Summary of the impact

Research carried out at Northumbria has explored the relations between culture and medicine during the eighteenth century, resulting in an improved historical understanding of the way in which culture influences the experience and treatment of illness. The impact has been significant for members of the medical profession and more widely for health professionals, as well as making a positive impression on the general public. It has also influenced local work in theatre and arts as therapy. The research continues to have implications for our understanding of both popular and medical discourses regarding illness.

Underpinning research

This research developed from the work of Professor Allan Ingram (Senior Lecturer 1980-88, Principal Lecturer 1988-93, Professor 1993-present) in the field of mental illness and of Professor Clark Lawlor (Lecturer /Senior Lecturer 2000-06, Reader 2006-13, Professor 2013-present) in the cultures of disease. Ingram's The Madhouse of Language (1991) led to a series of publications recovering little-known texts in writing about madness from the period (Voices of Madness (1997), Patterns of Madness (1998)) and analysing works of literature and art within a cultural and medical context (Cultural Constructions of Madness (2005)). Lawlor's Consumption and Literature (2006) was a case-study of a specific disease in terms of cultural and literary perceptions. His analysis of the phenomenon of a `fashionable' disease focused upon literature's role in shaping the individual expression of, and cultural perspectives on, mental and physical illness. He also broke new ground in actively seeking to extend historical analysis to a comparison with our own times.

The group's interests were consolidated by the award of a Leverhulme Trust major research project grant (£239,541) for `Before Depression: The Making of the English Malady, 1660-1800' in 2006, a project that took place between 2006 and 2009 and brought Leigh Wetherall-Dickson (Research Associate 2006-09, Lecturer /Senior Lecturer 2009-present) to the group. Her work until then had been on Caroline Lamb, though she also pursued an interest in autobiographies, diaries and journals, especially in relation to mental unease. The three researchers have achieved results in overlapping fields. Ingram identifies the discrepancy between the private experience of illness and increasingly professional medical views. Lawlor demonstrates how the status and experience of illness is altered by its literary context and Wetherall-Dickson shows the subjective experience of illness, particularly mental, being dealt with in autobiographical writings.

`Before Depression', with a programme of public lectures, a major exhibition of works of art and a website with downloadable talks, has played a major part in developing impact for this group, while the project has also resulted in a series of more strictly academic publications (Melancholy Experience (2011), the four edited volumes Depression and Melancholy, 1660-1800 (2012), four collections of edited articles (2011, 2012, 2013) and Lawlor's monograph From Melancholia to Prozac (2012)). The key conclusion reached by the project, and reflected in its publications, was that the nature of the individual experience of depression was intricately related to the cultural, social and intellectual contexts of the time. This, it was argued, extended to diagnosis and treatment, to literary, dramatic and artistic representation and, of course, to the nature of public understanding and/or stigmatisation.

Building on the success of the project, a further Leverhulme Trust major research award (£259,193) has been confirmed (2012) for `Fashionable Diseases: Medicine, Literature and Culture, 1660-1832'. This project will be broadening the range of maladies from `Before Depression' while focusing very precisely on the notion of `fashionability'. The project is underpinned not only by the work for `Before Depression' and research prior to that, but by Wetherall-Dickson's publications on Lady Caroline Lamb and by our Visiting Research Fellow, Dr Michelle Faubert (University of Manitoba), who has published on nerve doctors.

References to the research

Details of the impact

Exploring a historical perspective to depression and demonstrating that perception and individual experience of illness is interwoven with the cultural, social and intellectual contexts of the time has been particularly instrumental in the development of the impact. It has led to collaborations in the form of workshops with a range of local mental health groups and health practitioners and with local organisations such as Tyne and Wear Museums, who mounted the public exhibitions. There has been a measurable impact on medical practitioners, on members of the public, some of whom have been patients or are family of patients and on those working in the field of arts therapy.

Medical Practitioners

On 10 February 2013 Ingram, by invitation from a well-known psychotherapist, ran a one-day workshop in London on `Patients and their Gaolers' as part of the `Inner Circle' series aimed at practising psychotherapists. Views expressed as feedback demonstrate the kinds of impact this research has had on medical professionals: "This talk has broadened my outlook on the use of language — particularly with respect to accounts of "madness" from an historic perspective" (source 1); `It has given me a greater insight as to how so-called "mental disorder" was "identified" and "treated" in the 18th century and hence to think about how it is regarded today. It has reinforced the way I try not to be judgemental of my clients and how not to have preconceived ideas of their "condition"' (source 1); "I am the more determined to resist the pressure ... to perceive "mental disorder" where I see a humanly intelligible social situation. The historical reflection is directly relevant to achieving clarity in present-day therapeutic practice" (source 1). More broadly, feedback from the `Before Depression' lectures and from the website downloads (www.beforedepression.com) has testified to the beneficial effects of this work in illustrating that diagnoses are more a function of subjective opinion rather than objective science (questionnaire feedback from clinical psychologist, source 7) and, from a lecturer in mental health nursing, that the research had the effect of persuading his students "to see practice in terms of changes and consideration of ethical perspectives" (feedback questionnaire, source 7). Requests have also been received from clinical practitioner/teachers to store the podcasts as a resource for teaching (School of Health Sciences, Waterford Institute of Technology) and from a worker for a mental health and well-being community centre in Australia that provides resources, support and information to people suffering from depression.

