The Ballroom by Anna Hope: review and interview

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“Where love is your only escape ….

1911: Inside an asylum at the edge of the Yorkshire moors,
where men and women are kept apart
by high walls and barred windows,
there is a ballroom vast and beautiful.
For one bright evening every week
they come together
and dance.
When John and Ella meet
It is a dance that will change
two lives forever.”

The Ballroom is a remarkable work of fiction, where the love story between two patients in a Victorian asylum shines a light on a most unedifying and painful time in history. Set in what has been called ‘God’s own country’, the contrast between the ungodly practices going on inside Sharston Asylum and the majestic, pure beauty of the Yorkshire Ridings is acute. As part of this review-feature, I interviewed author Anna Hope about her research and the themes which underpin this evocative novel. 

British asylums were home to people diagnosed with mental illness and/or learning disabilities and although some of their stories have been recorded, sadly, the majority have been lost or weren’t documented in the first place outside of medical records. The history of stigma and fear associated with mental health services means that, historically, patients have been voiceless, socially, politically and culturally, and the public remain largely ignorant about what went on inside these asylums. Privacy laws means that a hundred years must pass from the death of the last patient before any personal details can be released into the public realm, hindering historians from accessing the archives, but author Anna Hope has managed to conduct extensive research which underpins the fictional story of two patients, Ella and John, and their doctor Charles Fuller, who were incarcerated in a fictional asylum she called Sharston, an institution which she says is “crafted as much from the imagination as the historical record” after she learned of a family connection to an actual asylum which once existed nearby.

Hope’s great-great grandfather was called John Mullarkey and he was a patient at Mernston Asylum in the West Riding of Yorkshire after his transfer from a workhouse. Seemingly suffering from what we’d now diagnose as a depressive disorder with an attendant malnutrition and cachexia, Hope’s author notes describe how he never recovered and died in Mernston aged 56 in 1918. The Ballroom is novel is dedicated to his memory and takes its name from her discovery of an actual ballroom inside the asylum, fallen derelict from lack of use. It was this poignant epilogue which triggered my tears which had been brimming for the last four chapters.

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Picture: Mark Davis / Guzelian Picture shows the ballroom at West Riding Pauper Lunatic Asylum at High Royds Hospital, Menston, West Yorkshire.

Tell us about your research and how you encountered the story of your ancestor…

“I came across the evidence of his time in the asylum by chance (if there is such a thing) when looking at the census records for my great-grandfather, his son. In a tiny crossed-out note on the side of the census form for 1911 it stated that John Mullarkey, the head of the family was in Menston Asylum, explains Anna.

“Having never heard of the place I immediately did a search on the Internet and came across local historian Mark Davies’s fantastic online archive dedicated to the history of what became known as High Royds hospital. It was there I saw the pictures of the ruined ballroom at the asylum’s heart and knew I needed to write about the place. When I eventually accessed my great-great-grandfather’s records I found them to be incredibly moving; he was a man suffering from what was deemed to be ‘melancholia,’ but really he seemed to have been sent out of his mind by poverty and worry over work. To add to this, on his admission from the local workhouse he was ‘emaciated’ and ‘poorly nourished.’ He never recovered and died in the asylum in 1918, ” explained Anna.

“I took many of the biographical details of his life: coming from the west of Ireland to find work in Liverpool as a young man, his ‘melancholia,’ his refusal to speak when arriving in the asylum, and used them for the character of John in the book, but I also always knew I wanted to have the freedom of fiction in creating John Mulligan. Similarly I re-named the asylum Sharston so I might have the greater latitude in writing about the place that fictionalisation allows, ” she adds.

The Ballroom introduces us to Ella, recently admitted from the cotton mill where she worked from a young age after smashing a window- she has barely had a life. The brutal working conditions there caused her eyes to suppurate painfully and skin to develop an inflamed rash. Her desire to see the beautiful moors she knew lay just feet from the building and her need to inhale air which was not clotted with dust motes led to an act of atavistic desperation and as a result of this, she was beaten and committed to Sharston under the care of an ambitious young doctor, Charles Fuller. His own employment there defies the stifling expectations of his own middle-class Yorkshire family and Charles struggles to find his own identity, He has high hopes that weekly music and dances in the asylum’s ballroom will help him make his name in the medical world as a doctor who uses music to tackle psychological fractures. He spends hours imagining the reception his paper will receive in London, adopting a purely intellectual approach in order to inoculate himself against his feeling. Charles is in denial of his own emotional connection to music, despite observing the benefits that listening to music brings to his patients.

John is one of those patients, an Irishman diagnosed with melancholia after a series of losses, and so is Ella. The Ballroom is, on first sight, the story of growing relationships in a closed-off world. John and Ella are catalysts for change and acceptance and submission and through them we meet other patients; resilient and spirited Dan who is John’s friend, and Clem, another victim of a time and place where women who dared to push against a seemingly gilded existence were sat firmly down, again and again, until they broke.

In her authorial note, Hope talks of her shock at learning that the then Home Secretary, Winston Churchill, was a strong supporter of eugenics, espousing his belief that mental illness, poverty and physical disability were all evidence of a weakened genetic stock and therefore provided a good reason to sterilise the significant numbers of people in Britain with these conditions. Her own discoveries colour the prose, allowing us to feel shock, and then dismay, as former critics of the practice become zealous devotees of it. This volte-face is an ironic result of what appears to be Charles own psychological breakdown as he fights with his insight and goes on to project his own failings onto the patients and especially, onto John who represents all those qualities he fears he lacks: poetry, a heart and soul that cannot be imprisoned and a disturbing masculinity which seems hewn from the wild moors.

I drew parallels between the black Ragtime musicians of New Orleans and their small emancipatory gains and that of Charles and his orchestra when he first tried to play Ragtime and failed to embody its spirit. As a reader it was a moment in the story where I held my breath, wondering if Charles would let himself be free. Charles is as imprisoned, in his own way, as some of the patients in the asylum. He fails to recognise this although Ella, Clem and John all seem to display a nascent awareness of this. Did you feel ever tempted to give Dr Charles Fuller the gift of insight, I ask Anna?

“I definitely thought about giving him insight and I do think he’s perhaps more aware than he allows himself in his thoughts,” Anna replies. “Ultimately though, I thought it was dramatically more interesting if he was deeply in denial about his own demons and desires. I think perhaps it’s impossible to become the sort of character Charles does without deep suppression of one’s empathy. And to have empathy you need to have some modicum of self-love. I’m not sure, despite his arrogance, how much Charles really loves himself. I loved him though, despite the horror of what he becomes. I think I kept seeing him as a small boy, terrorised by his father, someone who has never felt comfortable in his own skin and wants to hurt the world in the same way he’s hurting.”

 

Of particular distress to me was learning that relatives of Charles Darwin were also exponents of eugenics and their lectures may well have gone on to influence the modified Feeble-Minded Bill which was passed in 1913 as the Mental Deficiency Act. That Darwin’s own contribution to the knowledge we have of humankind should be so distorted and abused for political ends keeps the story taut as we await the unfolding of history, sitting alongside Charles as he struggles to retain his equilibrium at one of the London lectures and sits in his room, clutching transcripts of Dr Tredgold’s address to the society at Caxton Hall. Tredgold’s findings on the Feeble-Minded were eventually passed onto Parliament and Charles wants this for himself because he is surrounded by almost faceless patients and fears invisibility as a result of what must feel like voluntary professional incarceration.

The reader cannot help but draw parallels with the politics of today but there is authorial subtlety at play here and as a result, realisation creeps slowly and coldly upon the reader.  Whilst Charles and his fellow eugenicists burn with the fevered heat of the zealot, Ella, John and the other patients remain oblivious which adds to the creeping unease until Hope allows it to bloom fully in her reader. What is particularly affecting is our realisation that the patients remain unenlightened as to Charles’s plans for medical posterity. We see them react in confusion and fear as things happen to them but any resolution of this does not involve knowledge and a consequently attendant power. And so the paternalistic philosophy of the asylum system perpetuates their dis-empowered status and our knowledge makes us collusive.

