lunatic asylum

Inside a British lunatic asylum

One building dominated the horizon near where I grew up in north east London. It had the distinctive, squat, red-brick water tower common to the Victorian era British lunatic asylum. This was Claybury Hospital, a vast complex covering 290 acres for treating the mentally ill of east London and the Essex suburbs.

Both my parents were on the medical staff at Claybury in the 1960s and in fact, it’s where they met – in the cafeteria. However, my father decided psychiatry wasn’t his bag and changed careers but my mother was there until the asylum closed in the late 1980s. Despite all the criticism and misinformation levelled at psychiatric hospitals, as well as the fear they inspired, she loved the work.

To go inside a lunatic asylum

As a child, I got a privileged look at life in an asylum. And it fascinated me. Every weekend, I’d accompany my father in the car to pick up my mother as she came off her Saturday and Sunday shifts. As with many psychiatric hospitals, the grounds were idyllic. Beautifully landscaped with pristine lawns, chestnut trees, a large willow, an eighteenth century manor house incorporated into the hospital, tennis courts and two big old churches – Anglican and Catholic.

As children, my sister and I would go and practice our serve on the tennis court, which I think was for staff, while outside the wire fence, patients would walk around in their dressing gowns in what could often look like a mildly zombified state. I assumed this is what they meant by a “chemical straitjacket”. Quite frequently, patients would wander out of the main gates and into the local town and then be returned by police officers or locals.

It’s hard to convey the scale of Claybury. But it was like a self-contained village even generating its own electricity up to 1929. The hospital was a combination of closed, semi-closed and open wards. There was therefore a large cohort of permanently resident patients for whom Claybury put on a detailed calendar of social and sports activity. In 1964, a Social and Recreational Centre was opened that put on dances with a small orchestra providing the music.

From lunatic asylum to therapeutic community

In the 1960s, the hospital pioneered what was called the ‘therapeutic community’ approach to its 2,000 patients. Patients and staff collaborated on day-to-day functions. And former patients were employed to work with nurses on the domestic chores to keep the wards clean and functioning. This was termed the “Claybury revolution” and not all staff, used to a more authoritarian regime, liked the new way. But it was mandated by two charismatic and reforming managers at Claybury – Denis Martin and John Pippard.

They wanted to break with the old stereotypes of the Victorian asylum. Decisions on treatment would be made through democratic discussion and, as far as was possible, patients were encouraged to take responsibility for their own behaviour. The therapeutic community approach at Claybury become an international talking point in mental health circles.

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I was always taken by the personal relationship that my mother had with patients at the asylum. She would bring their artwork and even cookery home to share. I’ll be honest, as a child I was reticent to eat the cakes made at Claybury. I remember blurting out: “What if they put a razor blade in there?” Seriously ignorant comment. And I’d get a telling off for saying such a thing. When a patient passed away, my mother was genuinely upset. There were strong bonds between some of the patients and medical staff.

Controversial treatments

In terms of the controversial aspects of Claybury – one can’t ignore the use of lobotomies for a period. My mother was present at one and the nurse next to her fainted during the procedure. This awful operation was thankfully discontinued but not before it had ruined many lives. What still continues to this day is the use of electroconvulsive therapy (ECT). That is sending an electric current through the brain, normally to address severe depression.

I’m always amazed at the number of people who think ECT doesn’t happen anymore. It very much does. But way more sparingly than fifty years ago. I once asked my mother how ECT worked and she told me that a consultant had once summed it up to her: “We have now idea what it does but it seems to do the job”. In other words, ECT is based purely on the empirically observed, surface results without much idea of what it’s doing beneath the surface.

Contrary to what many people think, it’s performed under general anaesthetic – though in the old days that was not always the case. Having sadly lost a friend to depression (he jumped off a motorway bridge head first), I realise that for some people any cure is grabbed at when all else has failed. My mother recalled being on ‘suicide watch’ at Claybury when a patient in bed during the night tore a button off his pyjama bottoms, split it in half, and managed to slash his wrists. My mother told me this to illustrate how suicidal feelings can overwhelm some poor souls.

FIND OUT MORE: My father dies of Covid – a reflection

There is no doubting the asylum system was flawed and you wouldn’t re-invent it. However, nobody believes that we spend anywhere near enough on mental health or that ‘care in the community’ and the closure of the asylums was driven as much be cost saving as a desire for better therapies. And sadly, there is a high representation of mentally ill people in another institution these days: prisons.

