“We believe our response to mental illness is more enlightened, kinder, and more effective than that of the Victorians who built the asylums. Can we be sure? Taylor’s somber investigation, calling on personal experience, challenges complacency, exposes shallow thinking, and points out the flaws and dangers of treatment on the cheap. It is a wise, considered, and timely book.”–Hilary Mantel
Buy this book: Last Asylum
Friern was not just any loony bin. When my friend Raphael Samuel visited me there, what he saw with his historian’s eye was not the sad, doomed place Friern had become, but what it had once been: Colney Hatch, the emblematic institution of the Asylum Age. Entering the hospital in July 1988, I became part of a ghostly lunatic army, one of the tens of thousands of people who had resided there – some for days, some for decades – since its founding a century and a half earlier. When the hospital closed in 1993, my patient records travelled to the London Metropolitan Archives along with the rest of the hospital’s files, which today occupy more than eighty linear metres of shelving at the L M A . Perhaps one day some future chronicler of Friern will take my records down from the shelf and peruse them alongside those of my fellow Friernites, and so see for herself something of the story I am about to tell here, about the world in which I found myself in the twilight days of this famous old asylum.
By the time I was admitted to Friern – drunk, sick, suicidal – I had lost all sense of myself as a historian. My life had imploded and I had collapsed inward; nothing outside me mattered, least of all the old dump I had landed myself in. But as I dried out my mood lifted, so that by the time Raphael came to visit me, a week or so later, I was curious enough about my surroundings to question him. ‘So, what was this place then?’ ‘Barbara, darling! Colney Hatch! Don’t you know about it? You must read about it, write about it!’ Raphael was a notorious enthusiast but even so his excitement impressed me, and I recalled it five years later, in the early spring of 1993, when I heard that Friern was mounting a valedictory exhibition on its history. I went along to the exhibition with my friend John and we spent a couple of hours peering at architect’s plans, patient registers, photos of industrial workshops, summer fetes, the Friern football team . . . Like Raphael, John was fascinated. ‘What a place, what a story! Maybe you’ll write about it someday.’ This seemed implausible; but then – remembering Raph, who having urged me to write about Friern was always sure I would survive to do this (‘You’re too tough to go under, Barbara’) – I reflected that anything was possible. ‘Yes, maybe.’
Many people have seen inside Friern Hospital without knowing it. A B-movie image of a looney bin, its vast decaying wards were so nightmarishly atmospheric that photographers and film companies queued up to use them. Few extant interiors so faithfully mirrored the gothic inner landscapes of madness. The hospital’s most famous feature – a corridor extending over a third of a mile, the longest in Europe – could make even the stoutest spirit quail. Stretching out endlessly, its vaulted roof and dirty walls striped with light from narrow windows, empty except for an occasional figure shuffling along, muttering and gesticulating, this corridor was the very emblem of despair. Friends traversing it for the first time, en route to my ward, arrived wide-eyed with dismay.
At its founding, Colney Hatch – it didn’t become Friern until 1937 – was the largest asylum in Europe. Opened with much fanfare in the Great Exhibition year of 1851, Colney Hatch was, in conception at least, no gloomy Bedlam but a showcase for enlightened psychiatry. Its lovely grounds and elaborate frontage – an Italianate ﾭmings – signalled a prestige institution designed to comfort and heal the truant mind. Madhouses were notorious for ‘managing’ their inmates with chains and whips, but now this new asylum, in quintessentially Victorian fashion, put them to work instead. Like most of the great nineteenth-century asylums, Colney Hatch was a self-supporting community. Its 165-acre site boasted a large farm, orchards, gardens, stables, gasworks, waterworks, laundries, bakeries, and craft workshops manufacturing everything from brushes and beds to boots and clothing of all varieties. Most of the asylum’s food and, by the end of the nineteenth century, all of its clothing were produced on-site by the patients. Even the beer accompanying the patients’ dinner (until a busybody subcommittee of the London County Council banned beer from the asylum in 1891, to much protest) was brewed in the asylum brewery.
