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Beyond the asylum: Looking back on mental health

29 Jan, 2013

Professor Barbara TaylorProfessor Barbara Taylor – a historian at Queen Mary, University of London – is best known for her work on the history of feminism. But in writing a new book to be published next year, she has been looking back on her time as an inpatient at Friern Hospital, then one of the largest mental health institutions in Europe, and the demise of mental asylums in Britain.

“I’d been holding myself together with sticking plasters, but then it all fell apart and by 1985 I was in really serious trouble.”

It’s hard to believe the person being described from nearly 30 years ago is the same Barbara Taylor, historian, author and professor being interviewed about her upcoming book. She seems happy and settled in her new role at Queen Mary, University of London, even if she hasn’t managed to unpack most of her boxes.

However, at the beginning of the 1980s, Taylor had a serious emotional breakdown and began a daily course of psychoanalysis soon after. She left her job, and her life quickly became centred on her psychological distress and the problems associated with it. “I got into a lot of trouble with booze and with the kind of psychotropics that in those days people got on repeat prescriptions,” she says.

In 1988 her life took a further turn for the worse when she lost her home and was admitted to one of the largest mental health hospitals in Europe: Friern Hospital. Friern began as the mental asylum Colney Hatch in 1851, and when Barbara moved in, it was still a grand Victorian building. Its main corridor was a third of a mile long, with gothic staircases leading to wards that housed scores of inpatients.

Ward 16 became Taylor’s home. The paint was peeling away from the walls and the ancient radiators rattled through the night. There was a day room, with a television high up on the wall “so nobody smashed it”, and a communal kitchen and dining room. Ward 16 was an acute admissions ward, which housed everyone from those with anorexia nervosa or alcohol addictions to those with severe psychosis. Taylor says, “You had every variety [of people] so it made for a very interesting, lively place to live, and sometimes very frightening.

“There was a fire set by a young woman in the middle of the night once, so we were all huddled off our ward [into a different ward]. And there we all were, ward 16, the ward 16 team. It’s very interesting that we had this odd sense of group solidarity.”

Taylor had three admissions to Friern, totalling some eight months. “This is what my life is going to look like,” she remembers thinking. “I was becoming what was called a revolving door mental patient.” During this time she continued with her psychoanalysis. After her last admission to Friern in 1989, she attended psychiatric day centres until her final discharge from the mental health system in early 1992. She carried on with psychoanalysis until 2003. Friern was neither the beginning nor the end of her mental health treatment. 

A sketch of Colney Hatch in its early days

Relationships

In 1990 Taylor went through a crucial phase in her psychoanalysis, and thereafter things began to change and improve. In the years that followed, she met her partner and got a new job at a university. She continued her successful career, publishing several books on the history of feminism. Then, more than two decades on from her stint in Friern, she decided to return to the mental health system to research her new book.

Taylor found herself surprised at the literature: something was missing. “One of the main things that I’m interested to see is lacking from academic accounts of life in mental hospitals are relationships between patients. Friendships were absolutely the thing that kept me going while I was in Friern.”

In her book, she describes several examples of connections she made with other patients. For example, there was a breakfast club that a group of patients used to hold on Sundays, when everyone would get together and have a huge fry-up in the communal kitchen. She also formed a close friendship with a woman who had been in Friern for 25 years. “It is sometimes said that people with serious mental disorders cannot form friendships, but this is simply not true – as I discovered again and again.”

Taylor strongly believes in the importance of relationships – both personal and clinical – to mental health. In her new book, Taylor discusses the history of psychoanalysis alongside her own story of recovery. Relationships have played a part in psychiatric treatment throughout history, often alongside biomedical forms of treatment such as drugs. In the early 19th century, asylums used ‘moral treatment’ to care for inpatients. This regimen centred on treating patients through their minds and emotions, rather than physically or chemically. This was done through sympathetic relationships between asylum staff and the patients. But in the latter part of the 19th century, this form of treatment fell by the wayside.

Before World War II most mental hospitals had a policy of separating patients who became friends. But by the time Taylor moved onto ward 16, this was no longer the case and she was able to develop the relationships that made her time there tolerable. She talks about Friern as a “life-saving place” for her; a place that gave her the help she needed to recover. But this was not the case for every patient.

Revolution

In 2011 Taylor spoke on these themes to the Royal Historical Society. When the packed audience was prompted to ask questions, Taylor was surprised to see someone she recognised stand up. It was a woman who still actively uses mental health services – someone Taylor had known in the past – and she disagreed with a lot of what had been said. Taylor recalls: “She felt I had romanticised the whole thing. She said, ‘Your story is extremely unusual, very peculiar, you cannot take it as a pointer to what has happened to the majority of people.’” Taylor knew she had a point.

Friern closed down in 1993, and many of its previous patients and staff were glad to see the back of it. The mental health system was changing to a more independent style of treatment, where people with mental illnesses were no longer put into institutions as Taylor had been. Along with this change in attitude, Friern was transformed into luxury apartments – a big difference from its Victorian asylum past. Many people saw the mental health system reforms – the community care revolution – as a positive step. Through employment training, day centres and support groups, the community care model was intended to offer greater opportunities for people with mental illnesses. But Taylor worries that this is not the reality.

She agrees that, in theory, community care could be a lot better than the old system but is not convinced by what is actually happening in the UK today: “There is no such thing as an abstract community. All it means is not in hospital.” Some people find themselves isolated and looking for more grounded care, which is now very difficult to find.

Without institutions like Friern, Taylor thinks those who do become legally detained, or sectioned, don’t receive the care and attention that was promised through the community care revolution. “Bang them up before they bop someone else, fill them with drugs until they’re no longer a danger, get them out and get them on some sort of programme… There are things that are better and things that are worse, but they’re not necessarily the things that I thought they would be.”

Through research for her book, Taylor can now see the system through the eyes of a historian as well as a former service user, but questions remain. Did she romanticise her time in the asylum? Or is it true that some kind of contained environment is helpful for people with serious mental disorders? Considering the many changes to the system over the past two centuries, the community care revolution will surely not be the last.

Taylor doesn’t intend her book to be a political statement, but that doesn’t mean she can’t give her opinion. “What happens to mentally ill people is a bit like the canary in the mine,” she says, meaning that the social changes affecting the most vulnerable people in society are also affecting the rest of us.

Everybody has fears over what may happen to them if they get sick or old, and in the current economic climate, these fears are growing. We all rely on support from other people. Taylor now relies on her academic institution as well as her family and friends, just as most of us look for support from our jobs.

“Most people need institutions to give them a sense of belonging, ” she concludes, “so why should the mentally ill be expected to do without?”

Updated on 30 January 2013: Professor Taylor’s book is expected to be published early next year. 

Image credits: Barbara Taylor; Wellcome Library, London / Wellcome Images

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