Review of “Mental” from BBC Four

One of my contacts on Dreamwidth requested that someone in the UK review this history of British mental health care since the 1950s, which originally went out in May 2010 and was repeated last Friday. It focusses mainly on one asylum, High Royds near Leeds, which opened in 1888 and finally closed in 2003. There are interviews with several former patients, nurses and psychiatrists, not all of whom were committed to or worked at High Royds. (If you’re in the UK, you can watch it online until 22nd Jan; the person who asked me for this lives in Canada.)

There were three female and one male patient featured. One of the women was a long-stay patient, who was admitted to an asylum near Aylesbury (near London) some time after the War on account of her panic attacks, and remained in the system for more than 33 years. It seems that she was finally discharged during the 1980s, when a lot of long-stay patients were being discharged (but before the big “care in the community” drive of the 1990s). She described the asylum as a place where there was no privacy, with huge numbers of beds in a room placed end to end, and not much to do; she started helping a nurse make the beds because of boredom, turned to drink for much the same reason and ended up in a padded cell after entering the wrong ward and collapsing while drunk. She was given as an example of someone admitted for reasons which could have been treated in the community rather than necessitating a lengthy stay in the hospital; others seem to have been admitted for no sound reason. The regime was dominated by security, with every door locked every time a patient passed through, and high railings surrounding the grounds.

A nurse interviewed gave graphic accounts of the abuse (which those responsible called “thump therapy”) he witnessed from his colleagues (again, not at High Royds). He saw the charge nurse hit a blind patient for no reason, then explain himself, “if you live among shit, you become shit”. He also saw the charge nurse (and a couple of others) pour a bucket of cold water over a patient who displayed irritating repetitive behaviour, then fling the bucket at the patient’s head, before dragging him by the collar to the bathroom and repeatedly hold his head under water. It was said that there was no evidence of this at High Royds, but that it was endemic at a number of asylums in the UK at the time.

The programme traced the history of the various surgeries, treatments and drugs that were meant to revolutionise mental health care, as well as the political efforts (such as the 1959 Mental Health Act) to liberalise the regime and remove the oppressive security. Two female patients, one in her 50s and the other, I guess, in her 60s or 70s, described the reasons they were admitted and the treatments they got. The first was admitted because she was depressed, largely on account of having lived a monotonous life in a working-class neighbourhood and being expected to go on to another, working in a factory, and had approached her GP and asked to be referred to a psychiatrist. The GP referred her to High Royds for a one-week period of “observation”, which turned into a stay of several months followed by several years as a day patient, before she decided to wean herself off the drugs against doctors’ advice. She received electro-shock therapy, which she said she had agreed to only under the influence of the sedatives, and said she woke up feeling very confused.

The older lady had been featured in a documentary in the 1970s, receiving “pioneering” surgery in which an electrical charge was applied to part of her brain, to treat her occasional violent outbursts. A psychiatrist was shown talking to her, in which he said that they had to weigh up the risks to her of the surgery versus the risk of repeated admissions to hospital (she said she had also been threatened with prison). However, she said that the surgery turned her into a zombie for several years, and was bitter about what had been done to her. She said they had done far more violence to her than she had ever done in her outbursts.

Over the years, political talk about moving away from the asylum system, which had reached a high point with Enoch Powell’s Water Tower speech, was acted on only gradually, with beds being removed when someone died on a ward and their place simply being eliminated, resulting in wards disappearing over time. In the 1960s, the mental hospitals became “one more battleground” in the fight against the Establishment, with R D Laing claiming (this is how the programme described his theories) that madness was a natural reaction to a mad world, and an increasing move towards patients being viewed as knowing best, although the mainstream of psychiatry closed ranks against these kinds of ideas. The closing of wards often meant that people simply could not access care, with one mentally ill homeless man describing how he kept passing through a revolving door, with one short stay after another.

Towards the end, we come to the 1990s and the “care in the community” project, in which the first lady featured was shown trying to settle in the “community”; although she enjoyed her freedom, she found that people would pull their kids indoors until she was out of sight. However, a few high-profile violent incidents involving mental patients who had been released into the community resulted in a public outcry, and Blair’s government in the late 1990s responded with restrictive legislation, enabling doctors to compel patients to take medication or risk being taken back into hospital.

Towards the end, the notion that “asylums” provided rest and refuge which has perhaps been lost was mooted, but quickly dismissed; one mental health worker said that the old asylums were demeaning, and that nobody would want to return to 40-bed dormitories. High Royds itself has since been sold off and turned into luxury flats, as have so many other Victorian asylums; the idea that this might have been the object of closing them down wasn’t mentioned. In the Guardian, a former mental patient (who was in a hospital in Surrey for two months following a breakdown) remarks that the hospitals did indeed offer asylum and refuge, and describes her own experience in detail in this article from 2008. Only negative patient experiences featured in the programme; Laura Marcus’s experience was very different:

Mental healthcare can be a positive experience. During the two months I was there, the Sanny [Sanitorium] was a true sanctuary from a world that had clearly become too much. I was lucky enough to have my psychotic episode when we still had decent healthcare for the mentally ill. Not only was I admitted, as a voluntary patient, to this lovely old building with its occupational therapy unit, cricket pavilion, tennis courts and sumptuous grounds, but I was on a ward full of other young people and we were encouraged to share our experiences, socialise and go for walks in the nearby woods as part of our recovery. So I look back on that time with great fondness, gratitude even, but certainly not shame. The Victorians got a lot of things wrong in their attitude towards mental health but their asylums were intended to be, and often were, just that.

The Sanny, however, is no more. Like many former asylums, it has been converted into luxury flats. As a sop to English Heritage, there are open days when you can see the stunning architecture and gawp at the great hall where I once took my meals.

There were a few other noticeable omissions. “Care in the community” was a national joke in the 1990s, and became a euphemism for “not all there” and I can remember a poster at my college advertising some sale event, with the slogan “You’d have to be ‘care in the community’ to miss it”. Also, no mention was made of the continuing abuses in the mental health system which persisted well after the asylums were closed down. A particularly harrowing example is the interference of psychiatrists in the treatment of clearly physical chronic illnesses such as ME, in some cases resulting in patients’ health suffering drastic deteriorations. But they only had an hour; perhaps a two-part series (or, say, two lots of 45 minutes) would have been able to flesh some of these things out, but it did a good job of cramming fifty years into an hour.

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