UK Health Minister Enoch Powell’s famous “water tower” speech of 1961 announced the imminent wholesale closure of the old 19th century lunatic asylums. Henceforward there would be Care in the Community, and things would be so much better.
Things are “better”, in a perverted sense of the word. Many of the patients of 1961, the year in question, would nowadays have been aborted in the womb. Many who might have spent their lives locked away in institutions have been turned out into the “community” – which for some has meant the streets. The UK health service is no longer being kept ticking over by a seemingly inexhaustible supply of cheap Irish labour. We now get our nurses from further afield, or from agencies.
In 1961, I was employed as a mental health nurse – or more precisely as a nursing assistant. Unlike “proper” RMNs (Registered Mental Nurses) – of which there were and still are all too few – nursing assistants had nothing but on-the-job training. Barely out of school, with no experience of adult life, I found myself caring for people with the most appalling disabilities, some of them hard indeed to care humanely for. I spent hours of night-duty closeted with people whom even the police had found a handful. The experience marked me for life. This is why I consider myself, like any mental sufferer, a survivor of the system.
From my experience I wrote a novel: The Door Out Of Hell. It is fictional, but it is authentic. To the extent it portrays a situation which was replicated across the country in every major town and city, Ward 14 could have been anywhere. To the extent my knowledge was gained in one particular hospital, in one particular town, some people may think to recognise the fictional characters that populate the pages.
This is not true. The characters are not real people under false names, but literary composites, the blame for whose thoughts, words and deeds cannot be laid on colleagues with whom it was my privilege to work.
But there was something special about my hospital. It was run by far-seeing and humane people, to whom it is fitting here to pay tribute. Their attitude of selfless care trickled down to the bottom of the totem pole. Had the hospital been run by less caring people, it’s dreadful to think what this story could have been like: “The Scourge of the Swastika” perhaps? Other survivors of the system may conclude that the novel paints too rosy a picture, then as now. Perhaps it does. If that invalidates the world it tries to portray, then let them write their own story. Let as many survivors as possible expose the shameful state of our public provision for mental distress.
But let’s not mistake the purpose of this book: it is a coming-of-age tale about a young man’s maturing relationships – with other people and society at large. This young man had a lot of maturing to do – and that also is pretty true-to-life. The book paints a subjective picture of a peculiar world seen through the eyes of a peculiar boy – two “peculiar” boys, in fact: one a patient, one a nurse. Why was it written? Because I feel that this hidden world, for all its “peculiarity”, deserves revealing to the public gaze.
Does the book accurately portray the situation across the country as it was in 1961, let alone today? I don’t know. I would like to think that things have got better, but what I hear from people with more recent knowledge does not reassure me.
A lot of names for things have changed. When something has failed miserably in the past, if you change its name the problem vanishes without you having to spend too much to remedy it. “Mental nurses” (and some were, too!) are now “mental health nurses”. “Voluntary patients” (few were) are now “informal patients”. Both “formal” and “informal” patients are now “service users”. Stigma attaches to names, especially diagnostic names. In 1961 “cretin” and “mongoloid” were officially sanctioned terms. Even “lunatic” (blame the moon, not the sufferer) was once a euphemism for “madman”. But though you change the name, stigma doesn’t take long to catch up. As the Danes say: you can move house to escape it – but the goblin comes too.
It follows naturally, doesn’t it? Stigma is kept alive by people who are far more sensible than sensitive. They’re not easily duped. Nor are service users. “We may be mad,” I heard once, “but we’re not bloody fools.”
1961 was a bitter year in many ways. A lot of bad things came to a head that year: bad things that rumbled on for the next 20, 30, 40 years or more. The Congo – South Africa – Cuba – Vietnam – the Berlin Wall – to name but a few. Some say the phenomenon of the Swinging Sixties was a mass revolt against the attitudes and institutions that had given rise to the anguish of these times. Others point out that, even by 1961, Britain had not fully recovered from WW2.
Wars leave wreckage. People-wreckage – which lives on for years. When peace breaks out, sunny fields and rosy cheeks don’t happen overnight. And wars, like chronic illness, can go into remission. They can simply go off the boil – go cold.
The young people of today might be excused for thinking that the Cold War was somehow a phoney war – like a battle for market dominance between two brands of toilet paper. This is to ignore the immediacy of the nuclear threat. The Home Office department known as Civil Defence mounted eerie public exercises that became something of a national sport.
A sudden school outing – and you’d be bussed miles to some temporary depot where you got fed stew out of thin blue plastic bowls. The newsreels showed pictures of nuclear tests to everyone during their weekly visit to the cinema, in case anyone lacked the imagination to feel fear.
To those who have never lived through those times, the public mood was hard to describe. I caught a whiff of it once again in 2001, when I found myself in New York City the weekend after 9/11. But there was this difference: chronic fear produces shrivelled hearts – yet the people I saw spontaneously taking to the streets for peace and reconciliation, completely filling Times Square in a massive demonstration against over-hasty retribution (an event that went largely unreported) had hearts that were still too warm and full of blood that was too red.
In 1961 our hearts were cold and white. We found little pity in them for those left behind in the rat race. That didn’t elevate us in our own eyes. So to shore-up our self-esteem we persecuted minorities – at least those minorities who looked as if they wouldn’t lift a finger to help themselves. Someone sectioned under the Mental Health Act of 1959 could end up locked away for life on the signatures of two doctors. So too could someone diagnosed as schizophrenic. In doing such a thing we were honouring the crimes of the fascist enemy we had not long beaten.
A lot of dreadful things have happened since 1961. But a lot of encouraging things have happened too – let’s not lose sight of that. The sort of treatment meted out to war-hero Alan Turing, say, would be impossible today. Having had same-sex relationships no longer “takes away your ID card”, disqualifying you from speaking out in public, though paths to high office may remain bramble-strewn.
What a pity we can’t say the same for former service users. What a shame such progress hasn’t included improvements in services to some of the most vulnerable members of our community. Where mental healthcare is concerned we have a system that would shame a Third World nation, as much today as it did then.
Whatever the builders of Enoch Powell’s “water towers” were guilty of, they cannot be accused of penny-pinching in their efforts to remedy a recognised problem as best they knew how. It is we, their descendants, who have done that. And it goes beyond simple neglect to achieve the status of persecuting a defenceless minority.