Peter Townsend, social research and the incontinent body

A couple of months ago, I took a long train ride to Colchester to visit the University of Essex’s Special Collections and Archives, which today holds the Peter Townsend papers. Though Townsend is most known for his contributions to post-war social research on poverty, disability and aging, as well as his influence on government policy, I visited Colchester to find out what his work might tell me about the elderly incontinent body. I spent two days rifling through his research notes and materials, during which time I found a report which he had produced in late 1959 with the support of his wife, Ruth Townsend, and Robert Pinker, as part of a broader study of residential care for the elderly in England and Wales.

Summarising their impressions of Ladywell Lodge – a large, state-funded home for the elderly in London – the report offered a detailed, vivid description of its interior, as well as the behaviour of the staff and lifestyle of some residents. Built in 1900 and funded by the London County Council, in late 1959 the Lodge housed 725 people. The building was seen as large and imposing; stepping through the entrance gave the Townsends and Pinker the impression that they were entering Grand Central Station. The walls of the dormitories were covered by ‘brown tiles up to waist level and black empty fireplaces everywhere’, there were also ‘few signs of personal possessions’ and a ‘great shortage of cupboard and locker space’. Married couples admitted to this ‘depressing’ institution together were forced to live in segregated dormitories, and only 4 men and 12 women were seen to ‘do any form of hobby for as much as 2 hrs [sic] a week.’

This bleak, ‘prison-like’ environment was also seen to have health implications, which to the authors, was evidenced by the high number of residents with urine incontinence. By highlighting how some had to go through ‘5 separate dormitories to get to the nearest w.c’, the authors therefore linked the prevalence of urine incontinence to the material structures and layout of this institution, which they believed demotivated residents and discouraged them from getting out of bed.

As I worked my way further through the many documents which comprised this huge collection, I found numerous references to urine incontinence. And the more I read, the more I began to think about if and how Townsend’s work was both articulating and reinforcing a particular perception of urine incontinence. In her project research, Dr Claire Jones has confirmed that prior to the late 1950s, members of the medical and psychiatric profession understood ‘bedwetting’ or ‘enuresis’ as common complaints in children. By the 1970s, urine incontinence would however become a condition linked to old age and seen in certain elderly bodies. Reading through the Townsend papers therefore got me thinking about if they might help us to understand how and why this historically-specific discourse of the urine incontinent body emerged at the intersection of post-war social research and gerontology, both of which were in turn working on behalf of the newly-established welfare state.

In the late 1950s, Townsend’s study of residential care in England and Wales reflected a more general interest in aging amongst social researchers and politicians. Social surveyors had initially become interested in aging during the late-nineteenth century with a focus on the issue of poverty (Greenhalgh, 2018). In this context, aging was linked to particular material, bodily needs, which social surveyors argued should be addressed by the state, ultimately informing the introduction of pensions. Medical and psychiatric interest soon shifted to the inner, mental lives of elderly people and steadily grew through the 1920s and 1930s, with the emotions of the elderly becoming a key focus of intervention within the welfare state. Social scientists were enlisted to conduct research and gather data that shed light on the everyday, emotional lives of the elderly, whether they lived at home or in an institution. In the process, they offered recommendations for policy and arguably buttressed what Teri Chettiar has described as a post-war ‘intimate state’, focused on producing healthy, democratic citizens (Chettiar, 2023).

Townsend’s study of residential care for the elderly represents one of the most recognised examples of such research, known for its detailed examination of older people’s social lives and for its practical policy suggestions. And whilst this study has been widely discussed and critiqued by historians, few (if any) have sought to explicate the numerous references made by Townsend and his colleagues to urine incontinence. This seems to be a common theme in our project research, which is instead showing how and why urine incontinence became seen as a problem in very different institutional, political, social and economic contexts and located in different bodies throughout the nineteenth and twentieth centuries.

