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THE DEMISE OF THE ASYLUM IN LATE TWENTIETH-CENTURY BRITAIN: A PERSONAL HISTORY*

Published online by Cambridge University Press:  04 November 2011

Barbara Taylor
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Abstract

Mental health care in Britain was revolutionised in the late twentieth century, as a public asylum system dating back to the 1850s was replaced by a community-based psychiatric service. This paper examines this transformation through the lens of an individual asylum closure. In the late 1980s, I spent several months in Friern mental hospital in north-east London. Friern was the former Colney Hatch Asylum, one of the largest and most notorious of the great Victorian ‘museums of the mad’. It closed in 1993. The paper gives a detailed account of the hospital's closure, in tandem with my personal memories of life in Friern during its twilight days. Friern's demise occurred in an ideological climate increasingly hostile to welfare dependency. The transfer of mental health care from institution to community was accompanied by a new ‘recovery model’ for the mentally ill which emphasised economic independence and personal autonomy. Drawing on the Friern experience, the paper concludes by raising questions about the validity of this model and its implications for mental healthcare provision in twenty-first century Britain.

Type
Research Article
Information
Transactions of the Royal Historical Society , Volume 21 , December 2011 , pp. 193 - 215
Copyright
Copyright © Royal Historical Society 2011

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References

1 The full text of Powell's speech is available on www.studymore.org.uk/xpowell.htm. Powell's decision to close the asylums was strongly influenced by a 1961 study forecasting a steady fall in the need for psychiatric beds (Turner, Trevor, ‘The History of Deinstitutionalisation and Reinstitutionalisation’, Psychiatry, 3, 9 (2004), 1)CrossRefGoogle Scholar. In fact, the proportion of the population admitted to inpatient psychiatric institutions grew steadily between 1945 and 1990; what declined was the average length of these admissions, which decreased rapidly from the mid-1950s (James Raftery, ‘Decline of Asylum or Poverty of Concept?’, in Asylum in the Community, ed. Dylan Tomlinson and John Carrier (1996), 18–30; Peter Barham, Closing the Asylum: The Mental Patient in Modern Society (1997), 11–12, 158). The admission rate to Friern Hospital increased by 40 per cent between 1956 and 1961, but with an accelerating shift toward short-stay patients (letter from Friern Hospital Group Medical Advisory Committee, to group secretary, 4 July 1962: London Metropolitan Archives (LMA), H/12/CH/A/30/1).

2 Margaret Thatcher, ‘Speech at Friern Hospital’, 9 Oct. 1961: www.margaretthatcher/org/speeches/displaydocument.asp?docid=101111.

3 Friern's closure is described in Elaine C. Stewart, ‘Community Care in the London Borough of London Borough of Islington for Former Short Stay and Long Stay Patients Following the Decision to Close Friern Hospital’ (Ph.D. thesis, University of London, 1999).

4 Sarah Payne, ‘Outside the Walls of the Asylum? Psychiatric Treatment in the 1980s and 1990s’, in Outside the Walls of the Asylum: The History of Care in the Community, 1750–2000, ed. P. Bartlett and D. Wright (1999), 247. In 1960, there were 130 mental hospitals in England; by the time Friern closed, there were 41 (Busfield, Joan, ‘Restructuring Mental Health Services in Twentieth Century Britain’, in Cultures of Psychiatry and Mental Health Care in Postwar Britain and the Netherlands, ed. Gijswift-Hofstra, Marijke and Porter, Roy (Amsterdam, 1998), 22Google Scholar).

5 Scull, Andrew, Museums of Madness: The Social Organisation of Insanity in Nineteenth-Century England (New York, 1979)Google Scholar; enlarged and revised as The Most Solitary of Afflictions: Madness and Society in Britain, 1700–1900 (1993).

6 For the fate of the old asylums, see Lowin, Anna, Knapp, Martin and Beecham, Jennifer, ‘Uses of Old Long-Stay Hospital Buildings’, Psychiatric Bulletin, 22 (1998), 129–30CrossRefGoogle Scholar; SAVE, Mind over Matter: A Study of the Country's Threatened Mental Asylums, SAVE Britain's Heritage (1995).