Whilst the government of today is not advocating eugenics, there does seem to be a feeling that there is a growing British under-class who are depicted as taking more than their fair share. Instead of eliciting compassion and support, they are instead dehumanised and ‘othered’ as a prelude to drastic social-welfare cuts. It has been a primitive and successful strategy to date. We are privy to Charles in his private space, a small room in the grounds where he studies, practises music and reads a transcript by Tredgold which states: “I have no hesitation in saying, that nowadays the degenerate offspring of the feeble-minded and chronic pauper is treated with more solicitude, has better food and clothing and medical attention, and has greater advantages than the child of the respectable and independent working man, So much is this the case that people are beginning to realise that thrift, honesty, and self-denial do not pay,” and in this, we cannot help but hear the words of Ian Duncan-Smith.

And Charles in his own private space, reads of measures which involve the most private space of all- a person’s sexual and reproductive organs- a potential decision which will make them public property, and their removal a tacit condition to access welfare and mental-health care. The plot exposes a paradox: sterilised patients remain incarcerated in a hidden asylum, where daily doings are secretive but patients are not permitted privacy or secrets and their bodies and minds have fluid boundaries which are defined by those who have charge over them. They are permitted only the most cursory of identities.

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High-Royds asylum at Menton, West Yorks

An early scene introduces us to John and Dan as they dig communal un-marked graves and these graves act as sump for all manner of fears as well as being a literal and metaphorical barrier to hope and progression: even death is not an escape and death will not return identity to patients nor give them a longed-for privacy and personal space. Hope finds a way to navigate us through a realisation which might otherwise threaten to overwhelm the reader, via runaway Ella, whose furious, defiant flight is brought to an accidental end by her encounter with John as he sees her fleeing as he digs the graves for patients who die in the feared chronic wards.

Released from Scarston asylum, Hope’s prose roams and probes the glorious countryside and when the reader is plunged back into the crepuscular gloom of the buildings, it is a shock. The sense of place is profound and John and Ella’s appreciation of the world outside is heightened because they are divorced from it. The asylum is a scar on the landscape but it also seems hewn from it. The dramatic Yorkshire moors which seem wild, dangerous and untamed to those of us unfamiliar with them and to Charles who prefers the tamed and subdued, but to John and Ella, they are places of safety, an alternative and purer form of asylum for the couple who seek out the dark woods and fields of crops to meet and fully be themselves. As Ella finds ways of escaping the dankness of the laundry and the dank gloom of the day-rooms and dormitories, she steps into the light and we see her.

John and Ella are very much part of the landscape and show such love for the countryside and nature. Indeed Ella’s need for air and space and connection is what causes her to be committed in the first place when her breaking of the mill-window is deemed such a transgression, it cannot be the act of a sane person. I found their attempts to maintain this connection with nature inside such a dark place almost unbearably sad and Hope’s own love for the Yorkshire Ridings shines through her prose.
Was it a shock for you when your research led you to read about such darkness (unnamed graves, abusive practices) existing in what is called ‘God’s own country’? For the reader, it is such a contrast and a triumph of writing, I comment.
“I grew up in Lancashire, in a beautiful village on the moors, but close to towns like Bolton, Blackburn and Bury, which in the 80’s were suffering a lot from post-industrial malaise. It always struck me how these towns, which were often full of deprivation were so close to such wild, open country and I always thought about the mill workers, and what their relationship might have been to those moors,” Anna says.
“As for Yorkshire, my dad’s a Yorkshireman and I have many Yorkshire members of my family, and I see that darkness and wildness as definite Yorkshire traits. There’s a blackness to the humour there which I love, and which only comes from things being a bit tough, but also this sense of incredible expansiveness you get from the landscape. I walked a lot on Ilkely moor, for instance, when writing the book, which is such a rich and inspiring spot. But I suppose, no, it wasn’t a surprise to me to discover such darkness there, although it must be said the unnamed graves were by no means confined to Yorkshire and the north, I think such practises were widespread in the asylum system across Britain,” she adds.

 

Hope is adept at writing conversation, melding evocative visual imagery and exquisite dialect with casual chat which contain little speech bombs if you pay attention, encouraging readers to become more insightful. Clem quotes Emily Dickinson; “There’s a certain slant of light. Winter afternoons. That oppresses, like the heft of cathedral tunes” as she helps Ella in the laundry where they both work, a beautiful example of the way Hope uses light, shade, and dark to emphasise the taunt of the countryside outside as the light and dark of day and night flows over the moors and pushes against the high windows. Music contains the same light and shadow too, as does dancing and the question is whether a moment of joy makes the rest of life more or less bearable. We’re forced to ask that of ourselves.

There’s epistolary conversation too and the letters that John and Ella write to each-other, with Clem’s assistance, are full of delicate yet powerful natural imagery; the epic migration of the swallow and the changing light of the surrounding woodland; a flower picked from the lawns and pressed in an encyclopaedia. Like them, we are swallowed up by the stolid and sere asylum walls but Hope reminds us to look up, out of the windows as they do and to keep watch over the future on their behalf even when it seems as if the walls have closed in on them [and us] permanently.

For Clem and the other patients, the life of the mind is a divine agony and there are no easy answers, even in death. Charles introduction of music as therapy in the asylum is a troublesome catalyst, making patients vulnerable in new ways, opening them up to the divine as Dickinson elucidates in her poem. Handling a man’s cotton shirt with stained cuffs, Clem half muses, “Men. You can never  get the stains out,” a shivering reminder of events which might have triggered her symptoms and caused her incarceration. Mental illness can be hard to articulate for even the most verbally adept and at a time when this was not encouraged socially, and little benefit seemed to result from an open conversation with ones doctors, these asides act as signposts which we can navigate from, although it is frustrating that the doctors do not see what we, the reader with historical hindsight, can.

In The Ballroom, Anna Hope gives voice to stories rarely told and life to people who were secreted away, living lives so tenuous and shifting, they barely seemed to exist at all. The historical detail is handled skilfully by Hope and her own historiography never overshadows that of her characters whose ability to make themselves heard is already seriously hindered. Like Dickinson’s poem, her book shifts from the place where hurt originates- society, religious doctrine, the culture mores of the time- to the earthly recipients of that hurt- the patients and staff who are trapped in their own way. Hope roots her characters strongly in the dramatic landscapes of the Yorkshire Ridings, giving back the dignity, belonging and sense of place that asylum has denied them, and her prose soars over the story, reminding us of the swallows which so fascinate John as they return each year to make their summer homes on the moors. The love story at its heart is painful but one of the best I have read in a long time.

The Ballroom is very cinematic, I comment to Anna. Who would you like to see play the main roles? Or is it something you find hard to envision?
“I’d be lying if I said I hadn’t thought about it at all, but as an ex- actress I know how fickle that world can be, so I try not to think about it too much! If it happens, I’ll definitely have some ideas to pitch in though – the characters are so dear to me and I can sense them so clearly that to have a very different sort of actor playing the role would be hard,” Anna replies.
I’m pretty sure that The Ballroom will be on our screens at some point.
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Author Anna Hope // photo contributed

The Ballroom was published February 4th 2016 and is in all good bookshops.

Publisher: Transworld Publishers Ltd
ISBN: 9780857521965

 

 

 

 

 

 

 

 

A Home away from home: Anna Hope’s novel ‘The Ballroom’ has links with our own Suffolk history

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Picture: Mark Davis / Guzelian Picture shows the ballroom at West Riding Pauper Lunatic Asylum at High Royds Hospital, Menston, West Yorkshire. A photographic book entitled `Asylum’ has just been published and shows the work of photographer Mark Davis who has photographed derelict asylum’s round Britain and Ireland.
This feature was first published by The Bury Free Press in their print edition only and is reprinted here by kind permission.

Grand ballrooms are not the first thing that come to mind when we imagine the Victorian asylums of our recent past but a newly published novel by Anna HopeThe Ballroom, was inspired by her discovery old photographs of an ornate ballroom in a northern asylum, now fallen into disrepair. And whilst her story is set many miles away, in the Yorkshire Ridings, it has intriguing parallels with the old county asylum, once known as St Audry’s near Ipswich and the exhibition dedicated to it in Stowmarket’s Museum of East Anglian Life. After reading Anna’s novel and interviewing her for this feature, I realised that it was time to re-visit this local museum which has an exhibit about the old St Audry’s asylum and talk to Lisa Harris who is employed there as Collections and Interpretation Manager.

