Thursday, December 31, 2009

Another Kind of Favorite

This letter to the London Review of Books was another favorite from this past year. It changed the way I thought about a lot of things. Because it's annoying to scroll down to it, I'm quoting the whole thing.

Keep me in!

The list of stories of unjust incarceration for insanity is long, as Susan Eilenberg suggests (LRB, 23 July). Does it still happen? Or have things gone in a completely different direction?

I have been in and out of NHS mental hospitals for more than forty years. The first, following a suicide attempt, was Bethlem Royal, the old Bedlam, by then moved to a huge semi-rural site near Beckenham. On arrival my first feeling was of immense relief; I was in a safe place and didn’t have to worry any more. One almost never saw a psychiatrist; ‘treatment’ consisted of tranquillisers that kept one calm and anti-depressants that did nothing at all; this was in the days before Prozac. But the nurses were friendly and spent all day with the patients, chatting, playing games (Scrabble with schizophrenics can be very entertaining), going for walks in the grounds, even cooking meals with us. The male wing had a full-size snooker table and the female a grand piano, though the eccentricities of women playing snooker and men the piano were tolerated. After the first week or two I could even go for unaccompanied walks in the grounds. It would have been a very nice place to stay if one weren’t mad.

The fact that discharge was never mentioned merely increased my feeling of safety; when after six months I felt ready to face the world again I had no idea how to arrange to be discharged and was a touch afraid that if I asked they might try to keep me in – ‘section’ me, as it’s called. So one day I just walked out. No one came after me.

Three or four years later I was in hospital again: this time at Broadgate, near Beverley in Yorkshire, a huge Victorian place with its own farm. Things were much the same as at Bethlem. Uniquely, I was privileged to see the chief consultant psychiatrist once a week, but that was because I played trumpet to his trombone at the Saturday dances. The nurses spent all day with the patients here too, the only difference – in retrospect an ominous one – being that they had to write brief daily reports on the patients. This duty was taken lightly; one report I saw said: ‘Patient rose at ten thirty and spent the rest of the day in a horizontal position.’ I came across a lot of people shuffling about the corridors who had been in the place many years: however they had come to be there, their only ‘madness’ now was that they were quite unfitted for life outside. Again, after six months I simply walked out.

Looking back, those two places did me a lot of good, in spite of the absence of real treatment. Merely being in a sheltered environment, protected from self-destruction for as long as I needed, was therapy enough. For many years I managed to avoid going into hospital, except for a year at the excellent, intensive, highly successful and soon closed down Paddington Day Hospital.

But about nine years ago I was close to suicide again and found myself being taken into another hospital. Things had changed. Now we had the policy of ‘care in the community’. All notion of protection, of asylum, had gone: a patient (or was it ‘client’?) information leaflet explained that one’s stay would be as brief as possible. Nurses no longer spent much time with patients: they were closeted together in an office filling in ‘care plans’, and could get quite cross if one knocked on the door to point out that a patient was smashing up the furniture or another patient. Usually, in fact, knocks on the door were ignored. True, we saw psychiatrists as often as once a week, but their concern was to see whether we were ready to be discharged. We lived in dread of being called before the psychiatrist: many, including myself, tried to seem madder than we were in the hope of delaying discharge. I managed to stay a month – twice as long as the ‘target’ period – before being ejected despite my vigorous protests.

I was soon back. Returning to the same hospital I expected the nurses to be surprised and disappointed to see me again; they batted not an eyelid. Soon I noticed familiar faces among the other patients; people who had been discharged during my earlier stay and who were back again. Nine years later I have lost count of how many times the NHS has ‘cured’ me of severe depression. Clearly the new policy is statistically – and that’s what counts – very successful. It must have cost them far more than one long stay, but they’ve had half a dozen cures instead of one.

At present, two kinds of people are admitted to NHS mental hospitals: those bonkers enough to be a social inconvenience and those depressed enough to be ready to do away with themselves. If one’s desperate enough to want to get in, the magic word ‘suicide’ whispered in a suitably shamefaced sepulchral tone will do the trick. But mad or sad, one will be out again in two weeks. And back again in another two.

Simon Darragh
Walmer, Kent

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