What was the institution and who was it for?

Pamela Dale
Centre for Medical History, University of Exeter

• There are many studies of different institutions.
• They tell us some but not all of the history of institutional care.
• We need to keep asking new questions.
• This will help us get a clearer idea about different experiences.
• Everybody’s personal experience is likely to have been different. The different experiences are all equally valuable but hard to turn into one shared history.
• A way forward is to think who was in charge of the institution.
• This allows us to think about what they thought the institution was and what they wanted it to be.
• This helps us to understand the experiences of residents and the ways their needs were sometimes met and were sometimes overlooked.

What was the institution and who was it for?

For all our work on institutions we seem to be getting no closer to answering the important questions what was the institution and who was it for? My ten-year research project on the Royal Western Counties Institution at Starcross keeps turning up new questions and issues rather than satisfactory answers. On one level Starcross was just the same as all the other long-stay hospitals. It shared their well-known faults and is easily identified as an institution. From the outside it looks like an institution and from the inside it feels like an institution. Yet, Starcross itself was never one institution but several different ones, which included areas we might want to describe as a school, a factory, a kitchen, a farm, a hostel, a hospital, a refuge, and a prison. These different functions hopefully point to the different as well as shared experiences of residents and staff.

If it is not entirely clear how we can capture what the institution was or all the things it might have represented it perhaps becomes even more important to decide who the institution was for. As person-centred planning gains ground and our attention finally focuses on the real needs of service-users the institutional experience looks worse and worse. Yet the very persistence of the institution (there was one at Starcross for more than 120 years) suggests that it met some perceived need. If this point, rather than the simple limitations of the model of care, can be accepted then it is useful to look at competing interest groups and what they thought about the institution at different times in its history. A key to understanding what happened at Starcross is identifying whose interests were dominant at a particular time and what their vision for the institution was.