7 Michel Foucault, The History of Madness, trans. Jonathan Murphy and Jean Khalfa (2006). The most influential spokesman for the social control thesis has been the American sociologist Andrew Scull: see Most Solitary of Afflictions, 376–81, for his sophisticated version of the argument. For a nuanced defence of the asylum system, see Kathleen Jones, Asylums and After: A Revised History of the Mental Health Services from the Early Eighteenth Century to the 1990s (1993).

8 As studies from Britain and elsewhere show, the introduction of new drug therapies did not cause deinstitutionalisation, which was already well underway before the new medications came into use, but it fuelled optimism and played an important role in shaping community-care policy (Jed Boardman, New Services for Old – an Overview of Mental Health Policy, Sainsbury Centre for Mental Health (2005), 29).

9 John Welshman, ‘Rhetoric and Reality: Community Care in England and Wales, 1948–74’, in Outside the Walls, ed. Bartlett and Wright, 205. As John Raftery and others note, the deinstitutionalisation of mental health care also needs to understood as part of a long-term government drive to curtail public health expenditure by shifting provision toward the private and voluntary sectors: Raftery, ‘Decline of Asylum’, 20; Turner, ‘History of Deinstitutionalisation’, 3–4.

10 ‘Desert Island Discs’, BBC Radio 4, 16 July 2010.

11 See below, pp. 202–7, for a more detailed discussion of this.

12 Jones, Asylums, 146–8; Douglas Bennett, ‘The Drive towards the Community’, in 150 Years of British Psychiatry, 1841–1991, ed. G. Berrios and Hugh Freeman (1991), 326–7; Elaine Murphy, After the Asylums: Community Care for People with Mental Illness (1991), 10–11, 13. The provision of social welfare benefits and public housing was also crucial in enabling the unwaged mentally ill to live outside asylums, although generally in very straitened circumstances.

13 For the deinstitutionalisation of mental health services internationally, see International Journal of Mental Health, 11, 4 (1982/3) (entire issue); Fakhoury, Walid and Priebe, Stefan, ‘Deinstitutionalisation and Reinstitutionalisation: Major Changes in the Provision of Mental Health Care’, Psychiatry, 6, 8 (2007), 313–16CrossRefGoogle Scholar.

14 Boyers, R. and Orrill, R., eds., Psychiatry and Anti-Psychiatry (Harmondsworth, 1972)Google Scholar; Peter Sedgwick, Psycho Politics (1982).

15 Bennett, ‘Drive towards Community’, 327.

16 Admission rates (including repeated admissions: the notorious ‘revolving-door’ syndrome) were higher than ever by the end of the 1960s, but these admissions were increasingly short term (see n. 1 for references).

17 Barbara Robb, Sans Everything: A Case to Answer (1967). Robb's book caused a furor. An independent committee of inquiry was established to investigate her allegations of abuse and neglect; for its findings (which many commentators at the time decried as a ‘whitewash’), see www.sochealth.co.uk/history/Friern.htm.

18 Scull, Andrew, ‘Historical Reflections on Asylums, Communities, and the Mentally Ill’, Mentalities, 11, 2 (1997), 14–15Google Scholar.

19 For examples of this policy language see Department of Health, Independence, Well-Being and Choice (2005); Department of Health, From Segregation to Inclusion: Commissioning Guidance on Day Services for People with Mental Health Problems (2006).

20 Bott, Elizabeth, ‘Hospital and Society’, British Journal of Medical Psychology, 49 (1976), 126CrossRefGoogle ScholarPubMed. Bott's classic essay is more than three decades old, but problems of social isolation and family conflict among people with serious mental illness appear to be ongoing: see Kelly, Brendan D., ‘Structural Violence and Schizophrenia’, Social Science and Medicine, 61 (2005), 721–30CrossRefGoogle Scholar; Boydell, J., McKenzie, K., Os, J. Van and Murray, R. M., ‘The Social Causes of Schizophrenia’, Schizophrenia Research, 53 (Suppl.) (2002), 264Google Scholar; Leary, J., Johnstone, E. C. and Owens, D. C., ‘Social Outcome’, British Journal of Psychiatry, 159 (Suppl. 13) (1991), 13–20Google Scholar.

