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2.2.5 The emergence of asylum professionals

Asylums and institutions were not only sites of care and control, they were also places where people worked as staff and developed professional expertise. The people who worked there also experienced segregation, professionally speaking. In this section we take a brief look at the development of caring professions in the institutions.

Low status patients, frequently paupers, with low status illnesses and conditions, such as mental illness, mental frailty or mental handicap, provided no prestige to doctors and other staff who worked with them. These socially stigmatising conditions meant that asylum doctors in mid-nineteenth century England occupied a lower social and professional status than doctors who worked in general hospitals. They could not, for example, offer their services to the large public charities or other bodies. They could not become consultants. Assistant medical officers in the asylums were paid at a lower rate, had to live in, had to delay marriage and had few opportunities for research or professional development. Since doctors at the large general and teaching hospitals did not see people with mental illness, there was also a tendency towards segregation of knowledge and professional skills (Hurt, 1988, p. 115).

If the medical staff were regarded as low in status, the attendants, as asylum nurses were still being called until well after the Second World War, who looked after the patients were very much lower, both within the institutions and within nursing generally. Though the Medico-Psychological Association (MPA), the asylum doctors’ own organisation, was ostensibly in support of training and education for attendants, with several members running their own evening classes during the mid to late nineteenth century, there was concern that successful nurses might challenge the position of doctors. However, by 1899 over a hundred asylums were taking part in a training scheme which led to an examination and certification. Attendants who took part were almost exclusively from the public asylums and were supervised and trained by doctors. This was in contrast with general nurses who, led by such pioneers as Florence Nightingale, had set up training schools which were controlled by nurses. Few private institutions trained their own attendants. Nursing had its own professional organisation by 1887 with the establishment of the British Nursing Association. But asylum nurses were excluded from membership on the grounds that they did not have appropriate experience and were also socially inferior.