10 November 2020

Student Mental Health

'Historicising the “Crisis” in Undergraduate Mental Health: British Universities and Student Mental Illness, 1944–1968' by Sarah Crook in (2020) 75(2) Journal of the History of Medicine and Allied Sciences 193–220 comments 

This article explores how and why student mental health became an issue of concern in British universities between 1944 and 1968. It argues that two factors drew student mental health to the attention of medical professionals across this period: first, it argues that the post-war interest in mental illness drew attention to students, who were seen to be the luminaries of the future, investing their wellbeing with particular social importance. Second, it argues that the development of university health services made students increasingly visible, endorsing the view that higher education posed distinctive yet shared mental challenges to young people. The article charts the expansion of services and maps the implications of the visibility of student mental distress for post-war British universities. It suggests that claims that British higher education is currently in the midst of an unprecedented mental health “crisis” should be seen within this broader historical context, for while the contours of the debates around student mental health have shifted substantially, evidence that there was anxiety around student mental wellbeing in the immediate post-war years undermines accusations that contemporary students constitute a unique “snowflake generation.” 
 Crook argues 

Writing in 1961, Alexander Mair, Professor of Social and Preventive Medicine at St Andrews University, claimed that both mental illness and pulmonary tuberculosis were “known to be two hazards to which university students are especially liable.” Mair argued that physical and mental health were critical to academic effort, and postulated that “Perhaps a high failure rate, in future, may have to be explained in psychological and personality terms rather than on grounds of intellectual inadequacy.” He pointed to broader shifts in the definition of health to support this: he quoted approvingly the 1948 definition of health by the World Health Organisation, as a “state of complete physical, mental and social wellbeing and not merely the absence of disease and infirmity.” This definition, he contested, was “very apposite to the present argument and sufficiently all-embracing.” As Mair’s argument shows, students’ psychological status has long been of interest in British universities. Indeed, anxiety about student mental health has a longer historical lineage than that which is allowed by headlines proclaiming a contemporary crisis (“UK Universities Act to Tackle Student Mental Health Crisis”). Instead, the perceived crisis in student mental health can be traced back to the period following the Second World War, as undergraduates came to be positioned as the luminaries of the future and mental health came to be seen as a pressing social issue. While the contemporary debate is different in scope and intensity, the history of student mental health suggests that since the 1940s the student mind has been a locus of particular concern in the medical imagination and that medical professionals have long argued that distinct care and services are required to meet student mental health needs. 
This post-war era shift in interest in student mental health was set in a landscape of changing attitudes towards mental health more broadly. Rhodri Hayward has noted that during the 1930s and 1940s a belief emerged that “human nature itself could be improved through a coordinated series of psychological interventions.”  During the Second World War, as Chris Millard has established, the “psychological significance of personal relationships, of adjustment to situations, of communication and social interaction become central to the linked aims of maintaining military and civilian morale on one hand, and returning psychological casualties to service as soon as possible on the other.” As demonstrated by Mathew Thomson, the aftermath of the Second World War positioned psychology as a “tool of social engineering,” in which mental health was configured as “inextricably linked to the defence of a democratic way of life.” The period was one of transformation in British welfare history; the creation of the National Health Service (NHS) in 1948 and the integration of mental health care into its services, alongside the increased availability of minor tranquillisers, framed the importance accorded to mental health in the period following the Second World War. As historians have demonstrated, too, eugenics retained influence even after 1945; as we shall see, there are strands of eugenic thinking that emerged in discussions about the importance of student mental health. 
While the development of British higher education, universities, and students have been subject to historical study, for example by Carol Dyhouse, William Whyte, and Michael Sanderson, scholarship on the history of university student mental health in Britain has not yet developed. When Universities UK compiled a bibliography of the work on mental wellbeing and university students in 2016, the authors found little that explored the British context, instead pointing readers to the better-developed literature around American college campuses. A study of mental health in higher education under New Labour noted the “long tradition of viewing education as curing, or causing, mental illness” but stopped short of exploring how the years immediately following the Second World War shaped the mental health and higher education climate of Blair’s Britain. Meanwhile, scholars have explored the history of concern about the effect of schooling and examinations on children’s mental health. Recent scholarship has established that children in the mid-1880s were diagnosed as suffering from “over-pressure,” a scourge that might, in extreme cases, result in child suicide. The controversy allowed teachers, argues Christopher Bischof, to lay claim to “specialised, uniquely intimate knowledge about children.” The debate about undergraduate mental health in post-war Britain similarly allowed professional expertise to be affirmed: as we shall see, the expertise of those overseeing student health was recognised by the establishment of a professional association in 1951 that held conferences, conducted research, and promoted the development of student health services. 