Such industrious self-provision, especially in the year of the Great Exhibition, marked out Colney Hatch as a model Victorian institution. Many people coming to London for the Exhibition travelled up to Friern Barnet to visit the asylum, to marvel at its size and grandeur ﾭing peaceably in its fields and workshops. A few years later such tourists could, if they wished, attend a ‘lunatic ball’ (fifteen of these ﾭcerts, lectures and plays) or the ever-popular summer fete. The exemplary conduct of the patients at these events strongly impressed visiting guests, including one visitor to the 1869 summer fete:
The day was one of the hottest this year. In a meadow near the asylum there had been erected several tents, at which beer, tobacco, tea, cofﾭfee, and other refreshments were freely sold at a reasonable rate. There was also a band of musicians beside conjurors, acrobats, Punch and Judy, &c. Kiss-in-the-ring and other games were carried on . . . Besides the patients and attendants present, there were county magistrates and ladies, dressed to the astonishment of the many admiring patients. There were metropolitan guardians, and such friends and relations of the patients, numbering many hundreds, as chose to visit them on this celebrated occasion . . . out of 1,200 females, over 500 were permitted to take part in the proceedings; and out of 800 men, 300 were also on the ground . . . All these, carefully selected no doubt, participated in the excitement going on . . . Of the majority it seemed all but incredible that there was any urgent need of entire seclusion from society, so much did they seem to enjoy this passing glimpse of the outward world. During the afternoon two patients, both of them apparently affected by the heat, required removal, which was morally accomplished, without any interruption of the pleasures going on.
(In July 1989 I went along to the Friern summer fete. No beer was served, and there were no Punch and Judy shows, but otherwise it was much the same event as 120 years earlier.)
So idyllic did all this appear that it left more than one midnineteenth-century observer convinced that Colney Hatch was a model environment for the sane as well as the insane. The only concern was that patients residing in such a cheerful and healthful place would never want to leave.
Yet within a few decades Colney Hatch had become a byword for neglect and misery. Studying the asylum’s history, I marvelled that it lasted as long as it did. Perhaps we should see its continued existence as testimony to the degraded state of public psychiatry in the years before the ‘community care’ revolution – certainly this is how many would interpret it. But matters are more complex than this. Friern’s history exemplifies a phase of western psychiatry that began on a high tide of reformist optimism and then descended into troubled waters before finally foundering in a flood of anti-institutional, anti-welfarist sentiment. Whether its disappearace, along with the rest of the asylums, is a victory for improved mental health care is not clear. History’s verdict has yet to be delivered, and it is possible that the judgement will be more favourable to the old asylums, at least in some respects, than psychiatric modernizers would like us to believe.
Lunatic asylums were a Victorian invention. Before the mid-nineteenth century most lunatics lived with their families. Those without famiﾭlies, or whose families could not or would not look after them, roamed the country alongside paupers, vagrants and other social outliers. Religious charities provided some care, but this was limited and haphazard. In 1676 the famous Bethlem Hospital (‘Bedlam’), which had succoured disturbed minds from the fourteenth century, moved into a new building in London’s Moorfields district – England ’s first ﾭtry’s only public madhouse until the mid-eighteenth century, when it was joined by a handful of charity-funded madhouses in London and other urban centres. Poor lunatics sometimes lived in these instiﾭtutions, but more often they ended up in parish workhouses or jails.
England also had privately owned madhouses. These were few in number until the late seventeenth century, when population growth and a weakening of community and kinship networks led to an upsurge in private madhouse-keeping. Wealthy lunatics who could not be looked after in their homes were placed in these houses, as were growing numbers of pauper lunatics whose costs were met by their parishes. By the mid-eighteenth century mad-keeping had become a highly lucrative business, with many entrepreneurs turning a hand to it. Yet even at the height of this 'lunatic trade' numbers were low, with most private madhouses catering to a half-dozen people or less. The few public mental hospitals were also very small by Victorian standards, housing at the most 200 or 300 patients. The situation was the same in other western nations with the exception of ﾭenteenth century. Georgian England had more private madhouses than other countries, but even so in 1800 there were only around 2,000 people in specialized lunatic institutions in the whole of the country.
