A drop in the ocean: In the old asylums

24 November 2016

‘Bedlam: the asylum and beyond’ interrogates the original ideal that the asylum represented – a place of refuge, sanctuary and care – and asks whether and how it could be reclaimed. This blog series intends to showcase as many different voices and perspectives from people with lived experience of mental ill health and explore their ideas of personal asylum

This post is from David Beales, an artist and writer who showed work in Bethlem Gallery’s ‘Reclaiming Asylum’ exhibition. In his own words, David confronts the issue of prejudice against the mentally ill by using informative illustration and captions to raise awareness of the problems confronting the mentally ill in the community.

 Industrial Therapy
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Industrial Therapy | Patients could make a few extra pounds a week by working in the industrial therapy department. Some preferred this to sitting idly on the ward.

Though there were overcrowded dormitories in the old asylums and patients were caught in a poverty trap, usually inmates for life, it was not all grim. The food may have been overcooked, but it was at least regular and on time. In one hospital I remember (and they tended to be similar) there were films in the hall on Wednesday afternoons: pre-war black and white films, ghostly projections on a large, old roll down screen, with the dated dialogue and classical music soundtrack adding to the eerie effect.

A percussion band performed on the hall stage on Thursdays. A woman played what sounded a bit like slowed down stride music, a melodic improvisation on an upright piano, while the members of the band played triangle, clappers and tambourines. Patients from the locked geriatric and senile dementia wards, some ambulant, a few in wheelchairs, were led or pushed by nurses to the hall to sit on tubular steel and Formica chairs in the hall and spend some time away from the ward.

There was a games night when the tables and chairs were brought out in the main hall so that patients could play draughts, chess, snakes and ladders, or dominoes. In another hospital there was bingo night where patients could win a loose cigarette or a bar of chocolate for a line; a bag of five loose cigarettes for a house.

The hospitals interacted too. There were evening skittles matches against teams from other hospitals and in the summer there were cricket matches or a summer fete on the cricket pitch; at one time there were prizes for painting, drawing, cakes, jam and tapestry. There were yearly trips to the seaside. Coaches were hired and patients were each given 50p spending money by a member of staff who doled out the coins from a bag as he walked up and down the aisle of the coach.

 Guy Ward
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Guy Ward | There was little privacy in the dormitory, often there were no curtains around the beds.

There was camaraderie in the Guy ward dormitory, where the introductory conversations, and paranoid inquisitions that accompanied Terry Burns’ referral to that ward, subsided and metamorphosed into impromptu group therapy sessions. These were mainly for Terry’s benefit as he confronted his anxieties. The few of us who could hold a conversation patiently let him talk; we were his audience and confidantes. His anger burnt out as he found some stability and was able to drink without becoming aggressive, and confront and conquer his prejudices to find some stability and contentment before drinking on medication brought despair again.

Though patients in the old asylums often lived in terrible conditions, they left the psychiatric units with more beds and staff. The staff, when they could rely on the psychiatric hospitals to take chronically ill patients, consequently had more time to help patients suffering from anorexia, agoraphobia and post manic phase depression.

A patient who was admitted because they suffered from agoraphobia would be encouraged by a nurse to take a few steps outside the ward. When the patient had managed to take more steps down the drive leading to the ward, they were encouraged to walk to the phone box under a covered walkway a make a phone call. As they gained confidence they were encouraged to walk to the shops with the nurse so they could do some shopping. The rewards were also practical, preparing the patient for their return to the community.

I saw a patient suffering from anorexia nervosa kept in isolation, except for a nurse posted outside her side room door while she slowly reached a target weight. She was rewarded with a trip to the day room. When she reached the next target weight she was, like the agoraphobic patient, rewarded with a trip to the shops.

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A Day Room | In 1980 patients recieved £7 a week. Pensioners were given just £2 pounds a week or in some cases nothing as it was thought that the hospital took care of their needs.

Patients suffering from bi-polar disorder could rest and recover after a manic episode on the wards. The elderly bereaved, often men who had relied on their wives and had to learn living skills, used to be able do this in occupational therapy departments. These treatments may still be available, but for fewer patients than in the past. There were day hospitals, day units and occupational therapy departments for day patients, inextricably closed along with the large hospitals.

Day patients seem to be a thing of the past. Instead, patients in the community are left unmonitored in the community, sometimes in squalor, sometimes even sleeping rough or ending up in prison.

Before the hospitals were closed, the psychiatric units could operate a walk-in open door policy on week days. Patients could see the day hospital nurse and if they thought you were ill you might see a duty doctor on the same day. Now there are more patients but fewer beds. Now there are waiting lists.

Patients now may have to wait months before they can see a psychiatrist, and then find that there are no day resources in the area, no beds free and little the doctor can do besides prescribe tablets and refer the patient to cognitive behavioural therapy. This may be a course of half a dozen one-hour sessions with a therapist; hardly enough time for in-depth psychoanalysis.

Film above made for the Bethlem Gallery: David speaks to Michaela Ross about his work.

It is easier to identify the problems than to solve them. The recent announcement that there will be no increase in the amount of money the government can give the NHS means that there will be no reinstatement of day resources for the mentally ill.

Some patients have for a while, years in fact, attended user led initiatives. Art workshops like Centrepieces at Hall Place in Bexleyheath and Cool Tan Arts in Southwark. Or the Dragon Café, where patients meet at the crypt of St George the Martyr in Borough High Street, also in Southwark. It was started by Sarah Wheeler, to whom the book that accompanies Wellcome Collection’s exhibition, Mike Jay’s Bedlam: This Way Madness Lies, is dedicated.

Pictures from another art workshop, the Italian La Tinaia collective formed in 1975 in a disused hospital farmhouse by healthcare professionals, can be seen in the exhibition and book. Hopefully these will inspire others to start similar projects. They do not have to be art focussed. Drop-ins would help and why not ask community centres and churches if they can help? After all, someone got permission to use the crypt of St George’s church in Southwark to use the premises.

Day resources can provide sanctuary, refuge, asylum and respite from a world that seems to increasingly care less about the plight of the care in the community patient as time marches on.

David writes about these and other subjects in his book The Road to the Asylum about the mental health service, bohemian South London in the seventies and the casualties of society who often ended up in the old asylums.

Bedlam: the asylum and beyond‘ is on until 15 January 2017.