxiety - and its connection

to programmes of welfare reform in the early twentieth

century. Forms of worry, foreboding, apprehension, anguish,

unease and disquiet have always been with us, but it was only

at the end of the nineteenth century that the anxiety neuroses

(Washington D. C.: American Psychological Association, 1992), 897-

903. For good accounts of this reflexive process, see, Roger Smith,

“The History of Psychological Categories”, Studies in the History and

Philosophy of the Biological and Biomedical Sciences 36 (2005), 55-94; idem. Being

Human, Historical Knowledge and the Creation of Human Nature (Manchester:

Manchester University Press, 2007), 74-83; Graham Richards, Putting

Psychology in its Place (London, Routledge, 2002), ch. 1.2 Victoria E. Bonnell and Lynn Hunt, “Introduction“, in Beyond the

Cultural Turn, ed. Victoria E. Bonnell and Lynn Hunt (Berkeley:

University of California Press, 1999), 1-343 For the attempt to locate the emotional life in a different

temporal order (the evolutionary environment of earliest

adaptation), see, Daniel L. Smail, On Deep History and the Brain

(Berkeley: University of California Press, 2008); Lynn Hunt, “The

experience of revolution” French Historical Studies, 32(4), 671-678. On

neurobiology, J. Carter Wood, “The limits of culture? Society,

evolutionary psychology and violence”, Cultural and Social History 4 (2007),

95-114; Avner Offer, The Challenge of Affluence, (Oxford: OUP, 2003), 294-

98, 347-55. For recent histories of subjectivity that seek to

reserve a place for selfhood outside the play of discourse and

representation, see, James Hinton, Nine Wartime Lives, Mass Observation and

the Making of the Modern Self (Oxford, Oxford University Press, 2010), 19;

Michael Roper, ‘Slipping out of view, subjectivity and emotion in

6

were delineated as a distinct pathological condition through

the work of Sigmund Freud and Wiesbaden psychiatrist, Ewald

Hecker.12 A number of psychological, somatic and cognitive

states such as nervousness, arrhythmia and obsession that had

previously been taken on their own terms were now brought

together and understood as symptoms of an underlying disorder.

gender history”, History Workshop Journal 59.1 (2005), 57-72.4 Frederic Jameson, The Political Unconscious, (Brighton: University

Paperbacks, 1981), 22.5 There is now a very fine literature on the early uptake of

psychoanalysis in Great Britain but this literature remains wedded

to the idea of psychological enlightenment. It follows the early

lead of Bob Hinshelwood and Dean Rapp in identifying points of

cultural access for the new science, see, R. D. Hinshelwood,

“Psychoanalysis in Britain, Points of Cultural Access, 1893-1918”,

International Journal of Psychoanalysis 76 (1995), 135-51; Dean Rapp, “The

Reception of Freud by the British Press, General Interest and

Literary Magazines, 1920-25”, Journal of the History of the Behavioral Sciences,

24 (1988), 191-207; Dean Rapp, “The Early Doiscovery of Freud by the

British General Educated Public, 1912-1919”, Social History of Medicine 3

(1990), 217-43; Sandra Ellesley, Psychoanalysis in early twentieth-century

England , a study in the popularization of ideas, University of Essex, Ph.D.,

1995; Laura Cameron and John Forrester, “Tansley’s psychoanalytic

network, An episode out of the early history of psychoanalysis in

England”, Psychoanalysis and History 2.2 (2000), 189–256; John Forrester,

“Freud in Cambridge”, Critical Quarterly 46.2 (2004), 1-26; George

Makari, Revolution in Mind, The Creation of Psycholanalysis, New York, Harper,

2008, chs. 9, 11; Susan Raitt, “Early British psychoanalysis and the

Medico-Psychological Clinic”, HWJ 58 (2004), 64-85.Graham Richards,

7

Anxiety neurosis, Freud argued, included irritability, anxious

expectation, anxiety attacks, night waking and conditions such

as vertigo, palpitations, tremors and gastric disorders.13 The

symptoms were united by their common origin in accumulated

sexual excitation. What had once been seen as discrete

individual reactions to an uncompromising environment were now

“Britain on the Couch, The Popularisation of Psychoanalysis in

Britain 1918-1940”, Science in Context 13.2 (2000), 183-230. For a

striking exception, see Mathew Thomson, Psychological Subjects, Identity,

Culture and Health in Twentieth-Century Britain (Oxford: Oxford University

Press, 2006).6 e.g. Michael Roper, “Between manliness and masculinity, the “war

generation” and the psychology of fear in Britain, 1914-1970”, Journal

of British Studies 44.2 (2005), 343-363.9 For illustrative studies of these particular categories, see

Steven Brown, The Life of Stress, The Saying and Seeing of Dysphoria, University of

Reading Ph.D Thesis, 1997; C. F. Goodey, A History of Intelligence and

’Intellectual Disabilty’ (Aldershot: Ashgate, 2011); Ian Hacking, Rewriting the

Soul, Multiple Personality and the Sciences of Memory (Princeton, NJ: Princeton

University Press, 1995).10 For the idea that emotion states are sustained by different

language communities, see Barbara Rosenwein, Emotional Communities in the

Early Middle Ages (Ithaca: Cornell University Press 1997). For the

significance of material change in creating new forms of experience

see, E. Thompson, “Folklore, Anthropology and Social History“ in

J. L. Noyce, ed. Studies in Labour History (Brighton, Noyce, 1979), 21.11 Kurt Danziger, “When history, theory and philosophy meet. The

biography of psychological objects”, in D. B. Hill and M. J. Kral

(eds) About Psychology, Essays at the Crossroads of History, Theory and Philosophy

8

taken as aspects of a distinct neuropathological process. In

bringing together these symptoms, Freud and Hecker transformed

their significance. Anxiety, which had once described an

attitude to impending events, became symptomatic of psycho-

physiological frustration. An attitude was transformed into a

condition and a new psychopathological identity – ‘the anxiety

(Albany: State University of New York Press, 2003. See also K.

Danziger, Naming the Mind, (London: Sage, 1997),186-93; L. Daston,

“Introduction, The coming into being of scientific objects”, in L.

Daston (ed.), Biographies of Scientific Objects, (Chicago: University of

Chicago Press, 2000).7 For ideas of emergence in scientific practice, see, Peter Galison,

“Reflections on Image and Logic, A Material Culture of Microphysics”, Perspectives

on Science 7.2. (1999), 255-84; Hans-Jorg Rheinberger, Towards a History of

Epistemic Things, Synthesizing Proteins in a Test tube (Stanford: Stanford

University Press, 1997); Andy Pickering, “The Mangle of Practice,

Agency and Emergence in the Sociology of Science”, American J. Sociology

99 (3) (1993), 559-89;”On becoming, Imagination, Metaphysics and the

Mangle”, in Don Ihde and Evan Selinger (eds.), Chasing Technoscience,

Matrix for Materiality, (Bloomginton IN: Indiana University Press, 2003),

96-116; idem, “Science as Alchemy”, in Joan Scott, Deborah Keates

and Clifford Geertz (eds) Schools of Thought, Twenty-five Years of Interpretive

Social Science (Princeton: Princeton University Press, 2001), 194-206;

Gilles Deleuze, “What is a dispositif?” in T. J. Armstrong (ed-*),

Michel Foucault, Philosopher, (Hemel Hempstead: Harvester Wheatsheaf,

1992), 159-68.12 Aubrey Lewis, “The ambiguous word “anxiety””, International Journal of

Psychiatry 9 (1970), 61-79; Theodore Sarbin, “Ontogeny recapitulates

phylogeny, The mythic nature of anxiety” American Psychologist 23.6

9

neurotic’ – appeared. Yet this object did not remain stable.

In Freud’s own writings the meaning of anxiety would shift

from failed libidinal discharge to a psychic mechanism that

protected the subject from reencountering trauma.14 Anxiety

thus provides a good example of how the form and meaning of a

condition was established through a network of relationships.

Here, I concentrate on one element in this network: the

relationship between the changing meaning of anxiety and the

history of British welfare reform.