The nineteenth century saw this situation change utterly. In 1807 a House of Commons inquiry into the state of lunacy in England recommended the establishment of county asylums, financed on the poor rates, and in 1845 the provision of such asylums was made mandatory. A Lunacy Commission was created to regulate all institutions catering to the insane. Within a few decades public asylums had sprouted up at the edges of towns and cities across the country, and by the end of the century over 100,000 mentally ill people were housed in English asylums.
Similar developments occurred across most industrialised nations. State asylums began to be built in the United States in the 1840s; by 1904 there were 150,000 people living in these institutions. Canada too built its first public asylums in the mid-nineteenth century. These were small institutions, followed by much larger ones in the early twentieth century. In 1921 Saskatchewan opened a huge asylum in a small city named Weyburn. ‘He’s gone to Weyburn,’ a school friend confided to me after her older brother vanished one day. ‘What’s in Weyburn?’ I asked. ‘Crazy people, loonies!’ she giggled and ran off.
This ‘Great Confinement ’ of the insane, as Michel Foucault famously anathematized it, was fervently endorsed by medical opinion. Sequestration was vital for disordered minds, Victorian mad-doctors insisted. Families reluctant to lock their loved ones away were assured that it was only confinement in a well-regulated, salubrious environment, under the care of medical specialists, that offered any hope of recovery. Home-based nursing could never match skilled asylum therapeutics. Some asylum enthusiasts went even further, arguing that home was the worst place for a lunatic ‘because there circumstances that excite a maniacal paroxysm frequently exist’. After all, as the anti-psychiatrist R. D. Laing was to argue over a century later, it was often the lunatic’s family that had driven him or her crazy in the first place.
But the strongest case for the new asylums lay in what they had replaced. Some pre-Victorian madhouses, especially those catering to the well-to-do, had been decent institutions, but the overall picture had been horrific. Medical men responsible for the new asylum system, like John Conolly, a leading psychiatric reformer of the 1830s and 1840s, recalled all too well the terrible conditions of the recent past:
In the gloomy mansions in which hands and feet were daily bound with straps or chains . . . all was consistently bad. The patients were a defenceless flock, at the mercy of men and women who were habitually severe, often cruel, and sometimes brutal . . . Cold apartments, beds of straw, meagre diet, scanty clothing, scanty bedding, darkness, pestilent air, sickness and suffering, and medical neglect – all these were common . . .
From 1774 all madhouses had to be licensed, but the regulation was poorly enforced and reports of beatings, whippings and even starvation were legion. Public opinion had been slow to react to this. Most Georgian Britons regarded lunatics not as suffering fellow creatures but as demons, monsters, wild beasts – ‘mad dogs, or ravenous wolves’ as one London mad-doctor branded them. Insanity was sub-human, and those afflicted by it had no place in the great chain of being. They could, however, provide good entertainment: for most of the eighteenth century Bethlem Hospital was a popular tourist destination where, for a few coppers, visitors could stroll about gawping at gibbering figures chained to walls or locked up, naked, in filthy cells. Bethlem eventually came to symbolize the evils of the unreformed madhouse system, but the practices and ‘treatments’ employed there – shackling, bed-strapping, strait-waistcoats, bloodletting, induced vomiting and frigidity (the asylum was kept icily cold, as this was said to have sedative effects) – were near-universal in the eighteenth century. The acute suffering this caused was barely acknowledged, as most medical authorities held that lunatics were insensible to physical discomfort: ‘All mad folks in general bear hunger, cold, and . . . all bodily inconveniences, with surprising ease.’
Such attitudes were not universal however, and by the mid-eighteenth century there were signs of change. Enlightened physicians argued that mental disorders were brain diseases, not signs of diabolic influence or bestial states. Novelists and poets moved people to tears with images of minds unhinged by grief, lovesickness and other emotional travails. Madness was gradually humanized: lunatics were not brutes, it was said, but sick souls deserving of succour. In 1770 Bedlam was closed to tourists, and in the following decade King George III’s episodes of derangement earned him much sympathy. But the most important change came with the development of a new therapeutics known as ‘moral treatment ’, which by the end of the eighteenth century was exerting a strong influence on institutional psychiatry.