The St Audry’s Project tells the tale of the old St Audry’s Hospital in Melton, which began life as the Suffolk County Asylum in 1832, on the site of an old workhouse. When St Audry’s closed in 1993, its museum collection and archive were divided between various regional establishments. Since then, the Museum of East Anglian Life has been collating oral testimonies and working with local people to ensure that such an important and fascinating part of Suffolk history is not lost. Lisa explains the history of the collection and her involvement in it.

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Abbots Hall at Museum of East Anglian Life. Image: Museum of East Anglian Life

“The Museum of East Anglian Life was re-developing Abbots Hall and we wanted to look at the concept of home and belonging: home as in the people who themselves once lived in Abbots Hall; home as in being a proud Stowmarket girl, or a Suffolk person or even an East Anglian. We also wanted to look at different types of home, of which an asylum is one, and we knew we had the St Audrys collection which hadn’t actually been on public display before, to my knowledge,” she says

“All the archives that survived are based at Ipswich Records Office so this gave us a chance to talk about this whole element of life in Suffolk but also to link into the bigger picture and we were able to get funding from Comic Relief for this.

It is interesting that the collection came into being via the informal efforts of the staff who once worked at the hospital and I ask Lisa about this.

“The collection came here originally because it was in the teaching section of St Audry’s, housed in the attic. When they became a teaching hospital in the 1950s different staff gradually gathered items such as clothing, farm equipment and patients belongings and created a museum on site. But when the asylum closed in 1953, there was concerns as to where all of this might go. Some of the more medical items went to the Science Museum in London, a lot of it went to Felixstowe Museum and the rest came here”, she explains, sweeping her arm around the room lined with glass vitrines containing the tokens used as part of a patient-goods exchange system, the books and records, carefully inked in black fountain pen, pairs of spectacles, thick hard-to-rip nightgowns and decks of cards.

There’s staged vignettes too: a hospital screen has become an art installation where people have attached labels inscribed with the stigmatising language used to describe mental illness and the people who experience it. ‘Mental’, ‘schizoid’, ‘mental enfeeblement’ are starkly stamped on paper luggage tags and there’s a bed and bath with restraints in one corner plus the recorded voices of former staff who talk of their own lives there, often in a pronounced Suffolk burr. As visitors move slowly around the room, these voices fill the air, bringing the room to life.

Conducting research such as this can be made challenging by the stringent rules which control access to patient records: By law, a 30 year closure period is applied to administrative and committee papers, 80 years for student and staff records, and 100 years for personal medical records. This means the most important voices of all – that of the patients- are missing. Both Lisa Harris and Anna Hope emphasise the importance of that patient voice and the ways in which they sought it out for their respective endeavours.

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Anna Hope: author of The Ballroom

The voice of the patients in The Ballroom are vivid, born in part from the many hours of research its author put in, as Anna Hope explains. “Their [the patients] voices do break through too, particularly in the casebooks. I read extensively in the casebooks of High Royds for the period in which the book is set, and the patients jumped vividly from their pages; even the act of holding the casebook in my hands was powerful: the marbled covers, the smell of age, the photographs of the patients, and their own words, erupting into the present, making themselves heard.” Anna skilfully combines her research with the imagination of a fiction author, managing to avoid the trap that many authors fall into, of circumventing the objectivity of historical data to such a degree that accuracy suffers.

“We decided our exhibition would only go up to the 1920s because we can’t access any of the records after that date so why try to tell a story that isn’t out there yet in purely historical terms?” Lisa points out. “Our concern was telling that historical story in the hope that people can learn from it. And that maybe we don’t make the same mistakes in the future that we made in the past…or in the case of something has worked well, we’ll take that and work out how we can take that forward now. We’re trying to do sessions with medical professionals because in order to tell the story you’ve got to have some understanding of the terminology and the treatments. I’m not a medical expert, my understanding  is of curating and preservation: woodworm and rust!” She laughs. “I need to be able to point people in the right direction to get greater understanding, and to properly explain the context”, something which served her well when later on in our chat,  Lisa tells me about her encounters with some artefacts which appear to have a sinister purpose.
In 1832, when St Audry’s was called  The Suffolk County Asylum for Pauper Lunatics, Dr John Kirkman was appointed Medical Superintendent  and his reports and those of the doctors following him show a mind remarkably in tune with some of today’s philosophies of what constitutes good mental health care. The concept of an asylum as a home from home was central to his management: “Drugs are of course necessary in some cases, but moral treatment is essential to all and this is obtained chiefly by means of employment, amusement, pleasing associations and cheerful surroundings which act as medicine to the deceased mind” said the 50th Annual Report, back in 1888″  and the hospital became a self-sufficient community which nonetheless had strong ties to the village of Melton. Dr Kirkman couldn’t be more different to Dr Fuller, one of the narrators in Hope’s book.

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High Royds Hospital, Menston, West Yorkshire.

The Ballroom is Anna Hope’s second novel and it begins with the arrival of Ella Fay at the Sharston asylum in 1911. She is sent there because, after railing against the lack of light in the textiles mill where she works, she snaps and breaks one of the windows- a socially transgressive act in the eyes of her employers and her colleagues, albeit perfectly understandable and rational to us. John Mulligan is already a patient at Sharston, an Irishman suffering from depression provoked by the death of his daughter and his wife’s subsequent abandonment of him. When Ella and John meet at a Friday night dance in the asylum’s beautiful ballroom, they embark upon a slow-burn of a relationship, marked by surreptitious meetings outdoors and smuggled letters and encounters in the wild, expansive Yorkshire moors.

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The Ballroom by Anna Hope

Overseeing their care and to a certain extent, their fate, is Dr Charles Fuller, an ambitious yet inadequate medic who becomes slowly obsessed by the growing eugenics movement which advocated the social control and compulsory sterilisation of the poor and anyone with a mental illness or learning disability. In 1908, the newly appointed home secretary, Winston Churchill, was determined to solve the problem of what he referred to as  the“feeble-minded” – anyone who was deemed unable to self-determine. Churchill’s views on compulsory sterilisation crystallised and he began to circulate pamphlets on the subject among the cabinet. The Eugenics Society grew increasingly influential and in 1913 the Mental Deficiency Act established powers to incarcerate the “feeble-minded” in specially-built asylums. As we see in John and Ella’s story, the sexes lived separately and only met in strictly monitored meetings, in their case, the weekly dance and these impending laws threaten their relationship and very existence, in John’s case.

I asked Anna Hope about the clear parallels with todays social and political situation, not just in the UK but across Europe too, where cuts to health and social care have disproportionately impacted upon the poor and the mentally unwell and the language used to justify government policy has become ugly. “The welfare state; universal healthcare, access to education and greater social mobility are being eroded daily. Not just that, but I feel something even more insidious taking place; poverty has shifted in my lifetime from being something that should be ameliorated by a healthy government and society, to something that is perceived as the fault of those who find themselves poor. I think this is deeply dangerous and beneath the cuts to child benefits for instance, amongst many other cuts, there’s a disturbing echo, as you say, of eugenic policy,” she says.

As for the long view, Anna emphasises the importance of re-visiting the recent past in order to learn from it. We must guard against rose-tinted historiography too. “I think it’s a good time to look a little into our past and see what we were capable of” she says. “Churchill, for example, has been very well served by history, and for good reason, but if you look at his language as home secretary in 1911, in its insistence on ‘racial purity’ and the threat to the race from social degeneration it’s really not so very far from Hitler’s a few decades later.”

Do you think we lost as much as we gained from the abolition of the asylum system with regard to the purest meaning of the word? Have we forgotten that sometimes, some people do need a place of asylum while they recover, I ask Anna.

