Tuesday, 18 May 2010

Mental: A History of the Madhouse - a BBC Documentary



Watched this sobering documentary last night as part of the BBC's "Out of Mind" season, came to the unpleasant realisation that if I had been born maybe just a decade or two earlier I probably would have ended up in one of these places, when I went through a severe mental breakdown as a young adult.  Would incarceration in an asylum have done me any good at all?  I seriously doubt it, and whilst I am not free of depression, I am living my own life and getting on with the things that I want to do, in a way that would have been unthinkable in the fifties - I have no doubt at all that I would have been sectioned and confined to an asylum had I been alive then.


"A lot of patients were socially inadequate rather than seriously mentally ill" said Tom Booth, a psychiatric nurse at High Royds Asylum between 1954 - 1995.  "They couldn't cope, they weren't wanted", and many patients were just "dumped" by their relatives, unwanted by either their families or their communities.  Most were admitted on genuine grounds (schizophrenia, manic depression, paranoia etc), but many it seemed were admitted for slightly less severe conditions, such as one woman who suffered from panic attacks coupled with depression, problems which nowadays would be dealt with by therapy and maybe drugs, but certainly not incarceration.


Life in the asylums was impersonal, empty and repetitive, where patients had no privacy and were often crammed into dormitories containing thirty or more closely packed beds.  There was a prison atmosphere, doors were kept locked and people were treated as inmates rather than patients and viewed as such by all.  These were vulnerable people, shunned by a society who was not interested in them once they were safely locked away, and persistent abuse in asylums throughout the UK was sadly rife as investigation in subsequent decades has found out.  


Derek McCarthy was a psychiatric nurse from 1957 at St.Nicholas Asylum in Newcastle.  He recalls his dismay as he witnessed, on his first day at work, the charge nurse slap a blind man across the back of his head and send him flying into a wall.  "Thump Therapy" was considered almost inevitable for "difficult" patients: one man who repeatedly slid off his chair onto the floor while the staff were on a break annoyed the charge nurse so much that the latter threw a bucket of water over the unfortunate and then rammed the bucket down on his head - when the man continued to slide from the chair he was manhandled into the bathroom where he was repeatedly dunked and held down in water, until Derek McCarthy was instructed to dry him off and send him back to the day room.  When Derek could find no socks or shoes for the man, and asked for some, the charge nurse replied "what do you think this is, ******* Butlins?" and refused to provide any footwear for the patient.  His parting words were "don't you know if you live among sh*t, you become sh*t?"




The National Health Service was established in 1948 by the Labour government, which included asylums and mental patients as it became recognised that mental problems could be treated like physical ones.  Treatments for patients included Electro Convulsive Therapy (ECT) where an electric current was passed through the brain (until the early 1950's without any anaesthetic), which induced a seizure that seemed to help some patients suffering from mental disorders.  The patient had to be held down by several nursing staff for the procedure, as fractures could occur when they went into a violent fit as the electricity passed through their brain, and despite (barbaric) appearances ECT was regarded at the time as "a step forwards."


"Patients whose illness was of a deep-seated nature" (whatever that meant) were injected with large quantities of insulin to induce a coma, in the belief that this completely relaxed the mind, or to quote from the film made at the time, for the "functions of the brain have the opportunity of, as it were, setting out on a new path when consciousness returns".  Insulin therapy proved to be a harmful medical failure - forty four people died from from the treatment.


A well-known treatment at the time was the lobotomy, or pre-frontal leukotomy as it was fully known.  Some psychiatrists believed that by removing sections of the brain some serious mental disorders could be treated.  Dr Henry Rollin, a psychiatrist from 1939 - 2000, said they "made a hole in the brain, waggled the probe a bit, and that was it."  There was no attempt until much later to refine where the cut was actually made.  Dr Rollin said he "had the misfortune to recommend sixteen of them, sixteen patients who had the operation and it was of no benefit whatsoever to any one of them.  Some of them had the tragedy of personality change."  It was very obvious from his whole demeanour and the way he spoke that in retrospect he deeply regretted prescribing this treatment for those sixteen of his patients, just a few of the 15,000 total lobotomies performed in Britain, and it was only towards the end of the 1950's that the crude form of pre-frontal leukotomy was phased out.




Various drugs were also developed in the treatment of mental illness, such as Chlorpromazine (Largactil) which was the first of these new drugs and was used to calm psychotic patients.  Dr Henry Rollin said that stories about the drug would "get into the press, hailed as a miracle, which it wasn't, but the air of optimism was quite important."  Lithium was another prominent drug, and is still widely used today, although like many of these medications it is not without side-effects.  High Royds Asylum was at the forefront of medical research into the new drug treatments, which were used to treat specific the underlying physical basis of mental disorder, and staff presented their findings all over the world.  (However, a BBC documentary made in 1969 found disturbing conditions in asylums, for many of the tranquilising drugs still used by then caused other problems, such as making patients physically rigid and mentally slowed, so that they were more like automatons than human beings.)


