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Social History of Medicine 1998 11(2):255-281; doi:10.1093/shm/11.2.255
© 1998 by Society for the Social History of Medicine
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Case Notes, Case Histories, and the Patient's Experience of Insanity at Gartnavel Royal Asylum, Glasgow, in the Nineteenth Century

JONATHAN ANDREWS*

* Wellcome University Award Holder and Senior Lecturer in the History of Medicine, Oxford Brookes University Gipsy Lane Campus, Headington, Oxford OX3 OBP, UK

SUMMARY This article is concerned primarily with questions as to how and why case notes were produced and utilized, and how they may (or may not) be used by historians. More specifically, it discusses how the Glasgow Royal Asylum's case notes may be deployed to access patients' experiences of madness and confinement. The deficiencies and biases of the case record are also explored. So too is the relationship of case notes with other asylum based records, including reception order questionnaires, with a separate section on patient writings as part of the case history corpus. This leads into an analysis of how the Asylum's case notes became case histories and for what purposes. These subjects are related to changes and continuties in medical ideologies about insanity, social attitudes to the insane and the nature of medical practice in asylums. Some fundamental shifts in emphasis in the use of the note and case history occurred in this period. These shifts were associated with an increased emphasis on organic interpretations of mental disease and on clinical approaches to insanity; with the medicalization of asylum records and the wider discourse on insanity, and with declining deference to the public at large in the presentation of cases. The survey concludes by analysing the changing place of patient testimony within the case record.

Keywords: case notes; case histories; authorship; function; censorship; confidentiality; patients'; experiences; silence; asylums; insanity; Glasgow


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