Though references to urine incontinence in Townsend’s study vary in their focus, they often spoke to and revealed the material conditions and emotional dynamics associated with care of the elderly. In one document, for example, incontinence was cited by a welfare officer as the source of tension between an elderly person and their family in the home, driving the decision to admit the former to an institution. The daughter expressed confusion as to why her mother ‘wet the bed’, as well as frustration that ‘if you don’t go up and help her she’ll do it on the floor’; this generated additional work in terms of cleaning or replacing bedclothes. In other documents, urine incontinence was also linked to a particular kind of residential home – to welfare officers, the report suggested, caring for an elderly person with incontinence put strain on the staff and material resources of smaller institutions (which were often, not unrelatedly, funded privately and therefore housed people of the middle or upper classes). Many of these references were therefore mediated by both gender and class.

Perhaps most commonly, references to incontinence also offered evidence of deprivation within residential homes. In a report on St. Audry’s, an NHS psychiatric hospital, the unnamed author recounted how they had witnessed one ‘old woman get up quietly from her seat and shuffle down to the end of the ward, returning some moments later with a floor cloth, getting down on her knees and without comment she mopped up a pool of urine beneath her companion’s chair.’ Afterwards, they saw her lead ‘the old lady down to the sister’s room for attention to her … [with no] chiding, no scolding.’ Here, urine incontinence foregrounded an act of emotional intimacy and care between two elderly women in an otherwise overcrowded, impersonal, bleak environment.

In the end, only some of these examples would be included in the core output of Townsend’s study, which was a damning critique of institutional care of the elderly in England and Wales, published in 1964 and titled The Last Refuge. Together, many of these examples illustrated the particular emotional and material deprivation which characterised life for some in these environments; this was illustrated by Townsend’s description of the five-year-old felt surgical boots owned by one elderly man, which had become ‘impregnated with urine’ and were his only pair (Townsend, p. 275). Appealing to the senses (touch, smell), this description not only gave the reader a powerful impression of what life was like in these institutions, but also of how it must have felt. Through such examples, Townsend therefore evidenced his calls for the reform of existing provision and policy related to the care of the elderly, which he believed should move away from institutions, into the community.

Based on my reading, Townsend’s study and subsequent publications can be understood to have both drawn from and reinforced a particular discourse of the incontinent body. Through the 1950s, 1960s and into the 1970s, British geriatricians such as John Brocklehurst and psychiatrists such as John Anthony Whitehead would argue that incontinence in the elderly was not necessarily a consequence of organic brain disease or dysfunction, but a condition which could be linked to apathy and lack of mobility, all of which were common to the experience of old age and a loss of previously developed ‘powers of adaptation’. According to Whitehead, the treatment of urine incontinence should focus on addressing the emotional life and the material environment of the elderly person, which would encourage ‘activity, interest and occupation, the return of self-respect and the redevelopment of feelings of usefulness’ (Whitehead, no date). If we accept that this discourse of the incontinent body emerged at the intersection of post-war social research and gerontology, we should also consider if, how and why it was in turn shaped by the focus, concerns and priorities of an evolving welfare state.

There is much that I still do not know about this incontinent body. Whilst the Townsend papers help us to see how it hinged on (and arguably perpetuated) longstanding assumptions about gender and class, more analysis is needed to understand the significance of race. Though Townsend also refers constantly to the experiences of elderly people, I am wary of assuming that his study provides access to their thoughts and feelings in any straightforward or uncomplicated way; as noted by Charlotte Greenhalgh, ultimately Townsend’s goal was to amplify his research contributions, rather than those of his subjects, and to this end he selected and used their stories to inform government policy.

Despite these potential limitations, there is no doubt in my mind that the Townsend papers help to draw out and parse the discourse which surrounded and redefined the incontinent body at a particular moment in time. They are therefore a vital source base for anyone who wants to explore and understand the history of urine incontinence in modern Britain.

References

John Brocklehurst, Incontinence in Old People (1951)

Teri Chettiar, The Intimate State: How Emotional Life Became Political in Welfare-State Britain (2023)

Charlotte Greenhalgh, Aging in Twentieth-Century Britain (2018)

Peter Townsend, The Last Refuge: A Survey of Residential Institutions and Homes for the Aged in England and Wales (1964)

Peter Townsend papers, National Social Policy and Social Change Archive, University of Essex Special Collections

John Whitehead papers 1965-1973, AEGIS (Aid to Elderly in Government Institutions), London School of Economics and Political Science Archives