General Public

The lectures and downloads, as well as the art exhibition, have impacted beneficially on a wider public. Feedback questionnaires received from those downloading lectures include one person describing themself as "recovered, medication free, from bipolar disorder with schizo-affective side issues" and another as "ex-patient, poet and artist". The former states that it was "fascinating to see how "diagnosis" changed [and] assumptions differed" over time, adding: "Those in distress have been habitually mistreated and socially controlled, set apart and deprived of human rights. Anything that shows this to a wider audience, and helps to set a gold standard of holistic person centred support has got to be good" (source 7). The latter notes how the research put mental disturbance into perspective because "history shows the benefit of returning to a humanitarian perspective and foundation for all interaction rather than a purely clinical approach" (source 7). One family member simply appreciates the lecture because of depression in his family: "my daughter walks with the black dog" (source 7). There have been 518 lecture downloads since 2007 from around the world (source 6).

The `Before Depression' exhibition, 18th-Century Blues, took place at the Shipley Gallery, Gateshead, between June and August 2008 to very positive reviews and was visited by an unusually large number of people — 8,344, representing a 39% increase on the same period in 2007. Quotations from the visitors' book include various testimonies to the impact of this exhibition and, implicitly, of the work behind it: "A timely examination of depression which is often thought of as a modern disease" (source 5), and "A subject which affects so many; it is a show which illustrates how wide depression was, even in earlier times.... A thoughtful, insightful exhibition" (source 5). The project and exhibition remain in the public domain through an on-line blog entitled `Stay on Top; Coping with Depression', which encourages its readers to visit the website, download the podcasts and view the exhibition catalogue in order to `[discover] how professional anti-depression therapies have radically evolved, changed and contradicted each other over the last 150 years' and to `[unearth] long-forgotten experience-based tips [...] still worth considering' (source 5). In a review in The Tablet, the author testified to the impact of the exhibition: "This is a comforting show, not just because of geniuses it fields on the side of depression, but because of the refreshing glimpse it offers of an age of melancholic diversity" (2 August 2008, source 5).

An additional benefit of the exhibition was for the Shipley Gallery itself, whose then curator, confirms not only the rise in visitor numbers and national reviews in The Times and The Guardian (source 5), but that loans to a small regional centre from such major galleries as the British Museum, the V&A, the National Gallery, the National Portrait Gallery, Tate Britain and the Wellcome Library would not have been possible without the academic partnership, and intellectual underpinning, of the research group (source 2).

Arts Therapy

The impact on the sphere of arts therapy has been through Wetherall-Dickson's work on a pilot collaboration between LAUNCHPAD (mental health service users' information hub), Tender Buttons (theatre-as-therapy group) and Tyne, Wear and Esk Valley Early Intervention Psychosis Team. Wetherall-Dickson organised and led a one-day workshop entitled `Listen Here' (28 February 2013), the purpose of which was to connect academic research on the nature and treatment of mental illness with practice-based approaches and personal testimonies (source 7). The event received overwhelmingly positive feedback, including comments from mental health professionals ("how impressed I was by the event and interested to see how the discussion between The Arts and Mental Health continues in the region", source 4) and members of the public ("it helped in `Expanding my knowledge of the benefits (and real need) for self-knowledge, creative expression in connection with physical and mental health", source 7). The event is part of a more sustained collaborative project seeking to understand mental illness as something more than a mere diagnostic label indicating a broken individual. The project will be a point of entry into discussions about theory, contemporary culture and everyday life, with the findings being co-produced by practitioners and patients.

Sources to corroborate the impact

1. Individual Testimony plus Feedback: Psychotherapist and organiser of `Inner Circle Seminar' to corroborate claims about the benefits of the historical aspect of mental illness on modern practice. Feedback forms from this seminar also available. See also
   http://anthonystadlen.blogspot.co.uk/2012/01/locked-up-patients-and-their-gaolers-10.html
2. Individual Testimony: Curator of Shipley Art Gallery to corroborate claims about the impact of the art exhibition in terms of increased visitor numbers: 8,344 including children's clubs and special interest groups.
3. Individual Testimony: LAUNCHPAD Team Leader, www.launchpadncl.org.uk
   This testimony corroborates the beneficial impact of engaging with current debates about the origins and cultural representation and construction of mental illness.
4. Individual Testimony: Clinical psychologist, Psychosis Community Treatment Team, Gateshead to corroborate claims about work with local arts therapy groups.
5. Reviews of the Exhibition:
   Personal visitor comments from the Shipley Gallery visitor book for the period (available).
   The Sunday Times, 13^th July, 2008
   The Guardian Online (www.guardian.co.uk/artanddesign/2008/jul/09/art1)
   Stay on Top: Coping with Depression (www.stayontop.org/2011/08/30/18th-century-blues/)
   The Tablet, 2^nd August, 2008
6. Online Resources:
   Before Depression project website (www.beforedepression.com), website hits to date 122,143 Origins of podcast downloads: France, Germany, Spain, Taiwan, USA, Australia, Russia, Scotland, Ireland, India, Latvia, China, Netherlands, Canada, Turkey, Poland, Romania, Egypt, Pakistan, Iran, Hungary, New Zealand, Sweden, South Africa, Italy, Belgium, Switzerland, Norway, Bangladesh
7. Public and Professional Feedback in the form of questionnaires and emails from public lectures, talks and seminars. This corroborates claims about heightening public awareness of the complex history and problematic application of the term `depression' and the important contribution that the project has made to public awareness of depression as a concept.