Looking back: The journal of a mental hospital user in the 1960s

I am beginning to realise that most people want something from me. My employer – my sweat, the shops – my money, my brother – my ear, my father – my misery, my doctor and social workers – my mind. Is there no escape from this accursed society? (Journal entry, 5/4/71)

This is how 'David',* a young man first diagnosed with schizophrenia in 1960, sums up his life having lived nearly six years of the previous 10 as an inpatient in mental hospitals. At the time of writing, he was working and living independently. The excerpt comes from a boxful of letters, diaries and official documents given to one of us by his brother, some time after David's suicide in 1971 at the age of 27.

David was an extremely intelligent observer of other people's behaviour. He was given an intelligence test, which placed him in the top 10 per cent of the population. He often recorded verbatim what people had said, sometimes within minutes or hours of the occasion. With encouragement from David's brother, we have edited the journals and commented on how mental health services have changed since 1970. David's diaries are, in our opinion, of considerable historical importance.

David was rather withdrawn at school but he did not attract particular attention until there was some bullying and he began truanting. His mother had died when he was six and his father, though basically having his son's interests at heart, was unpredictable in his moods and often domineering. David's psychiatric career began after he was charged with stealing chocolate bars in a cinema. This minor misdemeanour was treated severely. He never appeared in court but was sent to a psychiatric unit for juveniles at the age of 16 in 1959. We assume he must have been behaving oddly. A year later he was in a mental hospital.  

David's hospital was relatively small by the standards of the day but it still retained the derelict remains of a farm at which the inmates had once worked. It was not seen as 'long-stay', and conditions there were probably better than in the larger institutions (see Wing & Brown, 1961). Much of his time was spent on an acute admissions ward, which was crowded and never entirely free from the threat of violence. Young men with drug addictions or convictions for grievous bodily harm were mixed in with old men suffering from senile dementia. Many of the Victorian hospitals had housed between one and two thousand people, their total population reaching a peak in 1954 (Scull, 1984). By this time, lifetime residence was no longer seen as an affordable or desirable option, and the aim for David, despite his long stays, was to rehabilitate him into a job and a 'normal life'. This is also what he clearly wanted. He saw himself as persecuted but also berated himself for being one of life's failures:

2/1/66. Why do I always return to this abysmal state of mind? … And there is the fear of it happening again. I have a horrible feeling that a schizophrenic such as myself has every reason to feel persecuted – he is! But I alone am not singled out for this kind of treatment. I see others in exactly the same predicament. It seems a certain type is doomed to be persecuted – for what else is it? ….. Will I ever be able to think again? At the moment I am physically and mentally incapable of doing anything. This is what they have done not for but to me.

24.7.66. I feel oppressed (not by anyone), depressed, stupid and inferior (which I am).

We were fortunate, in researching our book, to come across a psychiatric nurse who remembered David quite well. He showed us the ward where David had resided and explained how violent patients were dealt with. One method was to grab a patient's arm as it protruded through a hatch of the door in which the patient had been secluded. The patient was then fastened in an arm lock while another nurse would enter the room and administer the injection of a sedative. This nurse says he is still unable to lose the habit of being wary of exposing his back when entering a roomful of people, even when he is amongst friends. David's journal records feelings of violence, and also violent treatment from the nurses:

14/6/66. 100 mg of Largactil with each meal. … Got up early, washed, shaved. Had paraldehyde orally and then by injection… Now 4.15 pm and still very dopey from paraldehyde. Slept between breakfast and dinner, and dinner to tea… 9.10 p.m. Crowley attacked me after Murphy was her usual abusive insulting self, full of self-importance. My hair was pulled very hard. Crowley put both his hands round my throat and squeezed as hard as he could. However the threats (imitation) against Murphy may be effective enough to keep the bitch quiet. Injection I had last night (unnecessary, of course), very painful still. Presumably, object is to inflict physical pain, the other being mental pain. They are past masters in the art.  

Soon after admission, when David had been sedated and tranquillised, relationships with nurses were usually friendly. Privileges were granted gradually as behaviour 'normalised'. The hospital had extensive grounds to walk in, access was given to facilities in the local town, and at times, David attended as a day-patient while living at home. He formed friendships with fellow patients and drank with them in local pubs. There was no serious attempt at rehabilitation and he was sent elsewhere to industrial-style workshops for this purpose.

Sixties was an era of great enthusiasm for the new psychiatric drugs that had become available since the mid-1950s. David was chiefly prescribed chlorpromazine (Largactil) and sedatives. He was not given the ECT, insulin coma therapy, narcotherapy, and sometimes leucotomy, handed out to some of his fellow patients. In fact, he seemed to receive little of anything that could be described as therapeutic. He sometimes had long discussions with his doctors,
but he reveals little of what was said.

It seemed to be mainly about privileges. Yet, if we think in terms of formulating his problems, there was a key event, his mother's death, which he learnt about for the first time from his psychiatrist nine years after his first admission. She apparently thought he knew:

11/2/69. Ran out of Mandrax this morning. Felt awful. Saw Brewster who told me that my mother had been in Tullington [a mental hospital] on two occasions and had committed suicide. She prescribed Valium 5 mg t.d.s. Also my chloral was going up – 100%. When I told her of my condition she asked about ECT. I said I would sign.

