Tuesday, May 20, 2014

Mental: A History of the Madhouse (BBC Documentary)

Most people have heard the word bedlam, and know that it refers to a chaotic, noisy, and disorganized state of being. The origin of the word is the Bethlem Royal Hospital in London, originally founded in 1247, making it likely the oldest psychiatric hospital in Western Civilization. The city of London took over the asylum in 1546-47.

Conditions in Bethlem were often horrid at best, thus the term bedlam - from the fourteenth century, Bethlem had been referred to colloquially as "Bedleheem", "Bedleem" or "Bedlam."
Typically, the hospital appears to have been a receptacle for the very disturbed and troublesome and this fact lends some credence to accounts such as that provided by Donald Lupton in the 1630s who described the "cryings, screechings, roarings, brawlings, shaking of chaines, swearings, frettings, chaffings" that he observed therein.
At various times in its early existence, the doors were opened to citizens of the city to come and observe the people kept there (likely beginning in 1598 as a way to create income) - its proximity to two playhouses made it part of a night out for some people.

The hospital was rebuilt in a new location in 1675 and 1676, but it was shoddy work and within 200 years it would need to be rebuilt again.

Anyway, there is a lot to know about Bethlem, but it is only one of the many "madhouses" discussed in this fascinating documentary from the BBC.

Mental: A History of the Madhouse

Published on Feb 10, 2014

Documentary which tells the fascinating and poignant story of the closure of Britain's mental asylums. In the post-war period, 150,000 people were hidden away in 120 of these vast Victorian institutions all across the country. Today, most mental patients, or service users as they are now called, live out in the community and the asylums have all but disappeared. Through powerful testimonies from patients, nurses and doctors, the film explores this seismic revolution and what it tells us about society's changing attitudes to mental illness over the last sixty years.
Here is some more from the Wellcome Trust Library site - which is where the image at the top was also found.
Among the interviewees were patients, members of medical and nursing staffs, the historian Dr Peter Barham, and Dr Henry Rollin FRCP FRCPsych, emeritus consultant psychiatrist at Horton Hospital, Epsom, and former Librarian of the Royal College of Psychiatrists. Dr Rollin described the grimly low levels of medical care in many of those asylums, and of care in general. Historic film footage of crude brain surgery was shown. Of prefrontal leucotomy Dr Rollin confessed "I had the misfortune to recommend sixteen patients [for the operation] ... it was of no benefit whatsoever, and some of them had the tragedy of personality change." It seemed at times that the only escape from the tyranny of routine lay in the menace of maltreatment. A former psychiatric nurse in Newcastle told of a difficult patient being dragged away and having a bucket of cold water being poured over him by a staff member who then jammed the bucket on the patient's head. A young woman who suffered panic attacks went to one asylum and ended up staying inside for thirty-three years.

As an illustration of a classic old-style asylum, the programme focused on High Royds near Leeds (illustration top), which had all the right qualifications: a Psycho-type silhouette at twilight, miles of corridors, once fine but now decayed Victorian decoration, the indispensable looming water-tower, and of course a proposal to turn it into luxury residences when it closed in 2003.

High Royds. Drawing by Paul Digby, 2003-4. Wellcome Library no. 643245i

The Wellcome Library has a large drawing made by an artist in High Royds in 2003-2004 as part of the ritual commemorations that were felt to be required at the time of its decommissioning. It looks like drawings done by patients to describe their gloomy life in the asylum. In fact, as film of the High Royds corridors showed, the drawing is merely an atmospheric representation of the actual interior in which patients spent their "empty and repetitive asylum life". There was a "quasi-prison atmosphere" (Dr Rollin again). The film-makers found articulate people who were able and willing to describe their experiences at High Royds and other asylums, whether as patients or as staff. These interviews are priceless.

The film-makers were careful not to make High Royds seem like a scapegoat: after describing episodes of brutality towards patients, the commentary stated that there was "no evidence of this kind of treatment at High Royds" which on the contrary was "in the forefront of the drugs revolution" in therapy. Some of the reminiscences on the High Royds website are quite complimentary, though others, it must be said, recall much unpleasantness. Other asylums in Newcastle, Sussex and Buckinghamshire also featured in the narrative, often with superb historic film footage.

The film showed the long process leading to the closure of the asylums. The first real "breaking point with the Victorian period" (Barham) was the 1959 Mental Health Act. Dame Pat Hornsby Smith MP called for "sympathy and understanding" to be the principles underlying treatment of the mentally ill. In 1961 Enoch Powell as Minister of Health 1960-1963 started a war on the asylums with a remarkable speech seizing on the image of the "looming water-tower and chimney combined" as the emblem of the asylum. Powell urged "the elimination of by far the greater part of this country's mental hospitals as they are today". He lost battles but won the war when Care in the Community was introduced. But Dr Rollin was no happier about the new arrangements than about the bad old days of the asylum. "The whole concept of Community Care is a disaster: I don't think the community cares" (NIMBYism was one of the problems he had in mind).

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