Here we consider where some of the pressure for change was coming from in the earlier part of the twentieth century. Throughout the period of institutional domination there were, as we've seen from the early 1800s, voices which called out for change. Some contrasted the treatment of the sick and disabled poor with their richer counterparts in the private asylums. Others protested at the general inhumanity of regimented, mass care. Patients and their relatives had mixed experiences to draw on, but few felt confident enough to speak out in public against abuse or to suggest alternative forms of care. Shame was also a powerful deterrent to speaking out. Relatives were often unwilling to admit that a relative was an inmate of an institution. When change came it was as a result of action taken by people who were, for a variety of reasons, more powerfully situated. One source was the increasing professionalisation of those involved in the care of poorer and more dependent people in society.
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