The system of welfare administration that grew up around

late Victorian and Edwardian experiments in social insurance

and workmen’s compensation introduced new kinds of

psychological objects into British society. The most

significant elements in this system were the Workmen’s

Compensation Acts of 1897, 1906 and 1923 and the National

Health Insurance Act of 1911.15 The 1897 Act built upon

earlier experiments in employee protection, consolidating the

(1968), 411-418; German Berrios, The History of Mental Symptoms (Cambridge:

Cambridge University Press, 1996), 264-73. 13 S. Freud, “On the grounds for detaching a particular syndrome

from neurasthenia under the description ‘anxiety neurosis’

[1894/95] in J. Strachey (ed.), The Standard Edition of Complete Psychological

Works of Sigmund Freud, (hereafter SE) (London: The Hogarth Press and

the Institute of Psychoanalysis, 1978), 92-99.14 A. C. Oerlemans, Development of Freud’s Conception of Anxiety, (Amsterdam:

North-Holland Publishing Co., 1949); James Strachey, “Editor’s

Introduction, Hemmung, Symptom, Angst” in S.E. 20, 77-86.

10

notion of employer liability. The 1906 Act opened up the

possibility of redress for industrial disease.16 Although only

seven diseases were scheduled in the initial legislation,

twenty-five were included by 1913.17 By 1935 (allowing for

informality of recording) it appears that over 17 million

manual workers were included within its ambit and over 6,000

compensation cases were reaching the courts each year.18

As has been widely noted, the welfare framework created

around industrial accident and disease in Britain encouraged

litigation.19 Whereas in Germany disputes were conducted

through state-appointed arbitrators, British cases were

referred to insurance tribunals or - more commonly after 1923

- the courts, and it was in these institutions, I want to

argue, that the dynamic psyche was defined and sustained.20

Such legal disputes opened up the space of the psyche in three

ways. First, in the arguments surrounding compensation cases,

illnesses and injuries were transformed from accidents that

simply befell an individual to complex events bound up with

the personal motivations of the sufferer. Thus in early

disputes over compensation for workplace injuries and railway

accidents, the forms of illness and neuroses presented after

traumatic events were attributed by medical examiners to the

litigant’s unconscious desire for monetary reward.21 Second,

19 Wilson and Levy, Compensation 2, 256-59; Hennock, 118 but see

discussion in Bartrip, Compensation, 133-36. 20 By 1936, over 6000 compensation cases a year were being dealt

with in the courts, National Insurance Gazette (21/5/36), 322.

11

in these disputes notions of shock and trauma were deployed to

break down familiar ideas of mechanical causality, introducing

in its stead an etiology linking present-day disorders to long

forgotten events.22 Symptoms that arose long after an accident

occurred were joined to it through the idea of shock. The

notion of ‘proximate causation’ (which had been used to

establish limits to legal liability) was extended, as physical

accidents were now understood as involving ongoing psycho-

physiological process. 23 The concept of shock could establish

seamless narratives between any event and symptom. Third,

these disputes changed the nature of the doctor-patient

relationship. They turned patients from clients into

claimants, whose declarations about their symptoms required

interrogation.24 Psychological explanations of functional

illness helped to mediate these oppositional relationships.

Such explanations could be used to police claims for

industrial compensation while at the same time defusing any

possible element of confrontation in the doctor patient

encounter.25 In the reports of medical examiners, it was this

putative ‘unconscious’ rather than the claimant that was held

up as the dissimulating agent in pursuit of financial reward.26

Typical cases might include a cooper whose apparent loss of

feeling in his right hand (tactile agnosia) was attributed to

unconscious resentment about working hours, or a shorthand

typist whose frequent and suspect nervous spasms were

reinterpreted in terms of subconscious insecurity.27 Notions

of unconscious motivation allowed adversarial relationships to

12

be re-described in therapeutic terms.28

The inquisitorial form of the insurance relationship did

not simply sustain a particular emotion or form of

psychological rhetoric: it went much deeper than this. It

created new forms of experience and self-understanding. The

schemes’ critics complained that the patient’s identity was

transformed by the rewards and investigatory procedures

involved in workmen’s compensation. In 1911, Sir Dyce

Duckworth, the medical examiner for the Treasury complained

that the acts had fostered an epidemic of working class

neurasthenia which undermined recoveries from industrial

accidents.29 Two years later, John Collie, the medical examiner

for London County Council, described how the process of

litigation itself became embodied in the litigant: ‘…

contemplated legal procedure engraves deeper and deeper on the

brain cells what should be the phantom memory picture of an

accident’, creating hysterical injuries in place of ‘the real

physical disabilities which have long since disappeared.’30

William Thorburn, the President of the Royal Society of

Medicine’s Neurological Section endorsed this view. ‘Since

the passing of the Workmen’s Compensation Act’ he wrote in

1913, a new type of compensation has arisen, and not

unnaturally the traumatic neuroses have been modified

thereby.’31 Thorburn claimed that the old forms of gross

hysteria, such as physical paralysis, were being replaced by a

new and more complex form of delayed neurosis: ‘a type less

commonly seen in the last century, less acute in onset, far

13

more insidious, gradually increasing and becoming so

intensified with time.’32

The acts, it was thought, encouraged new forms of

suffering. The network of expectations and grievances

instituted by the new procedures promoted ‘a sort of

subconscious malingering in which the patient herself is

32 Ibid. 15 Useful overviews, see, Bartrip, Workmen’s Compensation in Twentieth-

Century Britain (Aldershot: Gower, 1987); E. Hennock, The Origin of the

Welfare State in England and Germany (Cambridge, CUP, 2007); A. Wilson and

H. Levy, Workmen’s Compensation 2 vols., (London: Oxford University

Press, 1939, 1941).16 Hennock, 115.17 Hennock, 115; Wilson and Levy, 105-7.18 Wilson and Levy, Workmen’s Compensation 1, 307-08; [ILO], International

Survey of Social Insurance, Geneva, ILO, 1936, 358; National Insurance Gazette

(21 May 1936), 322. Official returns only covered cases from the

mining, shipping, docks, construction, factories and railway

industries, see, Home Office. Workmen‘s compensation. Statistics of

compensation and proceedings under the Workmen‘s Compensation Acts, and the

Employers” Liability Act, 1880, in Great Britain during the year 1929 [Cmd. 3781] House

of Commons Parliamentary Papers (H.C.) (1930-31) XXIX, 775. 21 Ralph Harrington, “The Railway Accident, Trains, Traumas and

Technological Crises in Nineteenth-Century Britain” in M. Micale

and Lerner, Traumatic Pasts, History, Psychiatry and Trauma in the Modern Age,

1870-1930 (Cambridge, CUP, 2001); idem., “On the Tracks of Trauma,

Railway Spine Reconsidered”, Social History of Medicine 16.2 (2003), 209-

23

14

deceived as well as, and sometimes even more than, others

about her.’33 These arguments became familiar during the First

World War as the remit of the Workmen’s Compensation Acts was

extended and new pension regimes were instituted.34 Shellshock

helped to cement this new understanding of anxiety as a

pathological force that changed the meaning and experience of 22 Victorian Railways v. Coultas [1888] A C. 222 (J.C.C); Dulieu v. White

[1901] 2 K.B. 669; and Hambrook v. Stokes [1925] 1 K.B. 141 The best

overview remains, Hubert Winston Smith, “Emotions to Injury and

Disease, Legal Liability for Psychic Stimuli”, Virginia Law Review 30. 2

(1944), 193-317; see also Hubert Winston Smith and Harry C.

Solomon, “Traumatic Neuroses in Court,” Virginia Law Review 30.1 (1943),

87-175; Danuta Mendelson, The Interfaces of Medicine and Law, The History of the

Liability for negligently caused Psychiatric Injury (Aldershot, Ashgate, 1998) .23 In the Matter of Arbitration between Etherington and the Lancashire and Yorkshire

Accident Insurance Company [1909] 1 KB591, 598 repr in John Lowry and

Phillip Rawlings, “Proximate causation in insurance law”, Modern Law

Review 68.2 (2005), 310-19; Gilbert Stone and William Andrew Woods,

Workmen’s Compensation and Insurance Reports, (London, Stevens and Co.,

1933), 118.24 [Editorial], “Malingering and the Workmen’s Compensation Act”,

BMJ (24 June 1911), 1473-4; [Anon], “The case of the malingerer”,

Lancet (1 February 1913), 330; R. C. Buist, “Medical etiquette,

ethics and politics”, BMJ (21 March 1914), 642-43; A. Digby and N.

Bosanquet, “Doctors and patients in an era of national health

insurance and private practice, 1913-38”, Economic History Review 2nd

series, XLI (1988), 79-94; Norman Eder, “Medical opinion and the

first year of National Health Insurance”, Albion 11 (1979), 157-71;

idem, National health insurance and the medical profession in Britain, 1913- 1939, (New

15

administrative procedures and with it meaning and experience

of individual illness.35

After 1918, government investigations into war neurosis

and compensable industrial conditions, such as writer’s cramp

or miner’s nystagmus (an involuntary oscillation of the

York: Garland Publishing, 1982), 45-47, 189-90.25 Roger Cooter, “Malingering in Modernity, Psychological Scripts and

Adversarial Encounters during the First World War” in Roger Cooter,

Mark Harrison and Steve Sturdy (eds), War, Medicine and Modernity

(Stroud: Sutton Publishing, 1999), 125-48; idem., “The moment of the

accident, culture, militarism and modernity in late Victorian

Britain”, in Roger Cooter and Bill Luckin (eds.), Accidents in History,

Injuries, Fatalities and Social Relations, (Amsterdam: Rodopi, 1997); Thomson,

“Neurasthenia in Britain, An Overview”, in Marijke Gijswijt-Hofstra

and Roy Porter (eds.), Cultures of Neurasthenia, From Beard to the First World

War, [Clio Medica 63], (Amsterdam: Rodopi, 2002), 85-88; Joanna

Bourke, Dismembering the Male, 79-84.26 William Brown, “Psychology and medicine”, in William Brown

(ed.), Psychology and the Sciences (London: A. & C. Black, 1924), 145;

“Mind, Doctor or Patient”, The Listener (4 July 1934), 35.27 For these respective cases, see, Wellcome Library

PP/FPW/B/211/3/1 Frederick Parkes Weber Papers, Mind, Disease and

Therapeutics (2nd Series); The National Archives (TNA), Treasury,

Establishment Department, Superannuation Division, Registered

Files, T164/74/15. For good coverage of psychological approaches

in individual compensation cases, see, Karl Figlio, “How does

illness mediate social relations? Workmen’s compensation and

medico-legal practices, 1900-1940” in Wright and A. Treacher

16

eyeball) established this a new consensus around this

psychological reading of physical illnesses.36 Individual

conditions were now caught up in a larger framework of

meanings – of fears and rewards around loss and compensation –

and were reinterpreted in psychological terms. Everything

that now touched on the worker’s condition was invested with

(eds.) The Problem of Medical Knowledge (Edinburgh: University Press,

1982); Jo Melling, Where did work stress come from? Scientific

research, lay experience and the culture of “industrial fear” in

the British workplace, c. 1890-1946” in D. Cantor and E. Ramsden

(eds.) Stress, Trauma and Adaptation in the Twentieth Century, (Rochester, NY,

University of Rochester Press, forthcoming).28 R. A. Kaanan and S. Wessely, “The origins of factitious

disorder”, History of the Human Sciences 23 (2010), 68-86.29 Dyce Duckworth “Discussion” in Thomas Oliver, Some Medical and

Insurance Problems arising out of Recent Industrial Legislation, (London: Life

Assurance and Medical Officers Association, 1909), 111.30 Collie, “Malingering”, BMJ (13 September 1913), 645. See also A.

M”Kendrick, Malingering and its Detection under the Workmen’s Compensation and

other Acts, Edinburgh, E. &. S. Livingstone, 1912, 25-26; W. H. Brook,

“On the working of the Workmen’s Compensation Act of 1906”, BMJ (16

July 1910), 133-5, on 134; A. Murri, “Traumatic Neuroses”, Universal

Medical Record 2 (August 1912), 97-116; J. W. Geary Grant, “The

traumatic neuroses” The Practitioner XCIII (July 1914), 26-43, es 42-

43 on the intermixing of hysteria and malingering.31 William Thorburn, “Presidential Address, The Traumatic Neuroses”,

Proc. RSM 7 (1914), [Section of Neurology], 12.33 Lumsden, “The Psychology of Malingering and Functional Neuroses

in Peace and War”, Lancet (18 November 1916), 861. See also T.

17

psychological significance. Parliamentary committees on the

effectiveness of the Workmen’s Compensation schemes were

repeatedly warned of the emotional costs of the legislation.

In 1920 the Holman Gregory Committee reported that protracted

settlements ‘involve worry and in many causes introspection

and depression’. Claims investigation created an ongoing

Muirhead Martin, “Malingering and National Insurance”, Clinical Journal

43.1 (1914), 14-16; F. Palmer, “Traumatic neuroses and psychoses”,

Practitioner, 86 (1911), 808–20. 34 A. Bassett Jones and L. J. Llewellyn, Malingering or the simulation of

disease, London, Heinemann, 1917, 64; E. F. Buzzard “The Psychology of

Traumatic Amblyopia”, Proc. RSM 8 [Neurological Section] (1915),

66. On military pensions, see, Peter Leese, “Problems returning

home”, The British psychological casualties of the great war”,

Historical Journal 40 (1997), 1061, 1063; Barham, Forgotten Lunatics, 298-

308, 352-54. On the relationship between psychological models and

workmen’s compensation, see, Figlio, “Workmen’s compensation and

medico-legal practices”, es 194-95. 35 For the role of anxiety in shaping medical investigations of

shell shock cases, see, G. Elliott-Smith and T. H. Pear, Shellshock

and its Lessons 4th ed., London, Longman Green, 1919. Bernard Hart’s

evidence to the Southborough Committee, see, [Great Britain, War

Office], Report of the War Office Committee of Enquiry into ‘shell-Shock”, (London,

HMSO, 1922), 76-80; E. F. Buzzard, “Psycho-therapuetics”, Lancet (17

February 1923), 331-32; 36 The main point of reference for the debate over the

psychologisation of compensation occurred in the MRC investigations

into miners” nystagmus. Psychologists working for the Industrial

Health Research Board argued that small injuries were aggravated by

18

anxiety which, as one insurance agent noted, was a ‘prolific

cause in retarding recovery’.37 Eighteen years later, the

Stewart Committee, noted with dismay that ‘a disorder

[neurasthenia] in which the development of which anxiety can

play so detrimental a part, should be the subject of so much

uncertainty and conflict’ under current legislation.38 Members

of both committees endorsed the conclusions of earlier Medical

the unconscious desire for award, see, Millais Culpin, “The problem

of the neurasthenic pensioner”, British Journal of Medical Psychology 10

(1921), 316-328; “A study of the incidence of the minor psychoses,

their clinical and industrial importance”, Lancet (1928), 220-224.

“Nervous disease and its significance in industry”, Medical Standard

52, (1929), 9-14; “The need for psychopathology”, Lancet (4 October

1930), 725; idem., ‘some cases of “traumatic neurasthenia””, Lancet

(10 January 1931) 233-237, also editorial “The psychology of

accident neuroses”, Lancet (10 January 1931), 87.; “The nervous

temperament, its assessment and its clinical aspect”, British Journal of

Medical Psychology 11 (1931), 32-39; idem, Recent Advances in the Study of

Psychoneuroses, London, Churchill, 1931, 192-200. See also, T. A.

Ross, ‘some Evils of Compensation”, Mental Hygiene 3,4 (1937), 141-5;

“Heart and Mind” in C. M. Bevan Brown, G. E. S. Ward and F. G.

Crookshank, Individual Psychology Theory and Practice [I. Pamphlet no, 15] (London,

C. W. Daniel, 1936), 4637 J. M. Bannatyne (Harland and Wolf), in [Holman Gregory]

Departmental Committee on Workmen’s Compensation Minutes of Evidence vol. I [Cmd.

908] H. C. 1920, XXVI, 291, §7132. See also, [Holman Gregory],

Departmental Committee on Workmen’s Compensation Minutes of Evidence vol. II. [Cmd.

909] H. C. 1920, XXVI, 304, § 20123 (Memorandum George Cranston

Anderson).

19

Research Council investigations into nystagmus, holding that

pathological anxiety could only be relieved through the

replacement of disability pensions with lump sum compensation

payments. These inquiries revealed the co-constitutive

relationship between psychology and legislation, as the

anxieties created in the administration of the schemes became

the bases of their reformulation.39

As the machinery of welfare provision changed the

experience of illness it opened up new forms of psychological

observation and created new registers of psychological

expression. After the First World War, 216 outpatient clinics

were established to deal with service claims for psychiatric

injury.40 Although many of these psychiatric clinics closed

down within a few years, those that remained were used by

pioneer social psychiatrists to survey working-class life.41

38 [William Stewart] Report by the Departmental Committee on Certain questions

arising under the Workmen’s Compensations Acts [Cmd 5657] H. C. (1937-38)

XV, 25, § 67. See also, 10 (§23), 24 (§64). 39 Stewart, Report, 6, §. 11.; 90, § 195. Holman Gregory Minutes, § 3792, 5427,

5427; 6230, 6275, 6356; 6613, 7132, 8373; 11,583;

20

The clinics, it was claimed, provided clear evidence of the

growth of anxiety states, their changing class distribution

and the emotional poverty of working class life.42 This

evidence led, as Mathew Thomson has noted, to a

reconceptualisation of the anxiety neuroses and neurasthenia.

They were no longer the preserve of the exhausted aesthete or

the over-stretched white-collar worker.43 Neurasthenia was now

associated with the insecurities of unemployment and

industrial injury and the frustrations of modern living. It

was understood and experienced as a neurotic form of anxiety.44

At one level this flight into the anxiety state was seen

in terms of the population’s psychological transition.45 It was

a transition in which the language of distress lost its

familiar markers of gender and class. At the beginning of the

twentieth century, the renegade Viennese analyst, Wilhelm

Reich had noted of his working-class patients in Germany: ‘The

neuroses of the working population are different in that they

lack the cultural refinement of the others. They are a crude

undisguised rebellion against the psychic massacre to which we

are all subjected. The well-to do citizen carries his

neurosis with dignity, or he lives it out in one or another

way. In people of the working population it shows itself out

in the grotesque tragedy which it really is.’46

45 On the changing pattern of neurosis see J. L. Halliday,

Psychosocial Medicine, A Study of the Sick Society, (London: Heinemann, 1949),

126; J. A. C. Brown, Freud and the Post-Freudians, London, Penguin, 1961,

61-2

21

Yet by the 1930s Reich’s ‘crude undisguised

rebellions’ seemed to have undergone a process of

gentrification. In Britain, neurologists and physicans that

the old fashioned hysterias were being replaced in the era of

national insurance by a new breed of anxiety states.47 Kinnier

Wilson, a registrar at the National Hospital, Queen Square, 46 Wilhelm Reich,The Function of the Orgasm, (1942), 57 quoted in John

Hewetson, Ill Health, Poverty and the State, (London: Freedom Press, 1946),

1340 The National Archives TNA PIN 15/2401 Neurasthenia and psychoses,

treatment and entitlement to pension, committee‘s report (1939);

Peter Barham, Forgotten Lunatics of the Great War, London, Yale U. 2004,

37541 Ian Skottowe, “The psychiatric out-patient clinic”, BMJ (14 March

1931), 452-53; Doris Odlum, “The organization and staffing of Out-

patient Mental Treatment Clinics, Mental Hygiene 5 (1939), 57-

60;Charles Stanford Read, “Out-patient psychiatry”, Lancet 221,

1931, 1438-1441; J. R. Rees, “Psychotherapeutic clinics”, in M.

Culpin, Recent Advances in the Study of Psychoneuroses, London, Churchill,

1931, 310-29; C. Blacker, Neurosis in the Mental Health Services, Oxford,

Medical Publications, 1946, 5.42 C. Blacker, “A Patient’s Dreams as an Index of his Inner Life”,

Guy’s Hospital Reports 78.2 (April 1928), 219-45; idem., Human Values in

Psychological Medicine, Oxford, Oxford Medical Publications, 1932;

Stephen Taylor, “The suburban neurosis”, Lancet (26 March 1938), 759-

761.43 Thomson, “ Neurasthenia in Britain”, in Marijke Gijswijt-Hofstra

and Roy Porter (eds.), Cultures of Neurasthenia, From Beard to the First World

War, (Amsterdam: Rodopi, 2002), 88

22

insisted that the turn to psychodynamic investigations had led

to a transformation in the presentation and experience of

hysteria. The old hysteric, he reminisced, was like a circus

horse that ‘[n]ever failed to respond to the calls made on

her. But today we seek the clue to the ailment in the unseen

psyche, and she is somewhat at a loss; accordingly her

elaborated somatic manifestations are rather at a discount. A

cold scientific environment besets her, instead of a world of

emotional extravagance and limitless credulity. So a defence-

hysteria is now 'a la mode’, ...[and] the hysteric turns to

the possibility of compensation for trauma, or seeks to escape

from unpleasant reality by a flight into neurosis -at least,

so we are assured. The times have changed, and we, both

physicians and hysterics, have changed with them.48

The social significance of these changing presentations

was brought out in studies of war neurosis. During the

First World War it was a commonplace observation among

neurologists and alienists that true anxiety neuroses

were generally limited to officers while the gross

hysterias, such as paralysis and aphonia, were present

44 HRH Prince George, “The Place of Mental Health in the Life of the

Nation” Mental Health (1934), 6-747 C. E. S. Flemming, “Disappearing diseases”, BMJ (20 February

1926), 321; J. Campbell, “Psychology and the Practice of Medicine”,

BMJ (29 March 1931), 611; 48 Kinnier Wilson, “The Approach to the Study of Hysteria, J. Neurology

and Pathology 11 (1931), 195

23

among other ranks.49 By the time of the Second World War

this distinction had broken down.50 A new demotic idiom

for mental distress had been established: an idiom

expressed through the physical torments of the

‘psychosomatic’ disorders. 51

49 W. H. R. Rivers, “War neurosis and military training”, Mental

Hygiene 2.4 (1918), 513-53 repr. Instinct and the Unconscious, (Cambridge:

CUP, 1920), 205-27; Henry Head in Report of the War Office

Committee of Enquiry into Shellshock, (London: HMSO, 1922),

68-69; Eric Leed, No Man’s Land, Combat and Identity in World War One,

(Cambridge, Cambridge University Press, 1979), 163-4 but see the

revisionist accounts by, Tracy Loughran, “Hysteria and neurasthenia

in pre-1914 British medical discourse”, History of Psychiatry 19 (2008),

25-46 and Simon Wessely and Edgar Jones, “Hearts, Guts and Minds,

Somatization in the British Military”, J. Psychosomatic Research 56

(2004), 524-29 on changing patterns of embodiment.50 J. A. Hadfield, “War neurosis, a year in a neuropathic hospital”,

BMJ, British Medical Journal Part 1 (1942), 281-285; 320-323; Editorial,

BMJ 1 (1945), 913; M. Culpin, “Clinical psychology, some forgotten

episodes”, BMJ (1 December 1952), 955-5; J. Rickman, “A Case of

Hysteria, Theory and Practice in the Two Wars”, Lancet (21 June

1941), 785-86. J. R. Neill, “How psychiatric symptoms varied in

World War I and II”, Military Medicine (1993), 149 – 51;51 On the expanding category of the psychosomatic, see, E.

Wittkower, ”Studies of the influence of the emotions on the

functions of the organs”, Journal of Mental Science 81 (1935), 533-682;

F. Dunbar, Emotions and Bodily Changes, New York, Columbia University

Press; [1935], 1954. For an overview, M. Jackson, The Age of Stress,

24

These psychosomatic disorders – which encompassed

an ever increasing range of physical conditions including

allergy, ulcer, goiter, gastritis and infertility – were

themselves taken as markers of the changing patterns of

psychological distress between the sexes. As the

physical manifestations of hysteria declined so did the

distribution of psychosomatic conditions. Peptic ulcer,

goiter and hypertension – which in the nineteenth century

were believed to predominate in women – came to be seen

as male diseases. Similarly diabetes and suicide, it was

claimed, became predominantly female illnesses in the

interwar period. This ‘sex shift’ as it was called, was

taken as index of the changing psychological state of the

British population.52

As presentations changed, so too did the meaning of

anxiety. Among English commentators the concept lost its

psychoanalytic associations.53 Although it could still

denote frustration, this was usually seen in social and

economic rather than sexual terms. And the mnemonic and

Science and the Search for Stability, (Oxford: University Press, forthcoming).52 J. L. Halliday, Psycho-Social Medicine, London: William Heinemann

Medical Books, 1949, pp. 61-66; “The Incidence of Psychosomatic

Affections in Britain”, Psychosomatic Medicine 8 (1945): 135-46.

25

protective properties that Freud attributed to anxiety

were collapsed in British writings into a more colloquial

equivalence of anxiety with mental anguish. While this

process robbed the concept of much of its theoretical

complexity, it allowed the emotion to be read into many

situations.54 Through the emergent language of

psychosomatic medicine, any number of could now be

presented as evidence of individual’s anxious condition.

And it is in this moment we can see how the apparatus of

welfare administration could itself become a register of

psychological distress. The equation of anxiety with an

agreed collection of physical complaints – the

psychosomatic manifestations, allowed this inner state to

be subjected to statistical analyses and epidemiological

investigations. The presentation of sickness claims and

the changing record of the birth rate now obtained a

psychological significance: they became indices of the

changing levels of anxiety in the population.

**

State welfare schemes extended the register of emotional

expression. Whereas individual feeling was inscribed upon the

body, the psychological state of the population was traced out

in the changing pattern of insurance returns. And as

reference to the emotional state of an individual changes the

meaning of a situation, so too did reference to population’s

feelings change the significance of the political situation.55

26

Insurance administration provided the stage for new kinds of

relationships and new forms of embodiment and the apparatus

for turning these new experiences into quantifiable phenomena.

Through these processes it allowed the psychological forces

presented across the worker’s body to be read against broader

political and historical transformations. The process of

welfare administration populated the world with psychological

objects – objects that would serve to guide national policy.

The coupling of psychosomatic arguments with welfare

administration opened up a new domain of political

action. It connected individual behaviour, social

organization, welfare costs and economic performance

within a seamless whole. From the beginning of the

1930s, it was claimed that there was a psychoneurotic

component in roughly one third of outpatient

presentations and national insurance claims.56 Neurosis,

it was averred, affected three million Britons at an

annual cost of forty million to the exchequer.57 Such

arguments were initially used to underline the need for

schemes of psychiatric welfare and the building of

outpatient clinics.58 By the end of the 1930s, as we will

see, these psychological estimates were being used to

critique established forms of social organization.

The leading exponents of these arguments were

officials involved in the administration of insurance

claims. James Halliday, assessor for the Glasgow Regional

27

Health Board, was a leading proponent of the idea that

the British population had undergone a psychosomatic

transition in the twentieth century.59 He drew upon the

unorthodox analytic ideas of Ian Suttie who had traced

individual cases of neurosis to maternal separation and

extended his argument to claim that collective anxiety

stemmed from the workers’ increasing separation from

communal life and mother earth.60 Richard Titmuss, working

for the London Branch of the County Fire Office Insurance

company, saw in the changing pattern of fertility

statistics an indication of the broader failures of

modern capitalism.61 It was, he argued, a result of the

increasing individualism fostered by economic competition

and the demoralizing fear of unemployment.62 During the

Second World War, Titmuss and Halliday would vastly

expand the number of indices of psychic distress.

Working with the epidemiologist, Jerry Morris, Titmuss

attempted to map changing presentations of rheumatic

illness and ulceration onto the changing psychological

experiences of the British population.63 In the actuarial

psychosomatics that Halliday and Ryle developed, we can

see how the body was used to benchmark forms of social

and industrial organization. Psychic distress was no

longer read in terms of individual frustration or

disappointment but instead caught up in a narrative of

national life. The psyche, traced out in these insurance

returns, became the touchstone for political justice.

28

This new conception of the psyche changed the basis of

politics. Perhaps the clearest demonstration of this

transformation occurred in the Coronation Bus Strike of May

1937, the endpoint of a four-year dispute between the London

Passenger Transport Board, the Transport and General Workers

Union and the Rank and File Busmen’s Movement. This dispute

over the intensified working conditions imposed following the

amalgamation of London’s bus services in 1933 is now largely

remembered for the tensions it revealed between the TUC and

the rank and file movement.64 However, it also marked a

significant transformation in the basis of labour relations.

The resolution of the busmen’s claim rested not upon the

relative collective bargaining power of worker and employer

but psychological, etiological and epidemiological arguments

over the nature of busman’s stomach – a new form of gastritis

– arising, it was claimed, from the peculiar levels of strain,

anxiety and fatigue the workers experienced.65 This new

condition had been the stuff of anecdote since the beginning

of the 1930s but it took on a life of its own in the sickness

returns kept by approved societies of London United Tramways

and the London General Omnibus Company.66 Under pressure from

the unions and the Labour Party, the Medical Research Council

commissioned Austin Bradford Hill to carry out two inquiries

into the severity of gastric disturbance among busworkers.67

Although Hill remained ambivalent about the condition, the

mere fact of the epidemiological investigation turned a

statistical pattern into a pathological object with its own

29

discrete distribution and characteristics. In two industrial

courts of inquiry held in May and July 1937 and a subsequent

interdepartmental committee investigation two years later, the

search for economic and political settlement was mediated

through arguments over the busmen’s psychological and

psychosomatic health.68 The inquiries demonstrated the shift

from a language of rights based on custom and duty to claims

based in the language of psychology and physiology.69 It was a

shift from what E. P. Thompson termed ‘the moral economy’ to a

new ‘psychological economy’ in which working conditions were

negotiated through reference to anxiety, morale and danger of

mental injury.70 Psychological knowledge thus transformed the

basis of industrial relations. Although issues such as

working hours and labour conditions had long been the focus of

disputes, these disputes were now resolved through reference

to psychological objects measured and assessed in professional

investigations.

**

The psychological needs articulated in the economic demands

and physical complaints of Britain’s workers, and abstracted

through the epidemiological techniques of social medicine,

created a new political landscape. It was a landscape where

the circulation of emotion and desire was believed to affect

the circulation and distribution of capital. John Maynard

Keynes, who had long recognized the role of ‘animal spirits’

30

in the determination of consumer behavior, argued that

psychological knowledge was a crucial element in economic

forecasting.71 ‘In estimating the prospects of investment’, he

wrote in 1936, ‘we must have regard, therefore, to the nerves

and hysteria and even the digestions and reactions to the

weather of those upon whose spontaneous activity it largely

depends.’72

However in the generation of economists that followed

Keynes, particularly those associated with the Labour Party

and the New Fabian Research Bureau, the emotional factors in

the economy were reimagined in terms of the quantifiable

psychological conditions described in the work of Titmuss and

Halliday. Barbara Wootton, citing Alfred Marshall’s well-known

definition of economics as ‘that part of the individual and

social action which is most closely connected with the

attainment and with the use of the material requisites of

wellbeing’, argued that the boundaries of economics had been

redrawn by the production of conditions such as nystagmus.73

Nystagmus was held up by proponents of the new social medicine

as a disease emblematic of the psychological environment.74

Its character and aetiology had been defined in the debates

around Workmen’s Compensation and its presence was taken as an

index of the stress and insecurity experienced in the mining

31

community.75 As Wootton noted in A Lament for Economics, since

nystagmus was an affliction produced by coal mining it must be

counted ‘among the influences which affect the supply of

labour in coal-mining, the wages of coal miners and the price

of coal.’ ‘In this way’, she explained, ‘the boundaries of

economic studies as plotted by Marshall might be found to

include discussions of the nature of human needs,

physiological and psychological, not to mention philosophical

speculations as to the meaning of wellbeing.’76 Psychological

life became a central component of economic planning.77

The clearest articulation of this viewpoint came from

Wootton’s close colleague, Evan Durbin. Working at London

School of Economics and after 1940 with the Economic

Secretariat of the War Cabinet, Durbin argued that the

Keynesian guarantee of economic security through state

planning could only achieved if it were underwritten by a new

sense of psychological security achieved through a nationwide

system of therapeutic intervention.78 In his personal

manifesto, The Politics of Democratic Socialism, written shortly before

he joined the government, Durbin outlined his vision of a

psychological welfare state:

78 On Durbin (1906-1948), see Elizabeth, Durbin, New Jerusalems: The

Labour Party and the Economics of Democratic Socialism (London: Routledge and

Kegan Paul, 1985), esp. chs. 11 and 13; Stephen Brooke, “Problems of

Socialist Planning”, Evan Durbin and the Labour Government of 1945”,

The Historical Journal 34.3 (1991), 687-702.; Stephen Brooke, “Evan

Durbin, Reassessing a Labour “Revisionist”, Twentieth Century British History

32

Although wealth, physical health and social equality

may all make their contributions to human happiness,

they can all do little and cannot themselves be secured

without health in the individual mind … The only hope

for the creation of firm and lasting happiness in

society lies in the greater emotional health of the

7 (1996), 27-52; Nuttall, J. (2003). ““Psychological Socialist”,

“Militant Moderate” Evan Durbin and the Politics of Democratic

Synthesis”, Labour History Review 68.2, 235-252., idem. Psychological

Socialism. The Labour Party and the Qualities of Mind and Character (Manchester:

Manchester University Press, 2006, 49-54).53 John MacMurray “A Philosopher Looks at Psychotherapy”, Individual

Psychology Medical Pamphlets, no. 20 (1938), 21; J. A. Hadfield, “Anxiety

states”, British Journal of Medical Psychology 9 (1929) 33-37; Harris,

“Prognosis”, 649. 54 Nick Lee and Steven D. Brown, “The Disposal of Fear, Childhood,

Trauma and Complexity”, in John Law and Annemarie Mol (eds.),

Complexities, Social Studies of Scientific Knowledge, (Durham NC: Duke U. ,

2002), 258-7955 Vincent Crapanzano, Hermes Dilemma and Hamlet’s Desire, On the Epistemology

of Interpretation (Cambridge, MA: Harvard University Press, 1992), 229-

38. 56 J. L. Halliday, “Psychoneuroses as a Cause for Incapacity among

Insured Persons”, BMJ Su (9 March 1935), 85-88; BMJ Su (16 March

1935), 99-102; M. Cassidy, “The treatment of cardiac cases”, BMJ (13

January 1934), 45-47. T. A. Ross, “The mental factors in

medicine”, BMJ (30 July 1938), 209-11, see also, “Mental Factors in

Illness”, Times (22 August 1938), 11c. For other follow up studies,

see, Arthur Harris, “The prognosis of anxiety states”, BMJ (24 September

33

persons composing it … The greatest achievement of the

scientific method in this century, and the greatest

hope for the future benefit of mankind, lies in the

therapy for mind and spirit discovered by modern

psychological science. In the light of those

discoveries, and by means of its curative practices and

1938), 649-654; “Treatment of Neurosis, Neurotic Insured Persons”,

National Insurance Gazette (9 January 1936), 28; Henry Brackenbury,

“Election Address” National Insurance Gazette (11 March 1937), 156. For

lower estimates, see, D. Bruce Pearson, “Psycho-neuroses in

hospital practice”, Lancet (19 February 1938), 451-56; R. D.

Gillespie, “Psychoneurosis and psychotherapy”, Humphrey Rolleston

(ed.), British Encyclopedia of Medical Practice 10 (London: Butterworth & Co,.

1938), 248.57 Warwick MRC, MSS 292/140.1/2 [J. W. Yerrell], National

Association of Trade Union Approved Societies, Memorandum on Nervous

Diseases, 1937; NUDAW Approved Society 24th Annual Report for the

Year ended 31 December 1936 in National Insurance Gazette (25/2/37), 116-

17 on 1758 William Leonard, Report to the Minister of Health, H. C. Deb (19

December 1934) vol. 296, cc1175-286; [Duke of Kent], Institute for Medical

Psychology Report for the year 1933, (London: [Tavistock Clinic, 1934]), 3;

A. M. Spencer, “Psychotherapy and national health insurance”, Lancet

(10 June 1939) repr. Mental Hygiene 5.3 (1939), 7.59 J. L. Halliday, “The incidence of psychosomatic affections in

Britain, Psychosomatic Medicine 7 (1945), 135-45; “Epidemiology and the

Psychosomatic Affections”, Lancet (19 August 1946), 185-86;

Psychosocial Medicine, A Study of the Sick Society, London, William Heinemann

Medical Books, 1949.

34

above all by its preventative techniques, humanity may

hope in the future to conquer the neuroses of fear and

hatred from which the most horrible things in society

now spring.79

Durbin’s belief in the redemptive power of psychoanalytic

intervention was inspired by his close and productive

60 Rhodri Hayward, “Enduring Emotions, James L. Halliday and the

Invention of the Psychosocial” Isis 100 (2009), 827-3861 “The Birth Rate and Insurance”, Post Magazine and Insurance Monitor (19

December 1936), 2393; “Vital Statistics”, The Insurance Record

(December 1937), 360; Ann Oakley, “Eugenics, Social Medicine and

the Changing Pattern of Statistics in Britain, 1935-50”, British J.

Sociology 42 (1991), 165-94. 62 Richard Titmuss, Poverty and Population, London, Macmillan, 1938, 202-

04; Richard and Kathleen Titmuss, The Parent’s Revolt, A Study of the Birth Rate

in Acquisitive Societies, London, Secker and Warburg, 1942, 16-18. 63 J. N. Morris and Richard M. Titmuss, “Epidemiology of Peptic

Ulcer, Vital Statistics”, Lancet (30 December 1944), 845.64 Ken Fuller, Radical Aristocrats, London Busworkers from the 1890s to the 1980s,

(London: Lawrence and Wishart), 1985 143-59; Pete Glatter, “London

Busmen, rise and fall of a rank and file movement”, International

Socialism 74 (Jan 1975), 5-11;65 For accounts of the illness, see, [John Langdon Davies]. ‘strange

Illness of Bus Conductors” News Chronicle (2 December 1936), 3

[William Payne], London Busmen demand the right to live a little longer. London,

London Busmen’s Rank and File Movement, 1937; “Busmen’s Wives Tell,

The Heavy Toll of a Driver’s Job”, Reynolds News (2 May 1937), 5;

‘stomach Pains through motoring” Reynolds News (16/5/1937), 6.

35

friendship with John Bowlby: a friendship that lasted from

their first meeting at Oxford in 1927 through to Durbin’s

untimely death in the summer of 1948.80 Durbin drew from

Bowlby the idea that problems such as international aggression

or economic growth could only be understood if one recognised

the play of psychological forces in the political process.81 He

urged his fellow politicians to employ ‘psychological 66 H. Llewellyn Smith et. al., The New Survey of London Life and Labour vol.

VII, London Industries III, London, S. King & Son, 1934, 87; A.

Bradford Hill, An Investigation into the Sickness Experience of London Transport

Workers in Special Reference to Digestive Disturbances [IHRB Report no. 79],

London, HMSO, 1937..67 TNA FD1/4082 David Munro to Ambrose Woodall (20 November 1936)68 [Ministry of Labour] Industrial Courts Act, 1919. Report of a Court of Inquiry

concerning the Stoppage of the London Central Omnibus Service. Cmnd. 5464.

London, HMSO, 1937; TNA Lab 10/54 Report of a Court of Inquiry;

[Ministry of Labour], The Effect of Working Conditions upon the Health of London

Busmen, Report of Conferences between Representatives of the London Passenger

Transport Board, the Transport and General Workers Union and the Medical Research

Council under the chairmanship of Sir John Forster. London, HMSO, 1939; TNA Lab

10/536 Report of an inquiry by Sir John Forster under the

Conciliation Acts 1896 into a dispute between certain trade unions

and omnibus undertakings; “The Health of London Busmen”, BMJ (18

November 1939), 1003-4.69 See, “A test of public duty”, Times (7 May 1937), 7c; “Mr Bevin

presents the busmen’s case”, Guardian (4 May 1937), 4; “London

busmen’s grievances”, Guardian (5 May 1937), 14.70 E. Thompson, “The Moral Economy of the English Crowd”, Past and

Present 50.1 (1971), 76-136.

36

microscopes’ that would reveal how institutions of

‘government, party and property’ were merely ‘a thousand

fragments of personal ambition and patriotism, of secret love

and hatred, unconscious purpose and need.’82

This sense of government and society as a field of

71 E. G. Winslow, “Keynes and Freud, Psychoanalysis and Keynes

Account of the “Animal Spirits of Capitalism”, Social Research 53

(1986), 549-78.72 Keynes, The General Theory of Employment, Interest and Money (1936), in CW7,

161-6273 A. Marshall, Principles of Economics, [1890], (London: Macmillan,

1945), 174 Millais Culpin, “The need for psychopathology”, Lancet 219

(1930), 725.75 [Medical Research Council], Third Report of the Miners” Nystagmus

Committee, London, HMSO, 1932; E. Dickson, “The Morbid Miner”,

Edinburgh Medical Journal 43 (1936), 696-705; R. S. Brock, “A Study of

Miner’s Nystagmus”, BMJ (26 Feb 1938), 443-44; 76 Wootton, Lament for Economics (London: George Allen and Unwin, 1938),

42, 43-44. 77 Wootton, Freedom under Planning, (London, Allen and Unwin, 1945),

24-25.79 E. F. M. Durbin, The Politics of Democratic Socialism, An Essay in Social Policy

(London, George Routledge and Sons Ltd., 1945), 331; idem. (George

Routledge and Sons Ltd., 1942), 95-6.80 Ben Mayhew, “Between love and aggression, the politics of John

Bowlby”, History of the Human Sciences 19.4 (2006), 19-35; Hugh Gaitskell,

“At Oxford in the Twenties” in A. Briggs and J. Saville (eds.),

37

psychological forces was embraced during the Second World War.

Durbin’s friend and fellow Fabian, the psychiatrist Stephen

Taylor, argued for the institution of new systems for

surveying and managing anxiety – which was now seen as the key

to morale. Drafted into the Ministry of Information, Taylor

drew upon a broad range of organizations and medical

professionals to estimate the levels of neuroses in the

population. Taylor’s work is now fairly well known, in part

because his studies of civilian neuroses became central to

later debates among historians over British wartime morale and

the ‘myth of the Blitz.’83 At one level these debates rehearse

Taylor’s own efforts, and those of his contemporaries, by

picking over illness presentations and aspects of behaviour in

order to establish different readings of the psychology of the

population.

Taylor’s attempt to reconstruct the national psyche

reinforced the equation that he and his colleagues made

Essays in Labour History (London: Macmillan, 1967), 6-19.81 Personal Aggressiveness and War, (London: Routledge and Kegan Paul,

1937).82 Durbin, Politics, 7183 Calder, The Myth of the Blitz, (London: Pimlico, 1992); Mackay, R. 2002.

Half the Battle, Civilian Morale in Britain during the Second World War, (Manchester,

Manchester University Press, 2002); Edgar Jones, Robin Woolven, Bill

Durodie and Simon Wessely, “Civilian Morale during the Second World

War, Responses to Air Raid Re-examined”, Social History of Medicine 17.3

(2004), 463-79.

38

between social medicine and political action. As Taylor

noted, the Labour party agenda of social reconstruction and

the public health agenda of psychological medicine coincided

around this issue: anxiety could only be dealt with through

economic intervention. Writing in the wake of the Beveridge

Report, which could now be seen as a kind of social panacea,

he argued that the way to health and happiness, ‘lay not in

the medicine cupboard’ or ‘the pages of Keep Fit magazines’

but in the pragmatic pursuit of social reconstruction. This

would involve the provision of decent foodstuffs, the

construction of new houses and homes, the guarantee of income

to remove insecurity and the establishment of a system of

socialised medicine to remove the anxiety of sickness and its

associated costs from the British family. The pragmatic way,

Taylor argued, was the way pursued by the Labour Party.84

**

This language of public emotion and social neurosis became

central to the Labour Party programme after 1945. It

underpinned debates on post war planning and the organisation

of the welfare state.85 It shaped ministerial rhetoric and 84 Battle for Health, A Primer of Social Medicine, London, Nicholoson and Watson,

[1944], 122-24 c.f Taylor, MUN Centre for Newfoundland Studies,

Stephen Taylor 5.04.008, Labour Party Policy, A White Paper for a

Post War World [An unofficial but authoritative statement of

Labour’s proposal for reconstruction], 2, 24; Wilson Jameson,

“Industry’s contribution to positive health” in Ministry of Labour

Conference on Industrial Health (London, HMSO, 1943), 22-26.

39

defined the horizons of the political programmes.86 Aneurin

Bevan, despite his differences with Durbin and Gaitskell,

became an enthusiastic exponent of the possibilities of social

psychiatry. In September 1945, shortly after becoming Minister

of Health, Bevan warned members of the Royal Medico-

Psychological Association that ‘many of the maladjustments and

neuroses of modern society’ arose directly from poverty and

insecurity. ‘Unless’, he added ’we were able to plan our

social life intelligently, with a design and purpose into

which the individual could adapt himself there will be more

mental maladies which no clinical measures could solve.’87

Psychological problems demanded political solutions.

Bevan’s ideal of social planning was grounded in an

eclectic psychology drawn from late nineteenth and early

87 Aneurin Bevan, 104th Meeting of the RMPA, 1946, JMS Supp (Jan

1946), 15-16, repr. in C. Webster (ed.), Aneurin Bevan on the National Health

Service, (Oxford: WUHOM, 1991), 19.85 See references to anxiety and neurosis in the debates on the

foundation of the health service, HC Deb 12 June 1945 vol 411 c.

1527 (J. Griffiths), 1537 (J. Boyd-Orr), 1575 (R. McIntyre; H.

Morgan); national insurance, HC Deb 10 October 1945 vol 414 c. 329

(S. Taylor). On the overall need for security, Michael Young,

Labour’s Plan for Plenty (London: Victor Gollancz, 1947), 101-20.

86 For an overview, see Stephen Fielding, “To make men and women

better than they are? Labour and the building of socialism in the

1940s” in J. Fyrth (ed.), Labour’s Promised Land? Culture and Society in Labour

Britain, 1945-51 (London: Lawrence and Wishart, 1995), 16-25.

40

twentieth-century sources. He likened society to an organism

‘except that it has no head and therefore no mechanism with

which to receive and coordinate the [nervous] vibrations.’’88

This organicist metaphor was drawn from the work of Herbert

Spencer but it was animated through reference to the early

dynamic psychology of the neurologist, Wilfred Trotter

(brother-in-law to pioneer British psychoanalyst, Ernest

Jones) who had described human life as an ongoing conflict

between the herd and sex instincts. This shifting language

has usually been seen as part of the tension in Labour thought

between the old language of ethical socialism and a growing

commitment to technocratic planning. 89 However the language

and instruments of the new psychology allowed abstract ideals

such as communitarianism and citizenship to be recast as

problems of psychological health.

Durbin and Taylor, supported by a number of senior

ministers including Hugh Gaitskell and Stafford Cripps, began

to see the planned economy as a kind of therapeutic state in

which psychological health would be achieved through effective

social interventions.90 Government ministers, particularly

88 A. Bevan, In Place of Fear, (London: William Heinemann, 1952), 37-38.89 On the shift see, Martin Daunton, “Payment and participation,

Welfare and state formation in Britain, 1900-1951”, Past and Present 150

(1996), 208-12; Jose Harris, “Political Thought and the Welfare

State 1870-1940, An Intellectual Framework for British Social

Policy”, Past and Present 135 (1992), 116-41; Steven Fielding,

“Labourism in the 1940s”, Twentieth Century British History 3 (1992), 138-53.