“That’s a really great question. Before I started researching I think my preconception, from reading lots of novels, about the Victorian and Edwardian asylum system was that once you were there you were there for life and the key was thrown away. Reading the casebooks gave me a different picture; there were many women for instance who were suffering from exhaustion or what sounded like post-natal depression, and who must have been working all hours in the mills or similar places, who simply needed a place to rest” she says.
“Following their stories in the casebooks I was really surprised and happy to read how many of them improved steadily over time with decent food, and rest and time away from work and families”, Anna adds. “So the asylum began to be a more nuanced, complex environment, not just this bleak, monolithic place from which no one ever emerged.”
Lisa Harris concurs with this and addresses some of the common stereotypes and misconceptions people held and still hold about an admission to an asylum. “A lot of people come to us and say “I’ve been tracing my family tree and I think I’ve found someone who was in an asylum and they get worried about this” she states, then looks back at her own initial reactions when she began looking through the St Audrys collection in the early days of developing the exhibit at the museum.
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The ‘Home From Home’ exhibition at Museum of East Anglian Life
“When I started this, I didn’t know very much about asylums at all and the first thing I found was this set of branding irons,” she says, pointing to a set of narrow branding irons displayed in a glass case. “Now the first thing that went through my head and our Learning Officers head was ‘Oh no, they branded the patients,  that is awful!’, but as we went on, we thought this cannot possibly be true. We had an over-active imagination and I do give a talk about the implications of this [for historical research]. But, in the light of the restraints we also found it was an understandable assumption and we were really pleased when we discovered the hospital had its own farm!”, she laughs wryly.
How many of us have assumed patients never left once admitted and lived in social seclusion, isolated from local villages, a source of fear, prejudice and trepidation to the locals? Not necessarily so, according to both Lisa and Anna although it would be naive to assume that the patients lived free from this. People with mental illness still have to negotiate the impact of stigma, whether this be socially, occupationally or politically [usually all three] and this prejudice is deeply rooted in the past. Lisa tells me more about St Audry’s and its position in the local community.
“The hospital was like a little city and the whole village of Melton relied on St Audrys. There was an overseeing of the patients as they went into the village and people were protective of them. That’s what humans do, what they should do. Look at the Second World War and how we cared for people. Would we still do that today? I hope so…” she says, quietly and goes on to touch upon the misconceptions many of us have about asylums whilst also warning against adopting a rose-tinted view of life in one.
” My concern was always that I would look at this with rose tinted glasses because its really easy to do that but the more you talk to people and the more stories you hear, you think actually, I’m not rose tinting it.And I spent months reading the medical records, and they are obviously written to sound good but as you read them you realise that on the whole, these people really did care and they wanted the patients to get better.”
You hear a lot of stories” Lisa smiles, warming to her theme. “St Audrys was a home for unmarried mothers- which was not necessarily true-and it was likely a misunderstanding of postnatal depression. People say ‘they went in and never came out.’ Well, the research I did showed that unless there was an issue with other illnesses like dementia or epilepsy for example, which weren’t really understood back then, people were admitted and usually came out within two years.”
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This bath was used for psychiatric treatments: from the ‘Home From Home’ exhibition

 

Anna tells me, that same lack of medical knowledge meant that “it certainly wasn’t a great time for mental health-care” and expands upon this. “I’d argue that it was perhaps a little better than the age of lobotomy and experimentation that came not so long after the First World War. When you look at the records for the pre-World War One asylums there were very few drugs used on the patients, which meant that many suffered without remission but also that they were awake and alive in a way that later patients perhaps weren’t allowed to be.” Certainly the discovery of Chlorpromazine in the fifties led to its being described as a chemical cosh and many people suffered from its terrible sedating side-effects.

And what of the ballroom which first inspired Anna Hope to write her novel? Well, interestingly I also discovered that St Audry’s had a ballroom too which is, for me,  one of the most unexpected counterpoints to the stereotype of an asylum as a dour and crepuscular place- all worthy, joyless therapies and rigid monitoring. I also discovered that ballrooms were common in Victorian mansions from the 1880s until around 1920, and these mansions were, after all, family homes which links beautifully to Dr Kirkman’s belief that St Audry’s should replicate the home as much as possible and be filled with activities and things that were not merely useful but also stimulated the patient aesthetically.

“The more we looked into it, the more we discovered that St Audrys acted as a home away from home and this was all of the principles that Dr Kirkman put into place about being able to step out of your day to day life and the drudgery and issues that worried you,” Lisa says.

“If you had a mental illness, [although obviously these illnesses were understood in a different way to how we interpret them today], you then could be taken somewhere that was safe. You could be kept warm, you could be fed and given the chance to keep yourself clean but also, be given something that would keep your mind active. So being involved in day to day running- making clothes, helping with washing, on the farm,. It kept you busy and gave you the time to heal, I suppose”, she adds, and her words very much reflect the  St Audry’s 28th annual report of 1865 which reports, in the purple prose of the Victorian age,”the admission is in dark insanity, the discharge in bright reason and  light.”

Interestingly, in The Ballroom, Dr Charles Fuller, is initially keen to encourage his patients to enjoy dance and music, playing the piano for them in the dayroom and when he is introduced to the new Ragtime music emanating from New Orleans by a local music-shop employee he attempts and fails, to embody its joyful and less boundaried spirit. I held my breath as I read this because Charles is as imprisoned, in his own way, as some of the patients but fails to recognise this and I really hoped he might break free. The psychic struggle he becomes embroiled in is something I asked Anna about, especially with regards to his lessening empathy for his patients and increased ‘othering’ of them in line with his belief that eugenics is the way forward. “I thought it was dramatically more interesting if he was deeply in denial about his own demons and desires. I think perhaps it’s impossible to become the sort of character Charles does without deep suppression of one’s empathy,” she says, something which chimes with Dr Kirkman’s own beliefs about how to care for the mentally unwell, some of which are inscribed on the walls of the exhibit in the Museum of East Anglian Life. “No restraint can be employed which is so powerful as tenderness. Watchfullness, activity, gentleness and that peculiar tact acquired by long training to replace contests of strength between patient and keeper.

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Vitrine containing nurses uniforms from St Audry’s hospital
Lisa is privy to the reactions of visitors to the St Audry’s exhibit.” I’ve come in and there have been groups of people in here and they start a conversation along the lines of ‘Oh, we worked at St Audrys and it was really like family, with everyone looking out for each other. Generations of the same families worked there” she explains. “Dr Kirkman started the hospital in the 1800s but his ideas and principles carried right on through.”
“We did a survey a couple of years ago” she adds, “and since we’ve opened, the St Audry’s exhibit has seemed like a room where people feel the need to come in and be quiet and we’re not that kind of museum, not a quiet museum really! But the survey said that people felt they needed to talk to each other about it and our work has opened up ways for them to do this.
“It has encouraged adults and children to talk about mental health.”
Sadly, it has been more challenging to encourage patients to come forward, the latter more understandably. “We struggle to get in touch with people who once were hospitalised” says Lisa. “We’ve done appeals but they don’t necessarily want to talk about it.”
There is pain here, I comment. Lisa nods. “This  exhibit has made our team more aware of mental health  issues, and more aware of how we each have our own needs. I think its one of the most exciting projects I’ve ever worked on.”

The Ballroom is out now. 

The Museum of East Anglian Life website.

Related links: an oral history of a Suffolk psychiatric hospital

Museum images courtesy of The Museum of East Anglian Life, except where indicated.

Image of The Ballroom book cover, Anna Hope, the High Royds hospital, courtesy of Anna Hope/Transworld publishers.

The header image of West Riding Pauper Lunatic Asylum is courtesy Mark Davis / Guzelian

 

Here come the #HeadClutchers – images of mental illness in the media

If you are thinking of writing an article on mental health and illness, why not use our handy guide to some of the most popular and predominate images of this in the media- the ones that are the symbolic and metaphorical equivalent of a brick over the head in their subtlety, bearing little accuracy to the lived experience of people.

Clearly media folk are super important and very busy so we’ve decided to save you having to think at all about how you depict mental illness and mental health problems. So let us help you with those important editorial decisions.

The first one is the most critical. It is vital that all images of people with mental illness convey the levels of their despair in the most terribly obvious manner and the easiest way to do this is by use of the #HeadClutch. The only decision you need to make is about how many hands the person uses to clutch their face-

(1) Is it a one hand kind of article:

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(2)or a double hander?

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Once you have made this decision, we need to consider the surroundings and remember that people with mental health problems-

(3) appear to spend a lot of time in alleyways.

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(4) Or on the floor in the dark.

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(5) They also appear to like to sit on the side of an unmade bed. Never a made one.

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(6) If they are male and have ever had a mental health problem then they will invariably be unshaven.

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(7) And spend a lot of time clutching their heads on a park bench.

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(8) If it is raining or too cold outside, then the alternative is the corner of a room.

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(9) Or on the floor by open doorways with light streaming out of them. To convey, you know, a light at the end of the tunnel in an artistic manner. See too- the Venetian blind backdrop as that’s very popular, especially with picture editors who grew up listening to Japan in the 80’s.

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(10) Or maybe they prefer to spend time in weird never ending corridors?

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(11) Which is enough to turn anybody to drink.