Claybury – or the ‘loony bin’ as my schoolmates used to term it – is now a luxury housing estate. The wards of the one-time lunatic asylum are now bedrooms and dining rooms. One of the Victorian churches has a swimming pool in what was previously the nave. I own one of the pews, which I took with the vicar’s permission before the hospital gates closed for the last time. And the patients and staff are ghostly memories.

Peter Anthony McMahon

My father dies of Covid – a reflection

Little did I expect at the beginning of the Covid pandemic that my own father would succumb to this virus. But just over a week ago, he died in hospital of Covid-19 related pneumonia.

This was given on the death certificate as the primary cause of death. Being an 83 year-old, there were other underlying conditions including COPD (chronic obstructive pulmonary disease), gradual onset of dementia and E.coli, which he’d more than likely contracted in the care home – leading to his collapse.

My father had been a heavy smoker up until ten years ago but giving up had given him a new lease of life. However, his lungs were impaired and in 2012, he’d punctured one of them falling off a ladder.

Two weeks before his death, he collapsed at the care home where he’d been resident for nearly two years. Those of you with elderly parents or other relatives know only too well that the final years are punctuated with repeat falls and trips to hospital. But this time, I sensed it was a lot more serious. Though I didn’t know he had Covid.

Covid at the care home

The virus had ripped through the care home with 32 staff and residents being infected in a four month period from October 2020 to January 2021. I was eventually rung in January to be informed of this by the care home manager.

It also emerged that the GP (family doctor) was unwilling to give vaccinations on site for at least four weeks. However, the GP then relented and my father received his first Covid jab a week before collapsing.

What amazes and frankly distresses me about the care home situation generally is the refusal of about 20% of care home staff nationally to be vaccinated for ‘cultural’ and – yes, believe it or not – ‘medical’ reasons. Think about this – staff refusing to be vaccinated and then looking after your loved ones. I call that negligence.

At the hospital, he displayed all the signs of Covid infection but there was some uncertainty at the outset. However, a swab test came out positive after he’d been there for a week.

In the days that followed, he seemed to be resisting the worst of the virus. So much so that medical staff thought he could be transferred to an intermediate facility and then sent back to the care home. The E.Coli was presenting the great challenge and the difficulty he was experiencing with swallowing food. But my father seemed to be defeating the Covid virus.

This turned out to be very wrong.

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That turnaround moment

A week to ten days after being in hospital, the information given from the ward led us, as a family, to believe that he’d displayed once more what we called his ‘bounceability’. Time and again, the old man had looked ashen-faced and positively deathly only to claw his back to the land of the living.

So, we seemed set for another bounce.

The only thing I’d noticed was his dementia getting a little worse. This manifested itself in various vaguely paranoid ideas involving shadowy conspiracies against him. All pretty standard stuff I’m afraid to say. But it was still possible to engage him in rational conversation once you got through some initial nonsense.

What started to overturn the optimism were the daily reports to me by the doctors that indicated the antibiotics weren’t working and that he was becoming more delirious. I was assured, though, that the objective was still to get him back to the level he’d been in when he was admitted to hospital. Not perfect – but stable.

However, on the Sunday evening before his death a new doctor came on the line and asked me whether I fully appreciated the seriousness of my father’s condition. I was flabbergasted. I knew the antibiotics hadn’t been working and that he’d ingested material into his lungs.

But now I was told that if I wanted to come on to the ward and see him, Covid restrictions would be lifted. That could only mean one thing. I asked for some candour. And I got it. The doctor told me that the problem with swallowing was linked to the dementia – he was forgetting how to do this basic human task.

He’d now developed ‘aspiration pneumonia’ and was not conscious. In combination with his underlying conditions, it was doubtful he’d make the night.

But then he did.

All through Monday my father clung on. His breathing now becoming the classic ‘death rattle’. And even though he wasn’t particularly religious, I agreed to a chaplain giving last rites. I’m an atheist myself but the thought of him being entirely alone in his final hours overrode that consideration. A bit of ritual and company seemed right.

There are many awful decisions to make as the clock ticks to the end of a life. The doctor posed the question to me – do we try and cure or do we manage the situation? I opted to manage the situation knowing full well that there was no cure. A Rubicon had been crossed in health terms.