21 For the announcement of the website launch see www.e-health-insider.com/news/itemcfm?ID=2246. The website www.mhchoice.org.uk appears to be defunct.

22 Annemarie Mol, The Logic of Care: Health and the Problem of Patient Choice (2008), x–xi.

23 Ibid., xii.

24 Risk leapt to the forefront of UK government mental health policy after the widely publicised murder of Jonathan Zito by the schizophrenic Christopher Clunis in 1992. The public inquiry that followed revealed care failures that were deemed to necessitate a more risk-oriented policy approach. ‘Risk minimisation’ became the must-do, dominating day-to-day decision-making, albeit in ways that sat very uneasily alongside the ‘choice’ agenda. As John Wilkinson, a former manager of mental health services in East London, writes: ‘The very people who stalk the nightmares of tabloid editors and Heath Ministers and who must be policed in thought and act, at one and the same time are Consumers, who must exercise Choice and must assess the Performance of those providing them with services. The very people who must be subject to community orders and who must demonstrate Compliance – with treatment, with care plans – must grasp those opportunities made available to them through the new Recovery perspective!’ (Wilkinson, John, ‘The Politics of Risk and Trust in Mental Health’, Critical Quarterly, 46, 3 (2004), 83CrossRefGoogle Scholar).

25 The recovery model is a complex policy initiative. It has received strong impetus from the service-users movement, which sees in it a rejection of psychiatric paternalism in favour of a service that treats its users as persons rather than patients, and affords them a greater voice over their treatments and care. Critics however – which includes both users and practitioners – argue that the model has been ‘hijacked’ by mental health managers as a way of legitimating service cuts. For a government statement of the model see Mental Health Division Department of Health, New Horizons: A Shared Vision for Mental Health (HMSO, 2009); for service-users’ perspectives see www.psychminded.co.uk, and a host of other internet sources. For a detailed discussion of the model see Geoff Shepherd, Jed Boardman and Mike Slade, Making Recovery a Reality, Sainsbury Centre for Mental Health (2008).

26 Most inpatient admissions are now strictly time-limited; getting a patient ‘off the books’ – if only by shunting him or her onto another part of the service – is the goal. Outpatient services which do not fit into the new recovery model, such as rehabilitation programmes and day centres, are disappearing everywhere. For the decline in rehabilitation services see Mountain, Debbie, Gillaspy, Helen and Holloway, Frank, ‘Mental Health Rehabilitation Services in the UK in 2007’, Psychiatric Bulletin, 33 (2009), 215–18CrossRefGoogle Scholar. For day centre closures, see www.communitycare.co.uk, and scores of internet-based protests against local day centre closures.

27 The British Association for Behavioural and Cognitive Therapies describes the therapeutic relationship in CBT as a ‘partnership’ that aims to promote client independence: ‘The approach . . . relies on the therapist and client developing a shared view of the individual's problem. This then leads to identification of personalised, usually time limited therapy goals and strategies which are continually monitored and evaluated. The treatments are inherently empowering in nature, the outcome being to focus on specific psychological and practical skills . . . aimed at enabling the client to tackle their problems by harnessing their own resources . . . Thus the overall aim is for the individual to attribute improvement to their own efforts, in collaboration with the psychotherapist’ (Katy Grazebrook, Anne Garland and the Board of BABCP, What are Cognitive and/or Behavioural Psychotherapies? (2005)). For the need to time-limit CBT in order to avoid ‘dependency issues’, see Evans, Ceri, ‘Cognitive Behavioural Therapy with Older People’, Advances in Psychiatric Treatment, 13 (2007), 111–18CrossRefGoogle Scholar.