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(12) When there is light in the world of mental health imagery, it is often a light not seen in nature. We like this pink shade to ring in the changes.

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(13) And when things get really bad, there’s no longer any need to even see their face. And a bit of fog never did any harm- go that pathetic fallacy!

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(14) Although sometimes articles are illustrated by photos of people with mental health issues doing extra weird things like playing ‘Ring a Roses’ the wrong way around..This symbolises hope apparently.

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The MOST important thing you need to remember though is the #HeadClutch because without it, how will any of your readers know that the article is about mental health problems?

Every single one of these images was taken from an article in the mainstream press about mental illness or how to regain mental health. Google those terms and see what images come up.

Here are some other images of people you could use who may or may not have mental health problems, the point being it is not a fixed state or something that necessarily shows-

(1)  People with other people. Talking.

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(2) Or just people.

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(3) Or finding comfort in the coping strategies they have developed to manage their symptoms.

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(4) or follow the example of the IAINews and use images like this to illustrate the themes of your piece on the future of psychiatry:

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(5) Or get really creative and use photos showing groups of four people to illustrate the one in four stat that any one of them could have a mental health problem. Here’s four people doing regular stuff. Like eating and drinking.

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(6) Or images that show just how strong people with mental health problems can be and how strong they HAVE to be to cope with all the stereotypical crap in the media.

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So- editors, photo editors, journalists and copy writers….Are you going to settle for one of these same old stereotypes or maybe, just maybe, you might decide to be a little more careful and creative with the images you choose to portray mental illness in your next copy?

 

 

 

 

 

 

 

 

 

 

Nursing at St Audrys – an oral history of a Suffolk psychiatric hospital

 

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Images from the St Audrys project

Originally a workhouse known as the House of Industry for Looes and Wilford Incorporated Hundreds established in 1765, St Audry’s became the Suffolk County Lunatic Asylum in 1827 and went on to be renamed St Audry’s Hospital for Mental Diseases from around 1917 although the name ‘Suffolk District Asylum’ was also retained until the early nineteen thirties . Finally closing as a psychiatric hospital in 1993, the building was converted into private residencies although parts of the main structure were listed in 1985 and preserved.  St Audry’s became home for many generations of Suffolk people with mental illness and they left behind their stories, some of which are recorded although, sadly, the majority have been lost. The history of stigma and fear associated with mental health services means that patients historically have been voiceless both politically and culturally and the public remain largely ignorant about the subject too. In addition, data protection and privacy laws means that a hundred years must pass from the death of the last patient before any personal details can be released into the public realm, thus (rightfully) hindering historians from accessing the archives.

In 2012, a project was set up by the Museum of East Anglian Life to explore the hidden history of St Audry’s. The Museum, alongside Felixstowe Museum and the Suffolk Record Office, were recipients of the hospital museum collection and archive when it closed.  ‘Telling it like is: the story of a psychiatric hospital in Suffolk’ collaborated with mental health service users to create work to accompany a permanent display in Abbot’s Hall, part of the Museum. The project also explored and recorded people’s emotional connections with the St Audry’s site.

We spent an afternoon visiting Abbots Hall and the very moving (and at times troubling) exhibition, telling the story of St Audrys and the people who worked and were hospitalised there. Inspired by this, I recently interviewed a Registered Mental health Nurse from Suffolk who trained at the St Audry’s School of Nursing and was subsequently employed as a staff and then charge nurse at the hospital. Trained at a time when the introduction of new Antipsychotic medication meant patients experienced far less sedating effects and fewer side effects alongside the development of Nursing as a profession meant they saw some exciting cultural changes within mental health. Add to this the closure of the old style psychiatric hospitals due to the inception of Care in the Community and the Care Programme Approach and we see how many changes staff were privy to.

Here is this nurses oral history as told to me. Parts of their account include references to self harm, suicide and methods of restraint. 

“One of the back doors to one of the hospital blocks. I think it might be have been Rendlesham Ward. (the wards were named after local villages) – the rear door, when you looked at it from the outside, you could see the outline of a white nurses uniform and hat. And it wasn’t a reflection, apparently from anything else around, and the glass had been changed. This is the myth. They’d put fresh glass in but still this white nurses effigy remained as an imprint into the glass.

“When you looked at it you could see a white apron and triangle of the hat. It was most definitely there. Spooky. And I don’t even believe in ghosts or anything like that!”

“I started there Oct 16th 1978. It was still St Audrys school of nursing and the Ipswich student cohort came out there. In my final year, they developed the school of nursing and we decanted it to Ipswich General hospital. The hospital, by and large had a very friendly, family atmosphere. Many of the patients had been there decades, many months at least and they knew each other.

“Long stay patients went to different therapies…making garden furniture, paving slabs- breeze blocks I think they made. The staff sports and social club was actually built from bricks made in the grounds. and the paving slabs certainly were. They’d got rid of the farm when I was there. No more waste food could be given to animals from domestic or other food supplies- the new Health & Safety laws. We had a big food prep area that made industrial prepared potatoes/vegetables for other institutions such as schools and hospitals and our patients worked preparing the meals. Institutions were expensive but high value, for example with St Audry’s, about 5-10 yrs prior to its close, the boiler needed replacing. Amazingly enough it was more cost effective to install a new boiler than it was to run down the old inefficient one in the last ten years of its life.

“Supervision wise, they were supervised as workers, rather then psychiatric patients and this was an important part of developing and keeping their skills and dignity as working people. Nursing staff could be called in should a disturbance arise but we didn’t stand over them. We did have responsibility to ensure they were at work and we shared information- if a patient had an off day, supervision could be provided by OT, technical instructor (a non professionally qualified member of the Occupational Therapy team) or nursing staff. If somebody wasn’t performing at work, we had direct feedback that they might be relapsing. It helped contribute to the twenty four hour picture we built up of our patients and how they managed in the various environments they lived, socialised and worked in.

“Some of the OT staff and TI staff were hugely professional and engaged- they wanted to improve the social and economic functioning of their patients. NOT to make them ‘earn their keep’ but instead to improve the quality of their life and the value they held it in. Caring. At this time, we were in a relatively early stage in the development of the OT psychiatric knowledge base and the recent breakthroughs in drug therapy allowed therapy to become more modern. Occupational therapy took off because patients were better able to focus and engage and give feedback on how they felt they were doing and what they might like to do. Care became more proactive and nursing became less regimental.

“A lot of males went into psychiatric nursing whereas other areas of nursing  were more female dominated. Many of our original male staff were from national service/services backgrounds that had a heavily regimented and institutional control system and structure and this influenced how patients were looked after. Their background as enforcers of discipline and their physicality was relied upon when medication was very basic and primitive in its therapeutic effects. Patients often became very distressed and sometimes violent and the staff would use methods of restraint and control that nowadays (quite rightly) we have rejected. Patients usually knew where the boundaries were unless they were very unwell (and other patients would help those new to the wards) and the hospital was a microcosm of society: its social boundaries were rigid and hierarchical, it formed its own class system if you like based upon longevity of stay, type of illness, friendships and alliances.

“Even then when it was more commonplace I questioned the use of restraint and saw it as a failure of care. Only rarely could I ever find an absolute justification for it. I did what I could to discourage male C&R (Control and Restrain Teams) on female patients- just imagine what it is like to be pinned down by a man when you are so unwell you have even less capacity to understand why it is happening. As a staff member you have a split second sometimes to react and we didn’t always have enough staff or the wherewithal to use other methods, ones that involved pre-empting trouble, rows and aggression  directed at staff and other patients. I have been in a situation where a patient came at me with a stanley knife that the patient had managed to secrete about his person after spending time in the carpentry room with a technical instructor. I sensed the patient was behind me, whirled round and managed to talk them out of slashing me. Was I traumatised? I don’t know. I just got on with the rest of the night shift and reported it. Risk assessment wasn’t what it is now. Some patients were justifiably angry at being incarcerated and would take every opportunity to show that anger to us. We had to be on our best game, observation wise all the time. But it had to be subtle too.