He died at 01:20am on Tuesday morning. As agreed, I was phoned. Amazingly, I’d fallen asleep. But then found myself at my desk emailing family, writing death notices for the newspapers and even, I kid you not, amending the Ancestry.com website. The things you do to stay sane in that moment!

Within 48 hours, I had the death certificate in my hand with Covid-19 related pneumonia as the primary cause of death and COPD as the secondary.

Already, I’d had to deal with funeral arrangements. We’d decided, because of Covid, for my father to go directly from the care home to a crematorium and the ashes to be delivered to my home. Then later in the year, we’d have a service when the pandemic had lifted.

Now, I had to redirect the undertakers to the hospital. And then discovered that because of a Covid backlog, my father wouldn’t be cremated for nearly a month. So, suddenly, I was having to find out where his body would be kept. Whose fridge? The hospital to begin with – and then the crematorium – it turned out.

Disconnects in the health service

I’m a huge supporter of the National Health Service (NHS) in the UK. But those of you who’ve had to process your ageing loved ones through the system – will have lost your rose-tinted spectacles on the way. I should mention that both my parents worked in the NHS – my mother in a psychiatric hospital for thirty years. So we were an NHS family!

The plus sides of the NHS include having access to top medical care from paramedics, nurses and doctors free of charge. I was having lunch with my father when he had a stroke in 2018. The ambulance arrived promptly and the London hospital brought him back from the brink.

The staff were amazing and selfless. And I would say the same of the doctors in my father’s last few days. Always keen to update and keep me informed. Plus a pleasant and understanding manner.

So what about the downsides?

Well, the inability to share data in the NHS is mind boggling. With my mother, she would turn up from the care home (with advanced dementia) for a hospital appointment, after developing cervical cancer, and another hospital or the GP wouldn’t have sent her file in advance.

This wasn’t a one off. And it begs the question – can’t all this data be shared on these curious modern devices called computers?

I was also asked on two occasions – in an ambulance after my father had suffered a stroke and a week before my father died when he was in hospital – whether my father was allergic to penicillin. Now, I knew he was. But I bet a lot of people might not be able to answer that question.

Why on earth don’t we have a central database with this information accessible via our NHS numbers? Answer: because some people think it would infringe our civil liberties. So the next time you’re given an antibiotic that takes you to death’s door – thank your local libertarians.

Care homes

If we’d got my father into sheltered accommodation earlier, it would have been a godsend. But he’d experienced several falls at the home he’d lived in for fifty years, most of them with my mother. The GP’s records showed these falls and no sheltered accommodation provider would accept him. So – he had to go straight into a residential care home with nursing care.

The cost – about £1500 a week. Goodbye savings! I can only liken it to pulling a plug on his bank account. And for a man who saved diligently and was terrified of going overdrawn, he protested furiously at paying out this money. But we prevailed on him as a family that he should have the best even though it was our inheritances going up in flames.

From Spanish flu to Covid

After my mother died in 2016, I’d got my father involved with Ancestry.com. We opened an account and I began to plunder his grey cells for details on the family. And what a mine of information he turned out to be! In fact, he’d been doing a whole load of research for years as well as being able to churn out names and stories from memory.

At the time, he was at the very early stages of dementia. I’d certainly recommend something like family tree research as a great way to engage those whose brains are at risk of degenerating. Apart from anything else, I became totally addicted to Ancestry.com as we made some amazing discoveries together. So, keeping him mentally active wasn’t a chore – but good fun.

One of the things we uncovered were relatives who died of diseases like tuberculosis and the dreaded Spanish flu. The latter was the Covid equivalent of the years immediately following the First World War. My grandfather’s sister was one of those who sadly died of Spanish flu aged 29.

Final thoughts

This Covid pandemic has taken us all on quite a journey. Not a physical one but into our own minds and our closest relationships. I had no expectation that it would claim my father. And I’ve seen friends and acquaintances contract Covid but mercifully pull through. But it’s changed all of us.

How we emerge from this horror is anybody’s guess. I used to worry that every day would be like the next until the grave. Now, I’m craving normality and routine stuff like going for a walk, shopping and popping down the pub.

In recent years, digital strategists blathered about the virtue of ‘disruption’. You don’t hear so much of that anymore. But the virus has disrupted us. In our families, Covid has robbed us of loved ones. In our communities, it’s blighted the prospects of the young. And in our wider societies, it’s devastated entire sectors like retail and hospitality.

Covid came to visit me this month – and now I’m mourning a much loved father.