28 Melanie Klein, ‘On the Sense of Loneliness’, in her Envy and Gratitude and Other Works, 1946–1963 (1988), 300–13.

29 Lambert, M. and Barley, D. E., ‘Research Summary on the Therapeutic Relationship and Psychotherapy Outcome’, Psychotherapy, 38, 4 (2001), 357–61CrossRefGoogle Scholar; Gilbert, Paul and Leahy, Robert L., eds., The Therapeutic Relationship in Cognitive Behavioural Therapies (Hove, 2007)Google Scholar. In 1962, Denis Martin, the physician superintendent of Claybury Hospital in Essex, criticised psychiatric institutions for failing to develop strong relationships between patients and practitioners: ‘Lack of channels of communication seems to be the fundamental barrier to constructive change and fosters a very . . . superficial kind of personal relationship [between practitioner and patient]’ (Martin, Denis, Adventures in Psychiatry (Oxford, 1962), 15, quoted in Barham, Closing the Asylum, 7Google Scholar). Today this is a failing which many service managers – keen to avoid ‘dependency-generative relationships’ – seem to regard as a strength, while mental health staff who continue to emphasise the value of the therapeutic relationship are ‘dismissed as self-serving and mystifying’ (Wilkinson, ‘Politics of Risk’, 95).

30 John Conolly, MD, The Treatment of the Insane without Mechanical Restraints (1856; 1973), 13.

31 John Conolly, MD, A Letter to Benjamin Rotch Esq . . . on the Plan and Government of the Additional Lunatic Asylum for the County of Middlesex, About to be Erected at Colney Hatch (1847), 20.

32 Conolly, Treatment of the Insane, 58.

33 For moral treatment at the York Retreat see Cherry, Charles L., A Quiet Haven: Quakers, Moral Treatment and Asylum Reform (Rutherford, NJ, 1989)Google Scholar; Digby, Anne, Madness, Morality and Medicine: A Study of the York Retreat, 1796–1914 (Cambridge, 1985)Google Scholar; Charland, Louis C., ‘Benevolent Theory: Moral Treatment at the York Retreat’, History of Psychiatry, 18, 1 (2007), 61–79CrossRefGoogle ScholarPubMed; Samuel Tuke, Description of the Retreat: An Institution near York, for Insane Persons of the Society of Friends (1813; Milton Keynes, 2010). For Pinel see Philippe Pinel, A Treatise on Insanity (1806); Goldstein, Jan, Console and Classify: The French Psychiatric Profession in the Nineteenth Century (Chicago, 2001)Google Scholar; Weiner, Dora B., ‘La Geste de Pinel: the History of a Psychiatric Myth’, in Discovering the History of Psychiatry, ed. Micale, Mark and Porter, Roy (Oxford, 1994), 232–49Google Scholar.

34 Weiner, ‘La Geste de Pinel’, 235.

35 Goldstein, Console and Classify, 88.

36 Tuke, Description of the Retreat, 168.

37 Scull, ‘Historical Reflections’, 3. See also Tuke, Description of the Retreat, 133–4.

38 Arguing for the institutional confinement of the insane, some early champions of the asylum system claimed that removal from family life was, for many lunatics, a prerequisite to recovery (Scull, ‘Historical Reflections’, 3). Historians have tended to dismiss such arguments as self-serving, but it seems very likely, as Elizabeth Bott suggests, that for some inmates the asylum served as a refuge from miserable homes. Bott tells the story of one female patient who, during a period of turmoil in her hospital, remarked to Bott: ‘There are so many changes and upsets here now that I might as well go home’ (‘Hospital and Society’, 128).

39 Conolly, quoted in Scull, ‘Historical Reflections’, 4.

40 Digby, Madness, 37–50.

41 Scull, Most Solitary, 192.

42 Ibid., 190–3.

43 Smith, Leonard, Cure, Comfort and Safe Custody: Public Lunatic Asylums in Early Nineteenth Century England (Leicester, 1999), 275–6Google Scholar.

44 Walton, John, ‘Pauper Lunatics in Victorian England’, in Madhouses, Mad-doctors and Madmen: The Social History of Psychiatry in the Victorian Era, ed. Scull, Andrew (Philadelphia, 1981), 168Google Scholar.

45 Harriet Martineau, A History of the Peace (1858), book 3, 304; London Illustrated News, Jan. 1848.

46 See Walton, ‘Pauper Lunatics’, 182–92, for a detailed account of these concerns as they arose in relation to conditions in Lancaster Asylum between 1816 and 1870.

47 Foucault, History of Madness, 507.

48 Ibid., 510–11.

49 For a brief discussion of these differences in relation to therapeutic practices at the York Retreat, see Roy Porter, Mind-Forg'd Manacles: A History of Madness in England from the Restoration to the Regency (1987), 225–6. As Porter says, the Tukes were not concerned with exploring the unconscious minds of their patients but in ‘making them want to be good’. However, like most historians of moral treatment Porter underestimated the innovativeness of the Tukes’ emphasis on the therapeutic relationship as a curative agent.