“When I arrived, there were still charge nurses insisting on precision lined up beds- you could align the pillows all along the room, fold back of the sheets, all aligned. Not to emphasise high standards in care but simply because it was regimented. That was how you did it and all nursing in the seventies and eighties had yet to develop a professional knowledge base which expected you to account for why you were doing what you were doing and what the results of those actions might be. ‘Did it have an evidence base and was this best practice?’ was not a question nurses used to have to ask themselves. I mean, we knew then and know now that tightly tucked in sheets help reduce pressure ulcers because delicate or bony parts of the body laying on a crease or fold in the sheet fabric are more vulnerable to them, but in those days we did it because we were told to do it. The intellectual and scientific underpinning of our decisions and actions was less dominant. Wards had routines, individual matrons and charge nurses had their individual quirks, likes and dislikes that manifested as ward and care habits and practices and most of them were not rooted in objectivity.

“Minsmere House was the acute unit, very modern for its time (80’s)  and took all acute mentally unwell people, both male and female from aged sixteen to sixty four. New patients came into the services and were placed upon a regime of modern medications, O.T and pyschological therapies which encouraged independence and kept their personalities intact. Yet institutions required the enforcement of their rules which inevitably leads to the suppression of individual need to the needs of the group and organisation. Classic Talcott Parsons stuff. (Parsons described illness as ‘deviance’ with health seen as generally necessary for a functional society, thrusting the ill person into the sick role which came with its own ‘rights’ and obligations.)

I saw the sea change and both ends of the spectrum of care quite early on in my career. I saw the beginnings of community nursing through the formation of Community Mental Health Teams (CMHT’s). I saw people going from one type of care to another, we got to know their family backgrounds and saw them in context. I went from the families of inpatients at a relative distance, to us starting to develop the beginnings of community care plans that took into account, the needs of the entire family unit. For many nurses and other professionals, this was a big change and hard to adjust to for some.

A wide range of people were admitted to St Audry’s- people coming in, young in their illness with less of the dramatic symptoms you used to see when patients weren’t treated so swiftly or with effective drugs. They’d get admitted to wards for short term treatment to medium term treatment. Or end up on long stay wards up to thirty years. Also lots of elderly people, some ex workhouse with terrible, terrible experiences documented in their files (being ‘committed’ decades earlier, because they had given birth out of wedlock for example), some newly admitted people with dementia who one year earlier had been fully productive and engaged in their lives. No prior history of mental ill-health at all so a dreadful shock for their families who had looked forward to Grandad or Grandmothers retirement and now had to adjust to a very different future.

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St Audry’s

“Patients were not often confined to the hospital and its grounds unless they were too unwell to go out. I clearly recall one patient going down regularly, weekly. He’d have his weekly wages, buy his fish and chips at the local chip shop then nip to the Horse and Groom for a pint. He was severely socially dysfunctional in that he couldn’t relate to money. He’d hold his hand out with the money and they’d take it, the bar lady or shop assistant. The pub would only let him have his allowance of beer – they just knew what he should have as we went in there and obviously could have a quiet word with the staff alongside the patient so everybody knew where they stood. Everyone knew everyone and nurses would drink with some patients in the pub on our days off. I’d see patients in Woodbridge on market day – they’d walk there or get the bus. There was a certain amount of freedom with staff taking patients out on walks which would often entail a walk to the pub!  I recall taking bored patients out on Saturday which were slower days as occupational therapy was closed (this still happens on wards now) and there was no ward round or routine medical clinics to break up the monotony of the day. I’m not trying to make it into some bucolic ideal but there was a level of acceptance in the local villages and people generally did not take advantage, or tease or ignore.

“Weekends always a great cigarette crisis you see. Everyone ran out including the staff and we’d resort to smoking dog ends out the ashtrays- we called them dog end rollies. If you had papers, you’d remake the ends. Great attacks of nicotine withdrawal all round as in those days loads of psychiatric staff also smoked. You’d find inventive ways of taking up the slack and in the seventies and eighties, shops closed at weekends, there was little public transport and less staff drove so we couldn’t necessarily get to the metropolis of Ipswich nor spare the staff. Plus it was a village. If  the pub closed, there was no sales of cigs. Everyone had spent their weekly allowance, no shops, no money. Everyone went cold turkey. So we’d invent quizzes, put music on for dancing, walks, take them gardening, anything to keep them settled and take their minds off the lack of nicotine! We’d have Christmas parties and lunch with turkey carved by the psychiatrists, ward and hospital dances where male and female patients could mix. Quite a lively social life accompanied everywhere by great clouds of cigarette smoke. We all chuffed away like Thomas the Tank Engine.

“The minibuses- elderly patients used it for trips to local villages. The staff would try to visit where patients were from to help them reminisce and get them talking to each other. We would take people to Felixstowe and book the Red Cross hut out for the day. The Red Cross would provide staff and meals and we’d take wheelchairs, carry them over the sand so the patients could paddle in the sea, buy ice creams and sit along the front, summer and winter eating them. Alcohol wasn’t banned and we had wards where patients could have a drink. Every meds trolley had alcohol. Beer wine whisky rum and brandy could be written up on the charts for night- better than many other medications as drinking a tot was socially normal and social too. Wards still have a bottle of something in the dispensary now. We wanted to offer as many ‘normal’ experiences as we could because with the best will in the world, you couldn’t totally overcome the limitations of your surroundings. I can see that group outings can be as stigmatising as any of the other practices but it was the only way we could manage to engender a social life for so many patients, with the staff and resources we had. And they had friends, people they wanted to socialise with, even intimate relationships and going to the seaside was, truly, something to look forward to- for all of us.

The problem was that the Victorian nightingale wards were open, and you only got a curtain if you were lucky and a locker. So little privacy. The locker was lockable although only the staff member would have a key though. Several long stay patients saved up to buy their own beds, bought their own side tables and decorated their side rooms. Or family would bring in an armchair. Not often but it would be taken on board. No issues about fire retardancy and smoking on wards in those days and we did have ward fires. Although more fires started after they banned smoking in public and inside areas because patients, staff and visitors now hide away when they have a cigarette and then toss it in a place where it smoulders and sets things alight. The amount of small fires always went up when a trust banned smoking!

“There was a token economy of sex going on. Some patients would find ways of having a ‘finger’ for a fag- yes I know this sounds a crude way of putting it but that’s the truth of it and what many of them referred to it as. Sexual feelings don’t stop because you have a mental illness and nor does the need for human closeness, intimacy, comfort and pleasure. Some of the women got their cigs this way. The staff would encourage discretion because sometimes masturbation became addictive behaviour or a form of acting out and obviously sometimes the sexual activity might not be consensual or it was exploitative or the patient was especially vulnerable. We encouraged the use of private space for private activities. I don’t recall patients getting pregnant. Only staff and not only by their husbands! There was a fair amount of relationship problems and break ups among staff because the job could be stressful, there was a lot of staff and…well…live hard, play hard. Upsetting events at work can throw people together. They cling together like puppies in a basket and see their colleagues as understanding in a way that their partner does not. It could be an illusion or it could be the real deal.We had second generation staff- those born to coupled up nurses or nurses/doctors who came back here to work when they grew up!

“Sexual relations were not encouraged but they did go on, however a lot of medication related sexual dysfunction also happened, stopped some of the sexual behaviours and this is still a problem today. Sadly one of the biggest barriers to people remaining on medication that is otherwise beneficial to them in terms of preventing relapse and keeping them well and happy is the fact that it destroys their sex life. I did and do believe that patients have a right to open and honest discussion about sexual side effects and we don’t talk about it enough. We need to be trained to discuss alternative ways of maintaining sexual intimacy in relationships and we need to prepare patients before they start the meds, NOT wait until their orgasm is retarded or simply doesn’t happen.( This is a common side effect of SSRI’s, for example) We need to be able to refer service users for sexual therapy if they require it.

“I do recall that one male patient was with another lady in the cricket pavilion and he rushed back in a distressed state. She had collapsed and he mistook a seizure for sexual ecstasy. That curtailed their sex life! It kind of put him off.

“We had staff cricket matches- our social club had team and home matches which were quite well supported and we played matches and games in the grounds which were extensive. Some patients would wander over, others would be taken to watch. The kitchens would celebrate patients special events and birthdays with beautiful home baked birthday cake and other celebrations. They’d make match teas too. Staff related to their patients over a period of time and tried to make value of their lives, tried to make it constructive with events that would stand out in their mind, create memories that were happy and good. There were horrible staff, but not hugely. The kitchen staff tended to get on very well with the patients because they got hugely positive feedback for the food they cooked- it was a highlight of the day, sadly, and so patients would feel very warmly towards the chefs and cooks. They’d try to get in the kitchens and snaffle food too (and staff would be bringing up the rear!).

