In the early twentieth century, the modern British health system became structured in line with two sets of binary distinctions: between mental and physical, acute and chronic illness. According to some historians, this system was gradually transformed over the next decades through a series of changes in provision and policy, which integrated mental and general medicine and adopted a more progressive, humane approach to chronic illness. Challenging this narrative of integration and progress, this thesis shows and explains why over the twentieth century the modern British health system continued to conceptualise illness as either mental or physical, acute or chronic. During this period, members of the British medical and psychiatric profession positioned disease categories on either end of these binaries axes in order to connect them to specific provisions, resources and policies, to allocate medical care or financial support, and thus meet the needs of an increasingly comprehensive, yet often ill-equipped health system.
In order to explore this contention, focus is on a specific group of illnesses which emerged and persisted for long periods of time after an acute viral event, often came into conflict with and thus from historical perspective expose these binary structures. Whilst this thesis explores how these illnesses were ultimately brought within categories aligned with the concepts of mental/physical and acute/chronic, it also highlights one important exception to this rule: Encephalitis Lethargica. Unable to align with these binaries, to be related to a series of practical decisions, and therefore fitted into the contemporary health system, this category therefore disappeared entirely. Given that these binaries endure and inform inequalities in our health system today, this thesis also hopes to provide an account of the past which helps us to better understand and critique circumstances in the present.