Moral treatment was a portmanteau term for therapeutics directed at the minds and emotions of lunatics rather than any supposed organic cause of insanity. At a minimum, moral treatment required asylum-keepers to manage their charges without recourse to ‘mechanical restraints’ (shackling, chains, et cetera) or corporal punishment. In its stronger versions, it meant the abandonment of the ineffectual and often brutal ‘medical’ remedies popular among mad-doctors, in favour of a psychotherapeutic approach that utilized the asylum environment and staff–patient relationships as healing agents. In 1795 a French doctor named Phillipe Pinel was appointed physician-in-chief at the Salpêtrière Asylum in Paris, where he instituted a system of remèdes moraux based on personal rapport and clinical observation, engaging his patients in ‘repeated, probing, personal conversations’, taking detailed notes as they spoke. Pathological ideas and emotions (the ‘secrets of the heart ’) were identified and, where possible, gently challenged. Medical treatments such as bloodletting and purging were rejected in favour of the cultivation of strong personal bonds between asylum-keepers and their patients. Psychological healing, it was argued, was an up-close process, entailing a high level of emotional involvement on the part of the would-be healer. ‘To truly benefit the lunatic,’ Pinel’s student Jean-Étienne Esquirol declared, ‘one must love him and devote oneself to him.’
In the same years that Pinel was revamping Salpêtrière as a moral-treatment asylum, the Quaker philanthropist William Tuke was creating the Retreat, an asylum run along moral-treatment lines in York. Founded in 1796 and made famous in 1813 by Tuke’s grandson Samuel in his 1813 Description of the Retreat, the York Retreat embodied long-standing Quaker traditions of group support and personal counselling. Its design was cosily domestic, with low walls, pretty gardens and comfortable furnishings. Residents were treated as members of the Quaker ‘family’ and encouraged to participate in the religious life of the community. Chains and corporal punishment were banned, although milder forms of restraint were permitted as a last resort. As at Pinel’s Salpêtrière, physical remedies were mostly discarded in favour of rational conversation (to wean patients away from mad ideas) and appeals to the patient ’s moral sensibility. ‘Judicious kindness’ – douceur in Pinel’s idiolect – was the asylum’s maxim.
Pinel and the Tukes were curative optimists. By the end of the eighteenth century enlightened medical opinion had reconceived madness as an ailment to which any person – even a king, as in the case of George III – might succumb. Now these moral therapists insisted that the disease was only partial, that lunatics retained intellectual and moral powers which, if properly acted upon in a supportive environment, would replace ‘morbid feelings . . . [with] healthy trains of thought ’. All human beings, they averred, have a natural propensity to sympathize with their fellows. The task of the asylum-keeper was to reignite this innate ‘benevolence ’ through a combination of moral example and the exercise of his own sympathetic instincts. In 1839 John Conolly was appointed as the medical superintendent of Hanwell Asylum in Middlesex. He immediately banned all mechanical restraints and introduced a rule requiring employees to treat all patients, ‘however violent ’, with ‘kindness and forbearance ’. The creation of a calm and nurturant atmosphere was Conolly’s priority. The stresses of life wreaked havoc on delicate sensibilities, he argued. Domestic life in particular was full of travails and ‘excitements’ that could unbalance fragile minds. A well-conducted asylum would be a sanctum where chaotic minds were soothed into sanity:
. . . calmness will come; hope will revive; satisfaction will prevail. Some unmanageable tempers, some violent or sullen patients, there must always be; but much of the violence, much of the ill-humour, almost all the disposition to meditate mischievous or fatal revenge, or self-destruction will disappear . . . and despair itself will sometimes be found to give place to cheerfulness or secure tranquillity. [The asylum is] where humanity, if anywhere on earth, shall reign supreme.
