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.
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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.