50 Foucault, History of Madness, 483.

51 Ibid., 484–5.

52 Ibid., 499.

53 Porter, Mind-Forg'd Manacles, 5–9; Scull, Andrew, Insanity of Place/the Place of Insanity (Abingdon, 2006), 42Google Scholar.

54 Adam Phillips and Barbara Taylor, On Kindness (2009), 26–38.

55 Conolly, Treatment of the Insane, 115.

56 According to Samuel Tuke, one of the most important qualifications for an asylum manager was ‘a ready sympathy with man, and a habit of conscientious control of the selfish feelings and passions’ (quoted in Digby, Madness, 27).

57 Goldstein, Console and Classify, 97; Lewis, Aubrey, ‘Philippe Pinel and the English’, Proceedings of the Royal Society of Medicine, 48, 8 (1955), 584Google Scholar.

58 Digby, Madness, 37, 51, 58–61.

59 Ibid., 105.

60 Goldstein, Console and Classify, 86.

61 Ibid., 86, 99. See also Patrick Vandermeersch, ‘“Les Mythes d'Origine” in the History of Psychiatry’, in Discovering the History of Psychiatry, ed. Micale and Porter, 222.

62 Digby, Madness, 61; Tuke, Description of the Retreat, 59.

63 Joel Whitebook, ‘Against Interiority: Foucault's Struggle with Psychoanalysis’, in The Cambridge Companion to Foucault, ed. Gary Cutting, 2nd edn (2005), 323.

64 Foucault, History of Madness, 506–11.

65 Field, Joanna [Marion Milner], On Not Being Able to Paint (Los Angeles, 1957), 92Google ScholarPubMed.

66 Scull, Insanity of Place, 82.

67 Walton, ‘Pauper Lunatics’, 91.

68 Murphy, After the Asylums, 37.

69 Scull, Insanity of Place, 82.

70 Barham, Closing the Asylum, 75–7; Murphy, After the Asylums, 36–41.

71 Conolly, Letter to Benjamin Rotch, 21, 14, 12.

72 Richard Hunter and Ida Macalpine, Psychiatry for the Poor: 1851 Colney Hatch Asylum-Friern Hospital 1973 (1974), 24.

73 Ibid., 25–9.

74 Ibid., 44–5.

75 Ibid., 86; Barham, Closing the Asylum, 2.

76 Ibid., 84. Despite its integration into the NHS, patient costs at Friern for the remaining decades of its existence were kept well below levels at general hospitals (Stewart, ‘Community Care’, 308).

77 Bott, ‘Hospital and Society’, 97, 102, 103, 106; Stewart, ‘Community Care’, 27.

78 In 1969, the Head of Nursing Services at Friern noted proudly that ‘all treatments available in the psychiatric field’ were currently at use in the hospital, including individual and group psychotherapy (but not psychoanalysis, which was judged ‘too expensive of time to be a viable proposition’) (Nursing Mirror, Oct. 1969). The psychotherapeutic treatments were mostly delivered in Halliwick House, a small inpatient unit located in a separate building on the Friern grounds. Unlike the vast majority of Friern inmates, Halliwick patients tended to be drawn from the professional middle class.

79 Robb, Sans Everything; Stewart, ‘Community Care’, 279–80. The uncatalogued files from Friern deposited in the Royal Free Hospital Archives Centre at the time of the hospital's closure include files pertaining to the Robb scandal.

80 Peter Barham, ‘From the Asylum to the Community: The Mental Patient in Postwar Britain’, in Cultures of Psychiatry, ed. Gijswift-Hofstra and Porter, 224–6.