Conolly’s regime at Hanwell was widely publicized and highly influential. Responses from his fellow mad-doctors ranged from sceptical to openly hostile, but lay reformers and legislators were more persuadable, and by the mid-nineteenth century a dilute version of moral treatment, combining non-restraint with some traditional medical remedies, had become public policy. In 1847 the Lunacy Commissioners reported very favourably on the ‘substitution of mild and gentle treatment in place of the old method of mechanical coercion’, and by 1854 twenty-seven of the thirty county asylums in England and Wales had abandoned mechanical restraints. Visitors to the Hanwell Asylum were delighted to witness the inmates gardening, attending chapel and even dancing at a Christmas party without ‘a single circumstance occurring to mar [their] happiness’.
These happy times were the high point of the new Asylum Age. But they were short-lived. In the second half of the nineteenth century asylum populations rose rapidly, as pauper lunatics crowded in from the workhouses, and wards ‘silted up’ with the ‘chronically crazy’. Moral treatment foundered under the combined pressures of overcrowding, ‘cheeseparing economies, overworked medical superintendents . . . untrained, under-supervised nursing staff ’. By the late 1860s most asylums had reintroduced straitjacketing and other physical restraints. North America saw a similar pattern of decline as early asylums founded on moral-treatment principles deteriorated into repressive, nightmarish institutions, objects of fear to their neighbouring populations. By the end of the nineteenth century the curative confidence of the asylum pioneers had vanished entirely, to be replaced by a hereditarian determinism as gloomy as the decaying buildings housing the ‘degenerates’ and ‘defectives’ that lunatics had now become. Care collapsed into custodialism, as the mad were pronounced ‘tainted persons’, and the asylums became their prisons.
The story of Colney Hatch Asylum – my asylum, as I still think of it – exemplifies this sad history. Colney Hatch opened at the height of the moral-treatment boom. ‘No hand or foot ’ would be bound at the new asylum, the chairman of the Middlesex magistrates declared at the stone-laying ceremony, for here was no mere jail but ‘a curative institution . . . and we anticipate that with the advantages which this asylum can command, it will soon acquire a European reputation’. Yet even before the construction work began, John Conolly was warning the Middlesex officials that Colney Hatch’s projected size of 1,000-plus inmates would militate against the ‘close and intimate ’ care needed by lunatics. Wards would be unvisited, patients neglected, and ‘many good principles . . . hopelessly given up’. And sure enough, within a year of the asylum’s opening, the Lunacy Commissioners were expressing concern about overcrowding and insanitation. A few years further on, and a visitor to Colney Hatch was struck by the contrast between the asylum’s impressive facade and what lay behind it. ‘The enormous sum of money expended upon Colney Hatch . . . prepares us for the almost palatial character of its elevation . . . [and] the whole aspect of the exterior leads the visitor to expect an interior of commensurate pretensions.’
He no sooner crosses the threshold, however, than the scene changes. As he passes along the corridor, which runs from end to end of the building, he is oppressed with the gloom; the little light admitted by the loopholed windows is absorbed by the inky asphalt paving, and, coupled with the low vaulting of the ceiling, gives a stifling feeling and a sense of detention as in a prison. The staircases scarcely equal those of a workhouse . . . In the wards a similar state of things exists . . . of human interest they possess nothing. Upwards of a quarter of a million has been squandered principally upon the exterior of this building; but not a sixpence can be spared to adorn the walls within with picture, bust, or even the commonest cottage decoration . . . There is no more touching sight than to notice the manner in which the female lunatics have endeavoured to diversify the monotonous appearance of their cell-like sleeping rooms with rag dolls, bits of shell, porcelain, or bright cloth.