Georgian London

A horrific day trip to Georgian London!

Imagine you have decided to take a day trip to London two hundred years ago. What do do? Well, let me be your guide as we take a horrific day trip to Georgian London!

If you enjoyed the BBC series Taboo – you’re probably wondering what London was really like at that time. Could it really have been so bleak and awful. Well, in large part it certainly was.

That violent drama is set in 1814, the late Georgian period, and as luck would have it, I own several guides to London from the first two decades of the nineteenth century. One from 1804 is especially descriptive and I’ll quote liberally below.

These books were intended to guide a visitor around the city taking in places of interest, like a prison for example or a mental asylum. Yep, you really could pay to go and gawp at criminals and the insane. So – here’s a selection of oddities from the period of Taboo.

YOUR DAY TRIP TO GEORGIAN LONDON STARTS HERE!

Visiting a prison: You’ve arrived in London and wondering what to go and see. How about a prison? You could pop along to Newgate prison – where the Old Bailey now stands – and pay the “turnkey” two or three shillings to go in and stare at the unfortunates behind bars. One guide I have to London laments the overcrowded part of the prison for debtors, who were treated worse than thieves and other felons. Those who were condemned to death were normally held in irons, which must have been a thrilling sight for the Georgian tourist!

Then watch a public execution: My 1804 guide bemoans the attitude of Londoners to the growing number of executions. They’d become quite indifferent to them! “Among the many nuisances which disgrace the metropolis, there is not perhaps one which excites more horror than the frequency of public executions. The numbers of unhappy culprits that annually forfeit their existence by violation of the laws, afford sufficient proofs that an ignominious death is no longer our safeguard. Six, eight and ten criminals executed in the public streets, even in the heart of the metropolis, in the broad light of day, before the eyes of the multitude, scarcely excite emotion.”

You’re a victim of crime during your visit to London: There’s no police force at the time of Taboo so having been robbed, beaten up or defrauded by a fortune teller – you could take your case to one of the places where magistrates were in session every day of the week like the Mansion House, Bow Street, Hatton Garden or Guildhall. In a “summary way” they would deal with everything from murder to “disorderly houses”, “persons of ill fame found in avenues to public places with an intent to rob” and “vagabonds”.

Pop into a workhouse: In the early 1800s, Dr Hooper was the resident doctor at the St Mary-le-bone Workhouse and was happy to show any gentleman round if they were interested. There was also the St Martin’s Workshouse in Castle Street, near Leicester Square (roughly corresponding to the National Portrait Gallery). In my 1804 guide to London, it’s pointed out that one of the inmates was 104 years old! If you made a proper application to the master of the house or the churchwardens they were prepared to “readily gratify the curious”.

Strange entertainments: Like today, Londoners loved the theatre. Some of it was very bawdy while other houses put on fine operas and plays. Then there was just the plain bizarre. For example, Mr Cartwright could be found at the Lyceum putting on a display of “philosophical fireworks” while Miss Cartwright played the musical glasses. In the absence of movies, you could also go and watch The Phantasmagoria  – also at the Lyceum. Basically, images projected on to a screen from a “magic lantern”. No CGI I’m afraid.

Moral societies for bettering Londoners: If you were aghast at the depraved ways of Georgian London, you could join a society to improve things. In one guide to London I own the author recommends The Society for giving effect to His Majesty’s Proclamation against Vice and Immorality founded in 1787. There was also The Society for Promoting Religious Knowledge by distributing books among the Poor and The Society for Preventing Crimes by prosecuting Swindlers, Sharpers and Cheats, based in the Strand.

Observe the diseases killing Londoners:  In 1802, Londoners died of an interesting variety of ailments. Nearly six thousand had perished before reaching two years of age; 266 died of apoplexy; 3,503 died of “convulsions”; 559 were spirited away by measles; 1,579 succumbed to small-pox and 107 died of the condition that hit heavy drinkers of port wine – gout.

Cheer the chimney sweeps!: Children were still being sent up chimneys at this time. And there were plenty of chimneys to clean with most houses using filthy fossil fuels. There was a growing awareness that this was a terrible thing to do to young kids but nobody seemed to have come up with an alternative. Still, once a year, the chimney sweeps of London – on MayDay – dressed up in their finery (whatever that amounted to) and paraded through the streets to the cheers of London’s citizens. Only to be sent back up the chimneys the following day.