It would seem that she noticed his shock. However, she offered no counselling, only additional medication. Some of his medical treatment can only be described as incompetent. He was tried on almost every new drug as the pharmaceutical companies made them available –  without any serious attempt to evaluate their effect. He became addicted to Mandrax, prescribed for night sedation, at which time he started to behave in a disinhibited and aggressive way, and stole from shops and fellow patients. It took a very long time for his doctors to recognise his addiction and terminate his prescription.

One of David's chief and repeated concerns was the effect of medication on his intelligence:

17/10/64. Largactil which, although produces a queer sort of compulsion to do things, eliminates ambition, imagination, memory and intelligence.

29/6/66. I wonder at this moment of something said to me by a psychiatric worker at about the age of 14 – that my thoughts went too fast, that the answers came too quickly. It is a pity that the treatment I have had in order to correct this has had a catastrophic effect upon the intellectual abilities of my mind.

In the light of subsequent research into the effect of antipsychotic and other drugs on the brain, David's concerns now seem realistic (Moncrieff, 2007; Whitaker, 2010).

Nurses did not have a therapeutic role, and in the early 1960s they were not even allowed to look at the case-notes. In some hospitals, radical social psychiatrists were bringing about very significant changes in the way they were run by involving patients (see David Clark's account at tinyurl.com/cuawcw8) but the idea of a 'therapeutic community' seems to have bypassed David's hospital. There, clinical psychologists administered tests and carried out research. Occupational therapy was provided to help patients socialise and occupy them on fairly meaningless tasks, for some of which they received payment.

David eventually committed suicide while apparently in a clear and rational frame of mind. The quotation at the beginning of this piece comes from his reflections shortly before his death. He was still writing his diary as he expired. We can only surmise the reasons for his decision. Although he was holding down a semi-skilled job, this was no future for the intelligent young man that he was; and he was living in a squalid bedsitter. He had regular contact with a concerned social worker and saw his psychiatrist intermittently. However, he had become isolated from his family, he had no real friends and had insufficient money to enjoy life. The means to kill himself were straightforward – he asked his psychiatrist for several weeks supply of sleeping tablets (chloral hydrate) and was given them.

Would the Davids of today get more effective treatment? It is hard to feel optimistic. If living in the right location where, say, cognitive behavioural therapy for psychosis or long-term counselling support was available, a present-day David might view his 'illness' differently. David had skills as a writer that could have been put to use. He may well have taken to the aims of the Hearing Voices Network and perhaps attended their meetings (www.hearing-voices.org). If unlucky, given he had a job and lodgings, we fear it is all too likely that his case would have been closed, with only his GP involved in prescribing his medication.

It is some 40 years since David died. Both of us trained as clinical psychologists in the mid-1960s and remember those old Victorian 'lunatic asylums' and the characteristic smells of the back ward, with its hints of the farmyard stable and carbolic soap. There have since been major developments in psychological approaches to psychosis and powerful challenges to the concept of schizophrenia itself (Bentall, 2009; Boyle, 2002). Changes in NHS services have also been immense. However, when care was moved into the community, we cannot help but feel that an opportunity was lost to allow people like David to be part of that community. Perhaps for economic reasons, services have relied too heavily on medication as almost the only, and clearly inadequate, intervention. The questions posed by this intelligent young man, caught in a system that basically just warehoused him (Miller & Gwynne, 1972) and offered little active help, remain the same questions we need to answer today.  

David's Box: The Journals and Letters of a Young Man Diagnosed as Schizophrenic, 1960–1971, Polpresa Press, 2011, R.R.P £15.99 is available at a discounted price from polpresapress.co.uk.

- Richard S. Hallam is a clinical psychologist in independent practice and a visiting professor of clinical psychology the University of Greenwich  

- Michael P. Bender is a clinical psychologist who retired from the NHS and undertook studies in English literatureand is currently writing a book for people assessed as having dementia

[email protected]

*This name and all names given in published extracts from the journal have been changed to ensure anonymity.

References

Bentall, R. (2009). Doctoring the mind. London: Penguin.
Boyle, M. (2002). Schizophrenia: A scientific delusion? London: Routledge.
Miller, E.J. & Gwynne, G.V. (1972). A life apart: A pilot study of residential institutions for the physically handicapped and the young chronic sick. London: Tavistock.
Moncrieff, J. (2007). The myth of the medical cure. Basingstoke: Palgrave Macmillan.
Scull, A. (1984). Decarceration: Community treatment and the deviant – A radical view. Oxford: Polity Press.
Whitaker, R. (2010). Anatomy of an epidemic: Magic bullets, psychiatric drugs and the astonishing rise of mental illness in America. New York: Crown.
Wing, J.K. & Brown, J.W. (1961). Social treatment of schizophrenia. Journal of Mental Science, 107, 847–861.