Hektoen International

A Journal of Medical Humanities

Elizabeth Casson

Victoria Bates
United Kingdom

Dr. Elizabeth Casson. Reproduced with permission of the Elizabeth Casson Trust.

Dr. Elizabeth Casson (1881–1954) is often overlooked in the history of medicine and the medical humanities. Despite being awarded an OBE and being amongst the first female doctors in the UK, scholarship on her work has largely been confined to small pamphlets or local histories. However, such focused biographical approaches overlook the relevance of Casson’s work in Occupational Therapy (OT) to the wider history of the medical humanities movement.

In 1929 Casson became the first female MD to graduate from the University of Bristol (UK). Four years later she set up the first OT school in the UK, Dorset House in Bristol, which later moved to Oxford because of wartime conditions. This school both taught and practiced OT as a new form of healthcare that bridged the Victorian emphasis on industriousness and later developments in arts therapy and art as therapy. This pioneering work in OT provides a crucial backdrop to later uses of arts for psychological health and well-being, despite the common perception that OT is primarily a form of physical rehabilitation.

A medical career beckoned after Casson’s work as a housing reformer and a secretary for Red Cross Hall under the famous Victorian philanthropist Octavia Hill. This work gave Casson a particular interest in helping people rather than merely improving their homes. It is also no coincidence that her employer, Octavia Hill, is often discussed as part of the history of OT owing to her work in organizing therapeutic activities for the poor. As one obituary-writer noted of Casson, “[i]t is impossible to understand her subsequent work … unless one appreciates the deep impression which her association with Octavia Hill and her work made upon her.”

Years later, when Casson had completed her initial medical degree, she decided to specialize in psychological medicine. Within this field she found another impetus for her artistic approach to OT, stating that:

I found it very difficult to get used to the atmosphere of bored idleness in the day rooms at the mental hospital. Then, one Monday morning, when I arrived at the women’s wards, I found the atmosphere had completely changed and realized that preparations for Christmas decorations had begun … [T]he patients were working happily in groups making flowers and leaves and using all their artistic talents with real interest and pleasure. I knew from that moment that such occupation was an integral part of treatment and must be provided.

Around the same time, Casson took a holiday in the United States and was inspired by visiting an OT department in New York.

Within five years of this trip Casson had set up Dorset House treatment facility and school, the first of its kind in the UK. Although her role in the history of OT seems specific to the British context, there is international significance in the school’s early focus on the links between “artistic talents” and therapy.

Dorset House and a clinic at Clevedon housed around one hundred patients by 1939 and operated as a form of therapeutic community in which students and patients worked together. Drama and dance were common activities, with an annual production in which Casson often performed herself. Her great niece, recollecting “Elsie” Casson’s life, also noted how Elsie’s nephews were always “roped in … to partner the patients” at dances and social events.

OT has become associated with physiological therapies, increasingly so since the Second World War, but Casson’s work also engaged with the use of occupations, arts, and drama to improve psychological well-being. Although apparently inspired by Galen’s words that “employment is nature’s best physician,” her particular form of OT focused as much on the value of engaging with arts for psychological therapy as on the value of using the hands for physical therapy.

Some of the similarities between Casson’s early OT work and arts therapies are partly explained by her own artistic roots. She was a keen singer, actor, and artist in her youth. With an organ-maker for father and a famous actor for brother, Casson was particularly well situated to innovate in the field. Described as “eccentric” and “typically direct” by those who knew her, Casson deserves greater recognition for her work in the field of arts and health.


  1. Oxford Brookes University, Dorset House Archive, DH/3.
  2. Casson Memorial Lectures.
  3. Wilcock, A., and B. Steeden, Elizabeth Casson, 1881-1954 (College of Occupational Therapists, 2004).

VICTORIA BATES is Lecturer in Modern History at the University of Bristol. She has a particular research interest in the social history of medicine in modern Britain, including medico-legal history and medical humanities. Her primary research to date has been on the history of sexual forensics in Victorian and Edwardian Britain and on medicine in late-twentieth century popular culture. More recently, she has been researching the emergence and development of a movement to “humanize” medical care and education in the twentieth century.

Highlighted in Frontispiece Volume 6, Issue 3 – Summer 2014 and Volume 16, Issue 2 – Spring 2024

Summer 2014



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