“With regard to the upsetting side of the profession and life in St Audrys- I recall one elderly patient got to their mid sixties and had been depressed for decades. They’d been in for MECT (modified electro convulsive therapy- what we used to call ECT), lived life for thirty years with depression. Existed really. Decided in their sixth decade that this was it so took themself into the bathroom with a bread knife, was found but took three days to die- They just couldn’t recover. This patient got the knife from the kitchen as the elderly ward was not secure. Even when the kitchen was out of bounds, if you looked at what patients made themselves implement wise- my god that was a cabinet of horrors. We’d be as careful as we could, counting tools and implements in and out, checking everything was secure but sometimes things happened. That death had profound effects upon me and others. The sense that all we’d done was postponed this person’s death for decades and decades because they had been so depressed for so long. The staff were very shaken by that and the patients too. This can trigger spate suicide attempts among them so we promoted a time of high awareness and modified our awareness of risk factors. Grief is not always shown in way you expect by people whether they are deemed mentally well or ill. In fact Freud stated that the times when man (and woman) are unreachable to both therapy and reason is during times of bereavement or when they are falling in love. Freud spoke some sense here.

“We question ourselves also. What could we do better? What was the point of our jobs? Yes- we ask that too when we work so hard to try to keep somebody alive when they themselves do not thank you for it nor wish you to do it. In other branches of medicine patients and relatives say “Thank you for saving him, Doctor and Nurse” and “Thank you for saving me, Doctor or Nurse”. We cannot be assured of that response. Of course now we have all manner of risk assessments and critical incident evaluation and clinical and peer supervision to help us manage ourselves and others when things like this happen. Not then. We went home or to the pub or staff social club. Or we just buried it in our minds and carried on. We developed a dark humour, still have that dark humour and it is psyche saving, it really is but of course we needed to be careful who overheard because not everybody understands that it is not something that truly reflected how we felt about our patients. Our peers and indeed many of the patients themselves got it. I remember the patients with the most immensely acute and sharp sense of humour and sense of the ridiculous. They knew everything that was going on and nothing got past them.

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“Patients lived for decades there and died there too. The hospital had its own morgue and graveyard and we buried patients in it if their families had no other plans for them. Or sometimes families chose our graveyard because after all, the hospital may have been their loved ones only or main home and of course their fellow patients grieved for them and had a grave to visit. Sadly now, the graveyard has not been maintained. I find this very insulting to the patients memories, in fact I get really angry whenever I think of it and I used to go and lay flowers there every time I visited the area. I planted loads of Spring bulbs too. I wonder what happened to them. The patients used to love the snowdrops and aconites.

“Staff had to deal with patients’ relatives dying too – breaking the news to them and of course there were marital break ups that we had to support patients through. Their parents start dying and when you’ve had schizophrenia since you were seventeen and you are now fifty, you are very likely to have no friends off the wards and those parents are the only relatives that visit you. Remember that stigma of mental illness was much much worse and families often did not mention their sick relative in the local psychiatric hospital. The patient with schizophrenia now is in NO way comparable to what they were like twenty, thirty, forty years ago. The modern meds arrest the break up of the personality that we used to see with the older drugs such as Chlorpromazine which wasn’t nicknamed ‘Liquid Cosh’ for the hell of it. On these old drugs they became ciphers, empty vessels. A very harrowing thing to see and difficult to work with as we all need that feedback from those we communicate with. Getting little response every day, little emotion showing. Very hard and very sad. And that is just our perspective- imagine what it must have been like for them. Our difficulties pale into comparison. When we saw a spark of the old personality struggle through the haze of drugs, well, it was painful to see. I still feel ashamed of the effects of those drugs- the extrapyramidal side effects as they are known such as the dystonias (abnormal muscle tone resulting in muscular spasm and abnormal posture), dyskinesias (impairment of muscle movement) and akathesias (compulsion to move, inability to be still). Once these had set in, they never went away, becoming entrenched and incredibly disabling. There are some even worse ones too and some, rarely, caused death through something called Neuroleptic Malignant Syndrome (NMS). Ironically, I didn’t experience my first patient death to because of NMS until late in the 90’s when a patient had a totally unexpected and devastating reaction to a small stat dose of a antipsychotic medication, a decade and a half after we stopped using Chlorpromazine so freely.

“There were great minds trapped by psychotic conditions such as Schizophrenia. One person who was forty or close to it, had an ageless trapped face. His psyche was trapped. He used to move chess pieces around the board, take half of them off and it all looked random until you looked more closely and spoke to family. He was a chess champion, with a phenomenal brain, plotting seven or eight moves ahead. I worked in dementia too- these people have experiences they cannot always tell us but they are all great experiences. Remember their personhood. I used to ensure their rooms were plastered with photos, drawings, things that reminded us and them of their lives, their families and I brought in changes that were based upon some research I (and then some other staff) conducted into the effects of colour and other markers to improve mood and orientation. Remember that then, the research base for nursing was meagre and there was no real support in the UK such as grants and continuing professional development (CPD) in a formalised manner. We instigated those changes and they worked well. Twenty years after this Kitwood started his own exploration of dementia care and a lot of the principles he developed were ones that, all those years ago, I explored, although the trust then wasn’t that interested in supporting what we (and I) were doing.

“I recall this one patient, who’d been quite psychotic some 8-10 years. Had this belief that one day men would take a rocket ship into space, fly around, then land that same rocket back on earth. This patient was completely fixated on men flying into space- it absorbed so much of their thinking. Then in the year of the first space shuttle I was on the ward with them and the shuttle was making a final approach to land, all televised. I tried to engage them in discussion about this, tried to explain what was happening. They would NOT engage in the reality of it and then went back into their patter of ‘one day’ .”No mate, it HAS happened!” The actual reality of it was not the point for this patient. Their delusional framework was completely constructed around the future event and not it as reality and there was little success in challenging this. The patient wanted to retain that dream of a great and magical feat of science.

“There was often a lot of tenderness between patient and nurse- they would want to help us, offer to carry sports equipment and  would insist, fighting for the right to carry stuff back and we’d try to discourage this and guard against appearing to have ‘favourites.’. Anything they could do for you, they would want to try. Patients would know about your life. They would care. They knew the ages of our children, they would closely watch our faces and know instantly if we weren’t right, if we’d had a row with our partner before work. They would ask about it and we would have to manage boundaries without being seen to offend their genuine concern although I do think some staff get hung up about ‘boundaries’ and don’t have the skills to understand when, actually, it is appropriate to share, to let patients into your life a little more. When you work in a place for twenty or more years with patients who have been there for maybe double that time….well… There’s not much they don’t know about you, the hospital, the local area. You ended up all talking about the same thing- not because we didn’t see them as people who’d respond, but because we did interact with them. Patients would chip in and add to conversations and the ones appearing least engaged, would often surprise you. Patients would care about others too, taking you aside “keep an eye on….”They might not tell you why, but you knew it was to be taken very seriously. In fact ignore their observations at your peril.

Yes the old style hospitals have had their day and they were terribly institutionalising- patients often had communal clothing and the stories you hear of them sharing dentures in older times were true. That was untenable. BUT we have also lost a lot. No use talking about caring in a community that doesn’t actually care because it absorbs messages about the mentally unwell from the government and society as a whole- that they don’t matter, that they are not worth spending public funds on and should accept the dregs. That they should be housed in prisons and homeless hostels, in substandard housing or left to manage until they deteriorate to critical levels as opposed to being treated proactively so they maintain their lives in between any relapses in a way that is meaningful to them and to us all. People with mental health problems are so often valued according to the Marxist ideas of a person as economic currency which places untenable pressure upon them to manage within a work and social system that is not predicated upon the intrinsic value of people per se. It is the way we work economically that is broken, not the person with a mental health problem.

Our mental health system is broken and at least the old style hospitals gave the mentally unwell a bed, warm clean clothing, three meals and a sense of community. Now they are left to depend upon relatives with sharp elbows, trying to get the best care they can for their loved ones while government ministers pretend that cuts = better care.

“They must think we are all stupid”

To find out more about NSFTCrisis- the campaign for better mental health care in Norfolk and Suffolk visit them here. 

Telling it like it is- St Audry’s, the story of an asylum’.