Conditions continued to worsen. In 1861 the Lunacy Commissioners issued a highly critical report on Colney Hatch, listing among its many defects faulty ventilation, ‘bedsteads with sacking but no mattresses’ and the ‘habit of bathing many patients in one lot of bath water’. Stung by the criticisms, the asylum’s Board of Guardians responded by tartly reminding the Commissioners who the asylum was designed for: ‘Colney Hatch Asylum was established for Pauper Lunatics only, and [the] many luxuries and appliances suggested by them [the commissioners] are quite unsuited to that class of patient.’ Nothing daunted, four years later the Commissioners returned to the attack. By now the asylum’s population had doubled from its original size, mechanical restraints were in use, and the overall atmosphere, especially in the ‘refractory wards’, was so oppressive that it drove the Commissioners to strong words: ‘It would be difficult to instance more perfect examples of what the wards of an asylum . . . should not be, than are presented here . . . Five years further on, the Lancet pronounced Colney Hatch ‘a colossal mistake ’, and there were calls for the asylum’s closure.
The downward spiral continued relentlessly through the rest of the nineteenth century. In 1896 a temporary wooden building was erected to house infirm female patients. The Commissioners warned that the building was a fire risk but the warning was ignored and seven years later the building burned down, killing fifty-two women. The years after the First World War saw some small improvements: lockers for patients’ possessions, tea served ‘in a household manner’ on a few wards. The asylum now had a large number of recent Jewish immigrants among its patients and a kosher kitchen was provided for them, along with a Jewish cook. These were welcome innovations, but overall life at Colney Hatch remained austere at best and, in the case of chronic patients languishing on its notorious ‘back wards’, cruelly depriving.
In 1930 a new Mental Health Act introduced voluntary patients into the asylum system. For the first time people could enter asylums, and leave them, without compulsion. Outpatient services were also initiated, and it was assumed that asylum populations would now begin to decrease. But they did not, and in fact admissions continued to rise well into the 1950s, including admissions into Friern, which in 1954 were running at three times their 1939 rate. Nevertheless, the presence of voluntary patients presented a major challenge to the custodial ethos of the asylums, a challenge that mounted steadily towards a crisis in the wake of the integration of the asylums into the National Health Service in 1948.
Initial plans for the NHS excluded psychiatric services, possibly due to lobbying by asylum doctors who feared loss of power as they competed with general hospitals for funding and status within the state system. But Aneurin Bevan, the Labour Minister of Health responsible for the introduction of the NHS, was determined to end the ghettoization of mental health care, which he regarded as ‘a source of endless cruelty and neglect ’, and the old mental hospitals were propelled into the new regime. From this moment, although no one knew it at the time, the asylums were doomed. How could places that locked people up, subjected them to involuntary treatments, frequently neglected or even abused them, be part of a modern health system? No reform-minded government could tolerate it.
At first the asylums responded well to the challenge. The Second World War had seen some major innovations in institutional psychiatry (I say more about these in Chapter 17), and these continued to gather pace after the war, eventually cresting in a reformist wave that swept through the asylums, bringing with it new treatments and rehabilitation programmes, the unlocking of wards, and a revitalization of moral therapy. David Clark, the psychoanalytically minded medical superintendent of Fulbourn Mental Hospital, was a leader in these changes, introducing psychosocial therapies in the 1950s and 1960s that soon became very influential under the banner of the ‘therapeutic community ’ movement. Assisted by the introduction of new symptom-suppressant drugs, psychiatrists in many asylums – including Friern – began experimenting with group therapy and other psychoanalytically inspired treatments, and the sector was gripped by a resurgent curative optimism.
Some asylums turned their backs on these changes, but enough embraced them to bode well for the future. Yet it was at this very moment that the government, in the person of Enoch Powell, then Conservative Minister of Health, sounded the death knell for the asylum system. Addressing the 1961 conference of the National Association for Mental Health (now Mind), Powell attacked the old hospitals as medical dinosaurs. ‘There they stand,’ he told his audience: ‘isolated, majestic, imperious, brooded over by [the] gigantic water-tower[s] . . . the asylums which our forefathers built with such immense solidity to express the notions of their day.’ But this day had passed: ‘For the great majority of these establishments there is no appropriate future use.’ Powell meant what he said: a year later he issued his Hospital Plan providing for the replacement of the mental hospitals by acute-care psychiatric wards in general hospitals and community-based services for non-acute and aftercare. The ‘deinstitutionalization’ of mental health care – to use the unlovely neologism coined by sociologists – or ‘decarceration’, as others dub it, was under way.
