So in my on going attempt not to make this blog (solely) a space for me to complain about my lot, I decided to do a little research yesterday, with the intention of looking at how current MH care compares with that of 100 years ago. On reading some articles, I did find some parallels, but I also learned that MH has come a long way. Despite all the shouting we do, the campaigning for better services, less stigma, despite all of this, we have it pretty good.
I guess, if most of were to think about how the Mentally Ill were treated hundreds of years ago, we might think of Workhouses. The original aim of the Workhouse was to deter the workshy, idle members of society so that only those truly in need would knock on their doors. From reading this piece from Historic England, I discovered that in 1835, a Workhouse was built In Birmingham whose sole purpose was to keep ‘idiots’ and ‘lunatics’ segregated from society. Further, by 1837, more than 8000 ‘idiots’ and ‘lunatics’ were under the care of Workhouses.
I was curious as to how a person would be classed as either an ‘idiot’ or a ‘lunatic’ (both, frankly, disgusting terms) in the 19th century, so I followed a link in the article cited above:
Idiot; lowest rank of intelligence and functional ability. Nowadays classed as profoundly Learning Disabled.
Lunatic; broad description of Mentally Ill
I shall thereby use the abbreviations LD and MI, where appropriate, for the remainder of this post.
Around that time, Victorian Asylums were built to impress public officials, and meant for ‘those who may be cured’ or were ‘disruptive’. They boasted ventilation, grounds and gardens looked after by the patients. Although the term ‘those who may be cured’, evokes images of an almost laboratory setting, allowing Clinical Testing or Research and Development, I cant help but understand the logic of the underlying Psychiatric Theory that a carefully formulated and maintained environment, coupled with the presence of a ‘father figure’ (presumably the Psychiatrist himself?) calmed patients and restored sanity. I’ve established, on my own journey, that routine can be helpful. I also know of people who have access to Day Hospitals, where things like Group Therapy sessions, Art and Music Therapy are used alongside more Holistic approaches in an effort to reinstate routine in someone who has been ill for some time.
However, time proved that these measures were unfounded. Asylums became overcrowded and enter the introduction of straitjackets, sedation and seclusion. Further, the early 20th century saw the birth of ECT and the Lobotomy. Although these treatments were successful in some cases, they damaged others beyond repair…all serving to reinforce the stigma that lingered from the early days of the Workhouse.
And speaking of stigma, there also existed ‘Private Madhouses’, which employed ‘keepers’ who looked after those previously handled by their own families, but had become too difficult to care for. For a fee, families could have ‘mad’ relatives incarcerated in one of these institutions, where inhumane measures such as leg irons, and manacles, were often used to control patients who had become unruly.
Does this correspond to the stigma we speak of today? Families so determined that their dignity be upheld, and discretion and secrecy maintained that they would pay to have relatives taken away. I don’t think so…families may be reluctant to admit that a Son or Daughter suffers from MI for fear of being judged, or misunderstood. People with MI might have to endure ignorant comments, like ‘…give yourself a shake…’, or ‘…pull yourself together…’, but I doubt many families would effectively shun ill relatives to save face with the neighbours. Nor do I think many people, upon hearing the words ‘Psychiatric Hospital’, would instantly think ‘straitjacket’.
During the 1970s and 1980s, the focus was shifted to ‘Care in the Community’, I guess with a view to things being more or less as they are now. Unfortunately, some patients had become ‘institutionalised’ and were unable to cope outwith the setting of the Psychiatric Ward, and were left to live out their lives and die in these institutions. Otherwise, the main aim of the Community Mental Health Team (CMHT) is that people, wherever possible, should live independently, in the community. This has worked particularly well with those who suffer from LDs; where only a century ago, they would have been locked away from the World, they now live, for example, in Community Housing Complexes, with Carers who help them maintain some level of normalcy. As for those with MH problems, Hospital is seen as a last resort. There are Crisis (or Home Treatment) Teams (CT/HTT) whose role is to keep people from being admitted to Hospital. Controversial treatments like ECT are rarely used and most people are treated with a combination of medication and talking therapies (either in groups or one-to one).
So things may not be perfect. Stigma has always been around, in one form or another. CMHTs are underfunded and understaffed, meaning people will inevitably be let down. But I think, broadly, people are at least treated as individuals. We are given a diagnosis specific to our unique set of symptoms, combinations of medication that agree with, and work for, us. We are offered different types of therapy (CBT/DBT…) based on what is right for us. We have access to people like Eating Disorder Specialists, or Occupational Therapists, who serve to help us rebuild our lives after a MH Crisis.
Yes, we might have a long way to go…but we’ve come a long way.
All facts, figures and general information taken from: