Well? Well almost…

Through his research into the patient case notes of the Mental After-Care Association, Dr Stephen Soanes explores some of the attitudes towards convalescence in the mental health hospital system of the early 20th century.

As a medical classification, convalescence represents a caveat. Neither sick nor completely well, convalescence’s Latin roots (con-valescere meaning ‘to grow strong’) suggest a hedging of bets. Like the outwardly unremarkable yet managed convalescent homes themselves, the convalescent patient was adjudged to be outwardly normal yet to contain sufficient threat of internal disorder to require further observation.

Publicity images of Mental After-Care Association cottage homes from Monthly Pictorial, December 1934. Wellcome Library reference: SA/MAC/H.2/1.

In the 1920s-1930s the Mental After-Care Association (MACA) provided cottage homes for convalescents. These homes functioned as probationary settings. Such homes typically occupied suburban and coastal areas on the edges of urban society. Patients in these homes lived at the margins of both the institutional and the social. Stays were short-lived. MACA’s pre-1924 case books suggest that patients typically stayed for between a fortnight and three months. Often staffed by ex-mental hospital nursing staff, the very employment histories of those who ran them further connected the community management of convalescence with past memories of the mental hospital system.

Cases considered to have relapsed were returned to mental hospitals. The ‘fully convalesced’, meanwhile, went on to re-enter the wider community… albeit sometimes only to return. These case-histories show convalescence as a crucible where strength was tested, with some patients recorded as serial convalescents who passed through institutional care and aftercare on multiple occasions.

My PhD research looked into what it meant to be convalescent patients in England’s interwar mental hospital system. The MACA’s case-books (held at the Wellcome Library) offer a particularly fascinating insight into how patients forged their own understanding of their condition.

Some like Esther M (31 January 1918) and Aby S [sic] (27 November 1924) actively refused convalescence. Esther prioritised her child who she was told she must leave if she wanted to be sent for convalescence. Aby’s entry in the case-book simply records that she turned down any help. By refusing to accept the break afforded by convalescence, both patients undermined the significance of the label itself. To refuse cottage home care implicitly negated the utility of managed convalescence as a means to consolidate health.

In contrast, others welcomed the respite. The historian Diana Gittins has suggested that mental hospitals themselves may have provided a recuperative break to impoverished and overworked women. The out-of-town setting of many cottage homes and their regimen of enforced rest made them easily (if selectively) interpretable as social rather than medical institutions.

Alice T. wrote to thank the MACA for a ‘very nice holiday’ (25 November [1917]). Written testimonials in the MACA’s annual reports suggests that it positively welcomed the idea that its convalescence represented a holiday. At the same time, the description of convalescence as a simple holiday served in its own way to downplay the extent of expertise required for its performance. If convalescence was simply a holiday from everyday stresses, why would there be a need for specialist homes, staff and organisations?

The word has proven more durable than the practice. Since the conclusion of my PhD research in 2011 I have been fascinated to find convalescence invoked in a wide range of recent literary and biographical texts. If convalescent homes are largely a thing of the past in England, the caveat remains that – as was true in the early twentieth century – convalescence itself is alive and well in the English language.

Author: Dr Stephen Soanes completed his PhD, Rest and Restitution: Convalescence and the Public Mental Hospital in England, 1919-39, in 2011. He is a Project Officer (Postgraduate Recruitment) at University of Warwick. Stephen’s LinkedIn profile.