Powell was a Tory libertarian, but his assault on the mental hospitals earned him plaudits across the political spectrum, not just in Britain but internationally. Asylums across the western world were moving into crisis. The recent improvements in British asylums, scattered and experimental as these were, had few parallels elsewhere. American mental hospitals were vast, anonymous ‘bins’ often housing 10,000 patients or more, most of them held there under compulsion; Canadian asylums were generally smaller but no better. In the same year as Powell delivered his ‘Water Tower’ speech the sociologist Erving Goffman launched an excoriating attack on the American hospitals. In sharp, vivid prose, Goffman’s Asylums (1961) revealed the day- to- day degradations inflicted on inmates of a Washington asylum. Waving aside the hospital’s medical pretensions, Goffman condemned it and its counterparts as ‘human storage dumps’: a judgement echoing that of Thomas Szasz who the previous year, in a hugely influential book titled The Myth of Mental Illness, had damned the asylums as prisons presided over by psychiatrist-jailers. Goffman’s and Szasz’s indictments of the asylum system were echoed by ‘anti-psychiatrists’ in other countries, including Michel Foucault in France, Franco Basaglia in Italy and R. D. Laing and David Cooper in Britain: a formidable band whose collective onslaught on the mental health establishment became a high point of 1960s radicalism.
In Britain, Laing, Cooper and their supporters formed the left wing of an anti-asylum offensive which also included welfare reformers, investigative journalists and, eventually, patients themselves, organized into a growing ‘consumer’ movement, as well as Powell and his supporters. The language of these campaigners was militant – but they were pushing at an open door. In 1959 a new Mental Health Act had abolished the distinction between psychiatric and general hospitals and eased voluntary access to inpatient mental health care. In its wake, the ratio of voluntary to detained patients had risen dramatically: a transformation which made the custodialism of the old asylums appear ludicrously oppressive as well as outdated. Outpatient psychiatric services were also expanding, as new drug treatments made it possible to treat increasing numbers of people in their homes. By the early 1970s asylums everywhere were recording a steady shrinkage in their resident numbers. Moreover, many of the buildings that housed the old hospitals were falling apart. Renovating them would be hugely costly: an unwelcome prospect to governments, especially at a time of fiscal crisis. And then there were the scandals. The 1960s and 1970s saw a steady stream of exposés of neglect and abuse, which together delivered the coup de grâce to the Asylum Age. ‘Every few months . . . some sort of scandal is reported,’ a psychiatrist lamented in The Times, ending his article with a plea to the government to ‘finish the job and close down these old hospitals’.
Friern was in no condition to withstand these shocks. It was poor (funding allocation per patient was still far below general hospitals), its physical fabric was crumbling, and its reputation was shaky. Then in 1966 it was hit by a major scandal when a campaigner for the elderly, Barbara Robb, revealed serious abuses in its treatment of old people with dementia. Robb’s report, and the government inquiry that followed, led to calls for closure, although no official action was taken until over a decade later. But the writing was on the wall, and Friern was running out of allies. After all, who could defend a place that handled people like ‘human trash’, as one journalist demanded in the wake of the government inquiry into Robb’s findings.
The final decades of the asylums were very difficult ones. By the late 1960s the community care revolution was gathering pace: wards were closing, leaving their former residents at the mercy of ‘community services’ which, in most areas, were still rudimentary or non-existent. Homelessness was skyrocketing. By the end of the 1970s the asylum population had declined by two-thirds: a truly astonishing rate of reduction, especially when one realizes that it was achieved (as one of western psychiatry ’s most astute critics, Peter Sedgwick, commented at the time) ‘through the creation of a rhetoric of “community care facilities” whose influence over policy in hospital admission and discharge has been particularly remarkable when one considers that they do not, in the actual world, exist ’. Opposition M P s declared community care a ‘catastrophe ’: a judgement later endorsed by a leading figure in U K mental health politics, Baroness Elaine Murphy, who titled her account of community care between 1962 and 1990 ‘The Disaster Years’.