 

 

 

 

 

The Black Dog Project

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‘I Had a Black Dog’ is a comic, fun and heart wrenching story about one man called Joe and his own struggle with the multifaceted entity known as depressive disorder. Originally written by Matthew Johnstone, an artist, writer and photographer, the book is a radical and humane departure from the traditional self help format of many books about mental health and illness. Sometimes we need to NOT be advised in an overt manner; rather we need to walk alongside somebody who just ‘knows’ and this book (alongside the theatrical version in development) is just that. Acknowledging that depression can mess with a persons ability to ingest and digest information-although intellect is left intact- the book offers non patronising and intelligent pictorial depictions of the ways in which thought, affect and feeling can all be warped by the illness. This is as important for carers, friends and relatives to understand as it is for the ill person to know he has been understood.

Small Nose Productions is developing The Black Dog Project via a series of research and development sessions (a total of 3) held at local theatres and arts centres in front of small audiences. The New Wolsey hosted one of them under its #Scratch banner at their High St Gallery venue in Ipswich, a beautiful multi -use art gallery. Mark Curtis from Small Nose, in a previous interview, told Stage Review: “The project is about trying to raise awareness about Mental Health issues – and begins with this first 30 mins (a scratch production) of the best selling book. The company hope to take it to a full length version later this year”.

Watching the project in its rough format followed by a Talk Out/question & answer session provided us and the cast with a valuable opportunity to pool knowledge both lived and learned, offer feedback and share our experiences about an illness that has no definitive truth or any one narrative. Mirroring the book, the Scratch production clearly values that lived experience and the intra-personal above others and gains emotional resonance with its audience as a result. Spending time talking with audiences helps them manage powerful feelings brought back into now by what they have seen; shows such as this can be cathartic but only if one is given the space to make sense of what has been felt and thought.

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Developing a theatrical production from such a simple book contains its own challenges – reflecting the evidence base, keeping the simplicity of the concept which was consistently cited as one of THE main points of success whilst layering in subjective and individual experiences. Building in humour was vital too. Outreach work conducted by Small Nose Productions told them that their initial audiences needed their experiences acknowledged; they had to see themselves in the main character but how to avoid building a composite that ended up reflecting nobody? Audiences do not want a’ Greatest Hits of Depression’.  The work of Doctor Stuart Brown into the neuro-psychological effects of laughter was another important building block. Alongside the plain old enjoyment of a good laugh, the humour here has a more vital role- there needs to be a leavening too without making the laughed with, laughed AT. Our own experiences of a former career in mental health alongside living with PTSD shows us that the dark humour of staff and service users needs to be celebrated; it is dry, observational, political and astute.

Said Johnstone of Small Nose: “Their chaotic approach, constant search for the correct balance between laughter and something more poignant and their audacity for things that are silly and at the heart of us all, makes this company the perfect eclectic mix for dealing with the dark world of the Black Dog.”

The uses of comedy in the early production was multi-faceted. It lightened, it played with our feelings of inclusion and exclusion and it played with the characters inclusion and isolation. At times the humour tangibly pushed Joe aside and at other times it united us. Should the literal depiction of the metaphorical ‘Black Dog’ be less comedic? Some feedback suggested the dog lacked the overtly oppressive nature of depression, that it was too approachable or not ‘nasty’ enough or that it needed to be approachable and comforting because the heavy blanket of depression can in itself be a comfort. Hard for non sufferers to sometimes grasp, people speak of depression as an identity with gains at times; provision of a ‘get out’ clause for everything they find too difficult or taxing, hence the feelings of apprehension and even fear at thoughts of recovery and all that this entails. At least Depression is known. There is a difficult kind of solace in that and so we have a furry, cuddly playful dog leaping into the lap of Joe, throwing its arms around him and draped all over him, limbs splayed and not quite under its control, a playful clown mitigating the oppressiveness of the illness. Think Boxer or Spaniel rather than lupine and dark.

At times the laughs of the audience at the boisterous expressiveness of the Black Dog and its total unawareness and lack of control of its own corporeal body was unbearably poignant in that it highlighted the essential disconnect that lies at the centre of the world of the person with depression. On stage all was busy and social (in the restaurant) as life and the world moved and morphed around Joe. The audience seemed to be in collusion with the Dog against him and he was at a still point outwardly whilst his mind was clearly in turmoil. Disconnected from the world, from his own body (he did not inhabit it comfortably), from other people, his only consistency to be found was in his own intrapersonal relationship- the one with himself and his depression. We found it very hard to look at Joe as he sat there because he inspired feelings of guilt in us that we had laughed in the face of such inner turmoil.

We saw the beautiful subtlety of a facial expression that was really a non expression, a terrifying combination of both blankness and inner confusion. No confusion on his face but we knew it was there. Exacerbating this even more was the dogs vital engagement with us, playing to the crowd, prancing, clowning and making us feel uncomfortably disregarding and dismissive of Joe’s alienation. The dog was like a black hole, drawing all attention and life towards it. We were in the moment and Joe was not. He was scarcely in the play. The dog became less a reflection of his feelings,  more a case of reflecting all that he was not and no longer acting as metaphor for his illness. We wondered then ‘should the dog be just a dog and if so, should it be more dog like?’ Using a more lifelike mask (with a better budget maybe?) might help us manage the conflicting feelings about what the dog is but on the other hand, this uncertainty accurately mirrors the larger questions about what depression actually is and what it is not. Indeed is that something we should even need to delineate? Managing dissonance in an audience is tricky and we will be interested to see how this plays out as the project develops.

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The use of space and props has huge potential and already encapsulates some of the Depressive imagery and metaphor. Kicking off with Joe having a restless night, we see the lights go up on a sparsely inhabited set; bed, a set of drawers, a wardrobe, a bathroom, a desk for work, a kitchen table /  restaurant table….Illuminating the different room spaces and activities sparely and sparsely draws us into Joe’s inner life and the subsequent terrifying lack of. Having Joe and his Dog move the set around is part reflection of budgetary constraints and a deliberate feature. The actor playing the dog morphs into the waiter, the secretary and Joe’s girlfriend with his/her costume changes contributing to the comedy and Joe’s disconnect from it and our reactions. We laugh at the ill fitting wig, the crooked moustache, and throughout this Joe remains painfully and terrifyingly removed from it all. It is not that depression = feeling miserable. In fact depression can mean = feeling nothing at all. What on earth must it be like feeling nothing at all? 

One problem we could see with the idea of Joe and the Dog having to do the set changes themselves is that we lose some of the chronology of his illness. One of the ways in which depression affects a person is by changing the way they move, speak, think and act. The biological signs of a depressive disorder can include changes in sleep, appetite, sex drive and how we move- do we slow down (retarded movements) or do we speed up and become more agitated? Joe wound down like an old clock; he became less purposeful, less methodical despite trying to cling to routines and to us, this appeared commensurate with what we know to be the symptoms of some types of depression. Seeing Joe move the set around to reconfigure the furniture in a fast, strong and purposeful way (because of time constraints) interrupted this progression and we suggested that the company employ theatre students as interns dressed in the customary black to act as stagehands. Having Joe lost and still in the midst of a set change might enhance our sense of his life unfolding and renegotiating apparently without his consent or understanding. Or Joe could be more ineffectual at set changes which would reflect the unravelling of his life- the end of his relationship with his girlfriend, the changes in his job that he found so hard having previously arranged work to best suit his nature. He is not managing these well so he should not manage the set changes well either.

As the play approached its conclusion we were apprehensive that Joe’s final wresting with his illness, the all at sea analogy was actually leading towards suicide and this was compounded by our obscured view of the scene- a problem of the venue, not the play. Unsure as to whether anybody else in the audience interpreted it in this way, we felt anxiety at how on earth the play could come back from this story development despite the fact that this is sadly not that far removed from reality for some people with mental health problems. The actual ending, Joe developing ways to live with his depression reflected the book but the lack of explanations as to how Joe achieved this left us feeling a little adrift. It risks being seen as a hasty ‘wrap up’ rather then the truth of the book that inspired this play. Finding ways to bridge this gap we feel, is important whether via play content, talk out or within the programme notes.

We are greatly looking forward to seeing the finished version of The Black Dog Project and are grateful for the opportunity to both see and contribute to the development of the show. Thanks to the New Wolsey Theatre and Small Nose Productions. 

Visit http://www.smallnose.net/for more information on Small Nose Productions