81 David H. Clark, Social Therapy (1974); David H. Clark, The Story of a Mental Hospital: Fulbourn 1858–1983 (1996).

82 Clark, Story of a Mental Hospital, 180.

83 Bott, ‘Hospital and Society’, 104–5.

84 Roy Porter, ‘Introduction’, in Clark, Story of a Mental Hospital, x.

85 Sedgwick, Psycho Politics, 192–3. Sedgwick's assessment of the situation was endorsed by a Parliamentary Select Committee, which reported in 1985 that ‘the pace of removal of hospital facilities for mental illness has far outrun the provision of services in the community to replace them’ (cited in Barham, Closing the Asylum, xii). ‘Any fool can close a long-stay hospital’, the Committee went on to comment, but ‘it takes more time and trouble to do it properly and compassionately’.

86 Murphy, After the Asylums, 60–85.

87 Stewart, ‘Community Care’, 291.

88 Ibid., 293.

89 LMA, H/12/CH/A/30/6.

90 Writing about the situation in Friern in 1985, the Chair of its Medical Committee, Rosalind Furlong, described plummeting staff morale: ‘When such staff are already working under pressure in adverse conditions, this can have a profound effect’ (Furlong, Rosalind C., ‘Closure of Large Mental Hospitals – Practicable or Desirable?’, Bulletin of the Royal College of Psychiatrists, 9 (1985), 130–4CrossRefGoogle Scholar).

91 ‘In Conversation with Doris Hollander’, Psychiatric Bulletin, 28 (2004), 18; Stewart, ‘Community Care’, 294.

92 House of Commons Debates, 6 July 1990, 1.15pm (www.theyworkforyou.com/debates).

93 No one involved in the hospital's closure seems to have made any systematic effort to ascertain the patients’ views. Those patients who met with management wanted to see the hospital shut down, but were very anxious about what would become of ex-inmates; some, like the service-user activist and academic Diana Rose, became actively involved in supporting patients through the transition into community care (Dr Diana Rose, personal communication).

94 Tomlinson, Dylan, Utopia, Community Care and the Retreat from the Asylums (Milton Keynes, 1991), 135Google Scholar.

95 Tomlinson, Utopia; Leff, Julian, ed., Care in the Community: Illusion or Reality? (Chichester, 1997)Google Scholar; Leff, Julian, ‘Why is Care in the Community Perceived as a Failure?’, British Journal of Psychiatry, 179 (2001), 381–3CrossRefGoogle ScholarPubMed; Dylan Tomlinson and John Carrier, eds., Asylum in the Community (1996); Perring, Christine McCourt, The Experience of Psychiatric Hospital Closure (Avebury, Aldershot, 1993)Google Scholar; Barham, Closing the Asylum, 21–4.

96 ‘Friern Hospital Decommissioning Report’, Royal Free Hospital Archives Centre (uncatalogued papers relating to Friern Hospital's closure).

97 Leff, Julian, ‘The TAPS Project: A Report on 13 Years of Research, 1985–1998’, Psychiatric Bulletin, 24 (2000), 165CrossRefGoogle Scholar.

98 Thornicroft, G., Margolius, O. and Jones, D., ‘The TAPS Project 6: New Long-Stay Psychiatric Patients and Social Deprivation’, British Journal of Psychiatry, 161 (1992), 621–4CrossRefGoogle ScholarPubMed; Rosalind Furlong, ‘Haven Within or Without the Hospital Gate: A Reappraisal of Asylum Provision in Theory and Practice’, in Asylum, ed. Tomlinson and Carrier, 158–62.

99 Stewart, ‘Community Care’, 294–7.

100 ‘Testimony: Inside Stories of Mental Health Care’, British Sound Library Archive.

101 The film, Asylum, directed by Rebecca Frayn for Cutting Edge, was screened by Channel 4 in March 1999.

102 An earlier version of this account of the filming of Princess Park Manor appeared in the London Review of Books, 8 May 2003 (under the pseudonym ‘Eve Blake’).

103 Mental Health Division Department of Health, New Horizons (see n. 25).

104 Barham, Closing the Asylum, 13.

105 D. W. Jones, D. Tomlinson and J. Anderson, ‘Community and Asylum Care: plus ça change’, Journal of the Royal Society of Medicine, 84 (May 1991), 253.

106 See n. 26.

107 On the television as a ‘friend’, see Tomlinson, Utopia, 165–6. One ex-inmate, who spent his days alone in his flat in front of the television, told a researcher that it was just like living in a hospital ward ‘but with nobody else there’ (Dr Felicity Callard, personal communication).