Concern that student mental health was in crisis can be traced back to the post-war years in Britain. This unease, it is worth noting, was international: a conference on student mental health hosted in London in April 1961 was convened in light of the suspicion that in recent years “the incidence of mental ill-health among students in some countries has increased apparently to an alarming extent.”  It was widely argued that while all young people faced difficulties, university students faced particular challenges and that these were increasing in magnitude. In 1963 the sociologist Ferdynand Zweig conducted a study into The Student in the Age of Anxiety and mourned that the “happy and easy tone, the gaiety, the carefree existence of the bohemian are largely replaced by the conscientiousness of the plodding student who wearily drags his feet and sweats out his examination papers to the satisfaction of his superiors. A zest for life, the exuberance of youth, lightness, humour and wit are largely lacking.” The Cambridge University Student Representative Council reported in February 1967 that while students did not seem to suffer mental illness disproportionate to their age group, the present generation of students was under greater pressure to succeed than those studying twenty to thirty years ago. Like the psychiatrist G.M Carstairs - who observed in his 1962 Reith Lectures that the landscape of morality had changed, leaving adolescents psychologically unmoored - the Cambridge committee observed that “At present, when the moral values of society are constantly being re-examined, it may be difficult for a young person to form his own set of principles, and failure to do this can result in psychological disturbances.” Anxiety about student mental health became a lexicon through which broader concerns about social shifts could be articulated. As we shall see, it was not just Cambridge that was uneasy: a report from the University of Sheffield suggested that the incidence of anxiety had more than doubled over the five years preceding 1965. The report asked if the students themselves had changed, if they were indeed more anxious, or if they were more likely to seek help, as this upsurge was “far greater than can be accounted for by the increase in student population.” 
The student population did indeed change between the end of the Second World War and the cusp of the 1970s. Before the war just three percent of the age group received some tertiary education, rising to 6 percent by the early 1950s. By the end of the 1950s, Peter Mandler argues, demand for access to higher education had flourished, driving expansion. The post-war expansion of higher education was unambiguous and rapid as new institutions were awarded university status. Student numbers rose, driven, as Michael Sanderson has argued, by a concern for greater social justice and a perceived need for expertise after the Second World War.  The Robbins Report of 1963 was, John Carswell tells us, dominated by two themes: the expansion of higher education to enable greater numbers of students to access it, and the assertion of the autonomy of higher education institutions.  The report established that “courses of higher education should be available for all those who are qualified by ability and attainment to pursue them and who wish to do so.”  By 1972, 14 percent of school leavers went on to higher education: a new cohort of students emerged, and the stage was set for universities to become more socially diverse than ever before. 
Significantly, the Robbins Report also recommended greater research into universities, a call heeded by those concerned about student mental health. Dr Nicolas Malleson (1923-1976), a key figure in driving the interest in student mental health in this period, was critical to the foundation of the Society for Research into Higher Education (SRHE) in 1965. Malleson, who in 1965 wrote a handbook on student health services in Britain, was the Director of the University of London Research Unit for Student Problems as well as leading the University of London Central Institutions Student Health Service. As Michael Shattock has noted, Malleson’s early research into student drop-outs at University College London (UCL), where he had been Physician in Charge, was not welcomed as his findings that wastage was as high as 27 percent reflected unfavourably on the institution.  Malleson believed that too many students were failing at university because of emotional and psychological problems and that this wastage exacerbated the pressure on university places.  The drop-out rate at British universities remained a problem: at the end of the 1960s it was around 14 per cent.  As I later discuss, concern about student mental health was the driver for the establishment of organisations that treated the university as the subject of research. 
This article explains the interest in student mental health as arising from a particular investment in young people whose educational status made them visible and imbued them with a distinctive social value in post-war Britain. Moreover, I argue that student visibility was intensified by the conviction that they were a community that was particularly vulnerable, or liable to, mental distress. As I show, anxiety around student mental health in post-war Britain transformed the university into what Nikolas Rose has termed a “surface of emergence,” a site at which “psychology would find its subjects, scrutinize and study them, seek to reform or cure them, and, in the process, elaborate theories of mental pathology and norms of behaviour and thought.”  The transformation of the university into a site of introspective research in the post-war period was enabled and encouraged by concern for student mental health. Spanning from the 1944 publication of the Goodenough Report to the cusp of student protests in 1968, this article demonstrates that the contemporary “crisis” in student mental health has historical antecedent in post-war Britain. 
Drawing primarily on materials written by medical professionals working in university health services, this article makes a second argument, that the development of discrete student health services enabled the collection, articulation, and dissemination of data about student mental illness, and that this process itself affirmed that students experienced distinct mental health challenges. Here, the article is in dialogue with historians who have charted the rise of surveying techniques, and the ways that personal experiences and private feelings become legible and stable in the public realm. As Ian Hacking noted in discussing an earlier period, statistics provide more than information; statistics are “in itself part of the technology of power in a modern state.”  The institutional enablement of the production of data about student mental health forms a part of a larger story about how statistics became a guiding logic of institutional life. “Being studied, and being privy to the results, is an understood and unexceptional feature of modern life,” Sarah Igo has argued about modern America; we see here how student minds came to be studied and how concern for undergraduate mental health came to be a feature of the modern British university.