Friern’s closure was announced in the midst of this debacle. In July 1983 the hospital learned its fate from a televised news announcement. Staff were stunned: all those I have interviewed, including its medical director at the time and several consultants, insist they had no inkling of any closure plans. Indeed only three years earlier the Hospital Management Team had issued a glossy brochure, ‘Friern 2000’, celebrating the hospital’s achievements and looking forward to the next millennium. But the North East Thames Regional Health Authority had done its feasibility studies and added up its sums, and Friern was for the axe.
The years that followed the closure announcement were painful ones for the Friern staff, some of whom organised a robust anti-closure campaign calling itself CONCERN, which was soon outgunned by its opponents. ‘We were quite a militant group,’ Doris Hollander, a consultant on my ward who led the campaign, later recalled, ‘[but] [t]here were other powerful organizations saying “It has got to happen now” . . . There was no shortage of people who could point to all the terrible things in the old hospitals and disregard their positive side.’ Hollander’s views were aired in Parliament, where in July 1990 the Labour M P for Islington North, Jeremy Corbyn, described a state of ‘panic’ among patients at Friern, and demanded assurances that the hospital’s closure would not proceed unless adequate accommodation for its inmates could be guaranteed. A few of these patients and former patients also made their voices heard, attending meetings with Friern managers where they expressed support for the hospital’s closure mixed, however, with strong concern about post-closure provision. Even the local vicar got in on the act, collecting fifty signatures on an anti-closure petition. But to no avail: the decision-makers were unbudgeable, and the hospital’s fate was sealed.
As the clock ticked towards closure, a team of researchers moved into Friern under the aegis of a government-funded study into the impact of the hospital’s closure on its decanted residents. These researchers followed the progress of patients into staffed group homes over a five-year period and reported, for the most part positively, on their lives there. The people being studied however had been selected for their capability while many others, usually more disabled and so harder to place, remained in hospital; some were still there on the night before Friern closed. Moreover – and more important for the long-term consequences of the hospital’s closure – over a third of the decanted patients required readmission during the five-year follow- up. Alternative inpatient provision was radically insufficient, and seriously ill patients entering the hospital in its twilight days faced an accelerating crisis of resources. Many of these ‘new long stay’ patients, as they were awkwardly dubbed, did not qualify for the new community facilities: what was to become of them, when Friern’s doors closed for the final time?
In 1989 I was a likely candidate for ‘new long stay ’ status, or at least that was certainly how I saw myself when I entered Friern for the third time and remained there for nearly six months. My stints in Friern – a fortnight in July 1988, followed by four weeks in May–June 1989, and a final six months from June to November 1989 – came midway through the closure process, and the evidence of this was everywhere. Many of the nurses had left and been replaced by agency staff. The ward across the stairwell from my ward was empty, having been burned out in a major fire the previous year. (Its charred remains were still clearly visible through the porthole in the ward door.) Hallways were sealed off, therapy rooms shut down, the old apple orchards were choked with weeds. The kiln in the outdoor pottery shed broke down and was not repaired; a little pot that I left in the firing queue was thrown away.
Like many on my ward, I was anxious about the impending closure. Where would I go, when Friern was no more? What would become of me? ‘I’m frightened about the hospital closing down,’ I said to some fellow patients one day. ‘It has to close,’ a man named Simon, a big fellow with a rich Scottish accent, said to me. ‘The devil is here, down in the cellar. They tried getting him out, but he won’t go. Can’t you hear him down there?’
Copyright notice: An excerpt from The Last Asylum: A Memoir of Madness in Our Times by Barbara Taylor, published by the University of Chicago Press. ©2015 by University of Chicago Press. All rights reserved. This text may be used and shared in accordance with the fair-use provisions of U.S. copyright law, and it may be archived and redistributed in electronic form, provided that this entire notice, including copyright information, is carried and provided that the University of Chicago Press is notified and no fee is charged for access. Archiving, redistribution, or republication of this text on other terms, in any medium, requires the consent of the University of Chicago Press. (Footnotes and other references included in the book may have been removed from this online version of the text.)
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