41

those associated with the Labour Party Research Department and

the New Fabian Research Bureau, began to explore the

possibility of psychological planning drawing upon the

Tavistock Institute’s work on human relations.91 In September

1945, Durbin and Cole organized a conference on the

‘Sociological and Psychological Problems of Modern Socialism’,

in which they argued (following Bowlby) that the Labour

programme could only become effective through the

libidinization of policy. Responding to Margaret Cole’s

complaint that ‘the promoters of cinemas, greyhound racing and

Butlin camps, have shown a much livelier and more imaginative

sense of the demands and sentiments of a large citizen body

than have its professed organisers’, Bowlby argued for new forms of psychosocial intervention.92 As he noted, ‘Since the

capacity to libidinize long-term ends, social leaders and the

group itself is clearly critical for all co-operative effort’

it became necessary to tackle all forms of personal insecurity

and anxiety stretching back to maternal separation.93 In his

role as parliamentary secretary to the Ministry of Works,

Durbin pressed Herbert Morrison in April 1946 to institute a

programme of preventative psychiatry in which vulnerable

adults, teenagers and children would be subject to

90 For attitudes to psychology in the Atlee government, see, Martin

Francis, “Economics and Ethics, The Nature of Labour’s Socialism”,

Journal of Contemporary British History 6.2 (1995), 220-43, es 235-41; Nick

Tiratsoo and Jim Tomlinson, Industrial Efficiency and State Intervention, Labour

1939-51, (London, Routledge, 1993), ch. 5.

42

psychological screening and therapeutic counseling through the

planned new health centres.94

Although Durbin’s campaign was cut short by his death, the

ideal of preventative psychiatry enjoyed broad support among

the professions. In 1945, a joint meeting of the Royal

Colleges, the British Medical Association and the Royal

Medico-Psychological Association issued a statement claiming

that: ‘Where psychiatry begins and ends has not been settled.

Within the development of preventative medicine its borders

will become less rather than more definite.’ Like Durbin,

Bevan and Taylor, they argued that what they called ‘the

extrinsic factors of psychopathology’ – the anxieties

generated by economic insecurity and domestic unhappiness -

were now the proper targets of social medicine. 95 The old

Labour evils of poor housing and unemployment were now recast

in the language of morbid psychology.

The experience of anxiety that had been made evident

through the machinery of welfare administration now provided,

in part, the rhetorical foundations of that machinery.

Anxiety, as a psychological object, brought together different

aspects of life – the social, the somatic, the psychological

and the political – allowing new forms of government and

therapy to be imagined. Yet no single stable element underlay

these processes and investigations. Rather the form and

nature of personality, emotion and government were constantly

redefined through their relationship with each other. Anxiety,

43

which had moved in Freud’s arguments from being a symptom of

libidinal frustration to a mnemonic for forgotten dangers, was

now held up as a demand for social integration.96 In the

writings of the long-standing members of the British

psychoanalytic establishment, particularly those inspired by

the work of Melanie Klein, integration, rather than

satisfaction, became the key to psychological health.97 The

neurotic’s complaint was transformed into a demand for a new

social order.

**

The welfare state created new psychological objects and these

objects in turn shaped the emergence of the welfare state. Yet

the categories and conditions that emerged within these new

forms of welfare administration - suburban neurosis, busman’s

stomach and nervous fatigue – enjoyed only the most transitory

existence. Anxiety, which had provided the psychological

touchstone for post-war welfare schemes, would, by the 1960s

lose its leading position among the psychiatric diagnoses. It

was eclipsed by a rising tide of clinical depression.98 While

historians, psychiatrists, sociologists and epidemiologists

may argue over the basis of this shift - and its seems likely

that much of the transformation can be attributed to a process

of diagnostic reclassification driven by the pressures of

pharmaceutical marketing - it is worth noting that the rise of

depression entails new forms of political action.99 Although

the meanings of depression are contested, in the writings of

44

social epidemiologists and evolutionary psychologists, the

condition is related to problems of hierarchy, loss and social

justice.100 We can only look forward to the political

transformation that this psychological object might encourage.

If historians are to turn away from discourse in an

attempt to somehow confront the fleeting psyche, then the

changing patterns of suffering and somatisation experienced

across the British population in the twentieth-century would

seem a good place to begin. These changing patterns however,

do not reveal a deep subjectivity that somehow escaped

historical determination. Rather it is a psyche both

91 Tavistock workers enjoyed close relationships with leading

members of the Labour Party. Alongside Bowlby and Durbin’s

friendship, Eliot Jacques was close to Stafford Cripps and A. T. M.

Wilson with Max Nicholson, PPS to Herbert Morrison. Margaret Cole

remained on the Board of the Clinic from 1935. On these

relationships see Rockefeller Archive Center RF 1.1 401A Box 27

Folder 34992 Margaret Cole “Introduction” and Durbin “Response to Bowlby” in

Conference on Psychological and Sociological Problems of Modern

Socialism, BLPES Durbin Papers 4/8 Notes on Social Psychology.

Quotation on 5.93John Bowlby, [Light thrown by Modern Psychology on the Present

Problems of Social Development] in Wellcome CMAC PP/Bow/F.3/1;

idem., “Psychology and Democracy”, Political Quarterly, 17 (1946), 61-77,

quotation, 67.94 Wellcome CMAC PP/BOW/A6/1 Proposals for Socio-Psychological

Research (Evan Durbin to Herbert Morrison, 15 April 1946)

45

constituted in and working to constitute new political

settlements.101 Our attempts to grasp the psyche - whether in

the administration of an insurance claim, the development of

nation policy or the writing of narrative histories – endow it

with new characteristics and qualities. History is not an

inadequate measure of psychological change: rather it is all

too adequate. In its attempts to grasp the inner life, it 95 [Royal College of Physicians, British Medical Association and the

Royal Medico-Psychological Association], Memorandum on the Future

Organisation of the Psychiatric Services [1945] repr. BMJ Su (16 June 1945),

111-16, on 111; D. R. Macalaman, “The Development of Psychiatry

within the NHS”, Proc.RSM 42 (1949), 365-66; Desmond Curran,

“Psychiatry Limited” JMS 98 (1952), 373-381; F. A. E. Crew,

“Opportunity for adventure” Lancet (27 August, 1949), 357-58.96 A. C. Oerlemans, Freud’s Conception of Anxiety, 117. 97 Majorie Brierley, “Notes on Psycho-analysis and Integrative

Living”, International Journal of Psycho-analysis 28 (1947), 57-105; W.

Hollitscher, “On the concepts of psychological health and illness”,

IJPsA 24 (1943), 125; R. E. Money-Kyrle, ‘some aspect of political

ethics from the psycho-analytic point of view”, IJPsA 25 (1944),

166-71;; Gregory Zilboorg, ‘sociology and the Psychoanalytic

method”, ] 45 (1939), 341A. W. Wolters, “The concept of mental

maturity” Nature 156 91945), 494. For neurology, see, Roger Smith,

“Biology and Values in Interwar Britain, C. S. Sherrington, Julian

Huxley and the Vision of Progress”, Past and Present 178 (2003), 210-

42.98 A. V. Horwitz, “How an age of anxiety became an age of

depression, The Milbank Quarterly 88 (2010)99 Mikkel Borch Jacobsen, “Psychotropicana”, LRB 24.13 (11 July

46

populates the world with new psychological objects and,

through this process, self and society are made anew.

2002), 17-18 repr. Making Minds and Madness, The Great Depression, Cambridge,

Cambridge University Press, 2009, ch. 11; Peter Tyrer and Edward

Shorter, ‘separation of anxiety and depressive disorders, blind

alley in psychopharmocology and the classification of disease”, BMJ

(18 July 2003),158-60..100 Eric Brunner and Michael Marmot, ‘social Organization, stress

and health”, in M. Marmot and R. G. Wilkinson (eds.), Social

Determinants of Health, Oxford, Oxford University Press, 2006, ch. 2;

Eric Brunner ”Stress and the biology of inequality”, BMJ 314

(1997), 1472-7; Paul Gilbert, “Evolution and Depression, Issues and

implications”, Psychological Medicine 36 (2006), 287–297.101 See the interesting points made by Kanann and Wessely on the end

of patient patronage and the break up of the category of hysteria,

“Factitious disorder”, 74, 80.

47