A history of the madhouse

I was watching a potted history of the Victorian asylums during the postwar period on BBC 4 last night. The treatment of people with mental distress was an exercise in barbarism, violence and abuse. People institutionalised and left to rot in these places of horror. Certainly, the ‘madhouse’ was indeed a dumping ground for people whose behaviour was considered transgressive, women, for example, who had sex outside wedlock, had a child outside wedlock were accused of of “moral inadequacy” and sent to the asylum. If a woman didn’t behave within the patriarchal norms then it was the madhouse for her.

During the 1950s, there had been transformations in medical science such as the invention of ECT in 1938, psychiatric medication, and along with brain surgery. Coma inducing insulin therapy soon fell out of favour with the advent of psychoactive drugs. Meds such as benzodiazepines (such as Valium), antipsychotics (Chlorpromazine), and so on… a more apt description being chemical coshes. Also, the Mental Health Act  came into existence in 1959. The other thing that was becoming popular in asylums was the introduction of occupational therapy.

The fascinating yet depressing and moving part of this programme on BBC4 were the interviews with people locked up in these madhouses. One woman interviewed recalls speaking out about the treatment she was receiving, she got angry, the next thing she knew she was on the receiving end of ECT. She, understandably, is still angry about this today. It becomes more clear that the asylums weren’t about supporting people but about abuse and punishment. It was also a place for carrying out new invasive brain surgery, and psychiatric users were the ideal lab rats to experiment on. One woman, during the early 1970s, was encouraged to have surgery on her brain, the reality being that part of her brain was burnt away (the hospital made a documentary of this procedure and it’s distressing and harrowing to watch). The woman said that after the operation she was “zombified for 4 years”… She eventually picked her life up (no thanks to the psych system) but still feel angry that this form of experimental surgery was carried out on her (“more violence inflicted on me”) . The belief was that it would “cure” her mental distress instead it turned her into an automaton.

Many people who experienced insulin therapy, ECT, chemical coshes and brain surgery all loathed their experiences and that it didn’t make any difference to them except worsen their lives. One woman who was on massive dosages of various psychoactive drugs maintained that she became “awake and alive” once she came off the pills. Psychiatry has a tendency to render you powerless. Psychoactive medication may have seen originally as a miracle, the manufacturing of a cure without resorting to shock treatment. But they had devastating side-effects. Tardive dyskinesia meaning slow repetitive body movements, physical rigidity, many assumed that was how people with mental distress behaved in that slow shuffle manner when really it was side-effects from massive dosages of antipsychotics drugs. Valium was highly addictive (“mother’s little helper). Lithium also had awful side-effects. These methods of getting people out of the psych system by prescribing high dosage meds only caused more distress and addiction in the suburban setting. My own mother was addictive for many years on Valium, when a more enlightened GP reduced her intake it freaked her out. I also have had experience of a cocktail of antipsychotics, tricyclic antidepressants (Amitriptyline) and benzos (Temazepam) as a teenager. Indeed I felt dumb and rather dead inside, I felt like an automaton, a zombie, my brain felt addled, like cotton wool. I was 18, yet felt I had aged massively over night, I too shuffled, staring transfixed into space and I was completely pliable and passive. All my defiance and will had been anesthetised. I still feel angry with the psych system for doing this to me.

During my time as a patient in a day hospital, I met other people who had been on these meds significantly longer than me and many seemed institutionalised. I remember the man in his 50s coming back from ECT, he would look confused and befuddled yet upset. One woman told me that the shrink told her that if he couldn’t find a suitable drug for her then it was time for ECT. “Not bloody likely”… was her reply. When I first got involved in mental health advocacy, I ‘shadowed’ two advocates in the mother and baby unit, the women in there were experiencing post-natal depression. This was 15 years ago but the image still etched in my mind. Many of the women just sat there staring into space, not a flicker of emotion or anything. One woman was passed her baby, yet her response was utterly automaton, she was so detached from reality and confused while I watched holding her baby. Another woman asked me to read me her postcard from her family, she was adamant that she could read but with everything being so confusing she couldn’t grasp the words in front of her. The advocate asked her how many applications of ECT she had that week, she got confused, frustrated and upset that she couldn’t remember. I was told by both of the advocates that the unit’s policy was to either recommend ECT if the woman was breastfeeding her baby or psychoactive drugs if the woman was bottle feeding. In other words, fry the brains or chemical coshes…. The other hospital some miles away had a more enlightened approach to post-natal depression unlike the old fashion Victorian style nightmare oppressive regime in that psych hospital. Like I said those images of those women have never left me, they horrified me.

And as was shown on this BBC4 programme during the political upsurge of the sixties this also impacted on psychiatric thinking, along came the anti-psychiatry movement with Thomas, Szasz. Laing and Cooper (it has to be said that they paid little attention to gender). This fed into the burgeoning user movement (which deserves a series in itself) with self-definition, user involvement, campaigning to shift the medical model paradigm, fighting to be treated with respect. Being seen as whole people as opposed to be viewed as a combination of symptoms and labels. This was also important during the time of community care, especially  with the backlash, whipped up by tabloid frenzy, that former psych patients are ticking violent time bombs all mad, bad and dangerous to know, the demonisation and vilification of mental distress (also the ignorance shown by employers when it comes to mental health). Oh, and Nimbyism. One in four people may experience mental distress but it is still hidden with the fear of stigmatisation and facing the ignorance.  I remember telling a surprised looking neighbour once that I had been through the psych system. Her reply was, “But you don’t look like someone with mental health problems”… What does someone look exactly like….?!

The asylum system was a cruel, violent, barbaric and dehumanising regime. People enduring cruel and torturous treatments. They were the social dustbins were individuals were sent to and I sincerely hope that they will be relegated to the dustbin of history but with the Dickensian style plans from the ConDems I feel there might be a revisit to the grim Victorian inventions of the madhouse.

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