Some enlightened psychiatrists set about ensuring that more humane care was available to patients, such as occupational therapy to help them to keep busy and not sit about "brooding", and this too was viewed as a "serious, scientific treatment."  An open door policy was gradually introduced, patients were allowed to come and go more freely, asylums were generally "spruced up and made more homely", and 1959 saw the introduction by the Conservatives of the Mental Health Act to take a new approach to mental illness so it was no longer an illness with a stigma", which represented the final break from the Victorian ethos in the treatment of the mentally ill.


In his visionary Watertower Speech, Enoch Powell described asylums as "shameful relics of the past" and pledged to tear them all down, thus awakening the national conscience and perhaps some concept of what life might really be like in an asylum, to those living outside of them.  However, in reality it took a lot longer for the asylums to close.




Jean Davison ended up being a patient at High Royds for five years, after initially going in for just a week of rest and psychiatric assessment when she became depressed as a young woman.  On the first day there she was given Largactil, and then when sedated was convinced to sign up to a course of ECT, which left her confused and disorientated, when "things were familiar, but not quite right."  In the end she felt that "the hospital  had become part of the problem, not the solution", and that she got "sucked into their way of doing things, a different world which starts becoming part of your world."


Maggie Chapman was also a patient at High Royds, a 42 year old housewife with five children who was prone to violent outbursts, and was convinced by her doctors (who said that she would either end up in prison or an asylum forever because of her violent mood swings) to undergo a relatively new treatment which involved burning away part of the brain which they believed would cure her.  She describes the operation as "terrifying", as she was fully conscious whilst nylon balls were inserted into her forehead to act as guides for the electrodes which were then heated up inside her brain.  She describes this sensation as her head shaking inside, her eyes shaking, and naturally it made her flinch and move her head which didn't please the patronising and unsympathetic doctor performing the procedure.  She said that to this day she still cannot bear loud noises, and that following this treatment was "a zombie for four years", her speech gone, a "woolly body" and the inability to communicate with anyone.  Her treatment made surgical history, but Maggie says "GBH is what they did to my brain - I'll never forgive them for it."




By the mid seventies, still no asylums had closed as envisioned by Enoch Powell, but the recession of the time brought about a gradual closure of wards one at a time.  When someone died or was discharged, their bed was physically removed from the dormitory so that no one else could be admitted to take their place, and during the eighties asylums finally started to close under the rule of Margaret Thatcher.  By 1990 100,000 patients had been discharged into the wider social community, supposedly with psychiatric support, but the reality was that many were left to fend for themselves as "Care in the Community" was introduced, with organisations such as the Salvation Army left to pick up the pieces.


The Mental Health Service User Movement campaigned for patients to be more than the passive recipients of psychiatry, and to become more involved in their own care and treatments.  Many ex-patients have managed to forge a good life for themselves away from the "haven" of the asylum, but still found that there was stigma to deal with (one woman, Joan, who was in an institution for over thirty years and now lives alone with the help of a carer, says that one mother once ushered her children hastily away when they saw her approaching, as if she was dangerous, and someone else once said to her "why don't you go back to Broadmoor?", to which she feistily replied "well, if I kill you then I'll be straight back there!" (Joan hadn't been in Broadmoor) at which I thought "yay - you tell 'em!"




The programme finished with the thoughts that whilst Care in the Community has been in some respects a good thing, giving ex-patients their freedom and the ability to live their lives away from an institution, rather than most likely being there until they died.  However, it has not been without its' problems, and following such incidents as the 1992 stabbing and death of a passenger at Finsbury Park station, by a recently released mentally ill man, there have been cold feet, fears from the public of uncontrollable mental patients running amok in society and causing mayhem, the kind of rampant NIMBY-ism that is so often encountered in situations like these.  Doctors were given the power to force these people to take medication, but in some respects this seemed like a retrograde step.


Maybe the asylums actually were havens for some people, in the true sense of the word "asylum", and something that Care in the Community could never replace?


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I feel that it is so important to respect and treat with compassion and care those with mental health problems, for it is an issue that affects many, many people, and often completely unbeknownst to their families and friends.  Even today there is STILL a stigma attached to being "mental", and surely now is the time for greater awareness and enlightenment?  Please have a look at Stamp Out Stigma, and sign the pledge if this is something that you feel strongly about: http://www.stampoutstigma.co.uk/pledge/#pledge


Seeing this programme only makes me more keen to show the personal side of the asylum through my photographs, as a testament to those that lived and died there, and also as a mark of thanks that I never had to be treated in one myself.


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Watch the programme here: http://www.bbc.co.uk/programmes/b00sfpvf


More info on High Royds:
http://www.highroydsarchive.co.uk/index.html
http://www.highroydshospital.co.uk/


My photographs
Asylum T:
http://www.flickr.com/photos/vivecakoh/sets/72157623133008855/


West Park Asylum:
http://www.flickr.com/photos/vivecakoh/sets/72157621884630127/


Hellingly Asylum:
http://www.flickr.com/photos/vivecakoh/sets/72157617470309785/




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