Cultures of Harm in Residential Institutions for Long-Term Adult Care in Britain, 1945-1980s

This project returns to the hospital inquiry documentation of the 1970s to gain a deeper understanding of the values, belief systems and practices that fostered a culture of neglect and abuse in some wards and institutions.

The Research Project of Dr Louise Hide (affiliate: Wellcome Trust Research Fellow)

For the ‘Cultures of Harm’ project, funded by the Wellcome Trust, I am analysing the extensive documentation generated by abuse inquiries that took place during the 1970s. My main focus is on the Whittingham Hospital in Lancashire and South Ockendon Hospital in East London, both of which concern people who were in need of long-term care, particularly older people and those with intellectual disabilities. A close analysis of these records, including thousands of pages of interview transcripts and witness testimonies, reveals a deeper understanding of the prevailing belief systems, attitudes and practices that gave rise to and perpetuated abusive behaviours.

How, I ask, did these belief systems emerge within specific contexts that revolved around the changing meanings of ‘harm’ and ‘care’, particularly during the period immediately following the Second World War? What, for example, were staff attitudes towards pain? Indeed, ideas around the degree to which certain groups of people are believed to be sentient have shifted since the eighteenth century, raising important questions about what it has meant to be human over different junctures in time.

Cultural beliefs and practices do not exist in a vacuum. They are discursively constructed by ever-changing ideologies circulating both outside and inside the institution. In the post-war period, we cannot discount the traumatic after-effects of conflict, the re-organisation of the health system including the formation of the NHS, the prospect of deinstitutionalization and the move towards community care, the introduction of powerful new psychotropic drugs, immigration, political activism, and the move towards the privatisation of long-term care from the late 1970s. All had a bearing on the social, cultural and psychological mechanisms that created, interpreted and normalised belief systems, language and behaviours. Their influence was pervasive in the meanings that staff, patients and the public attributed to notions of ‘harm’ and ‘doing harm’ – concepts which were, in turn, articulated within shifting meanings and expectations of ‘care’, being ‘cared for’, and what it meant to be a ‘carer’ for some of society’s least valued citizens.

I am interested not only in the beliefs people held, but in how they gained traction in ward environments and were passed on through certain cultural vectors such as: rhetorical devices (language, jokes and silence); the organisation of spatial and temporal structures; the role of material objects such as clothing; and the practice of cruel, violent and neglectful behaviours. How were these actions and behaviours understood within contemporaneous ideas of compassion and empathy? What organisational and individual mechanisms such as complicity, denial and ‘turning a blind eye’ allowed them to take place over long periods of time?