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Is it time to reconsider the asylum?

Is it time to reconsider the asylum?

They have become associated with chaos and cruelty. But a new exhibition argues that we need to reclaim asylums as places of refuge

They have become associated with chaos and cruelty. But a new exhibition argues that we need to reclaim asylums as places of refuge

Maggie Fergusson | September 23rd 2016

It’s odd to be nostalgic for a place you’ve never seen, but that’s how I feel about Broadmoor. The high-security psychiatric hospital in the south of England was not far from my school, and every Monday morning at 10am, when the siren was tested, a mournful, plangent wail drifted across the hockey pitches. The siren had been installed in 1952, after a patient escaped and killed a little girl, and if we heard it begin to whine other than on a Monday morning, we knew that someone was on the loose. We were thrilled and terrified, both at once, at the prospect of meeting a madman. Because I’m afraid that’s how we thought of them: as hardly human.

Spread over five interlocking spaces, the Wellcome Collection’s “Bedlam: the asylum and beyond” aims to explore what it is like to be mentally ill, and how perceptions of mental illness and its treatment have evolved over nearly nine centuries. It helps visitors to feel compassion for anyone who suffers from mental illness, and in a small way to comprehend their anguish. Today those with mental illness are presented with what the curators describe as “a chaotic marketplace of therapies” ranging from prescription medicines and clinical treatments to spiritual practices and online support. But surfing the web is a lonely business, and many need much more than it can offer. So do we in fact now need to turn backwards in order to move forwards? “In this ever-changing landscape the asylum might seem out of date or irrelevant,” the curators acknowledge, “but can the idea that it represented – a protected space of refuge and care – still be recovered?”

Setting the mood for the rest of the exhibition, the first space is given over to a 2014 installation by Eva Kot’átková, inspired by her conversations with patients at Bohnice psychiatric hospital in Prague. In among abstract depictions of restraint and agony – a gagged mouth, a stairway leading nowhere, a pair of hands cupped around a single eye, a man in the centre of a maze – are typed-up testimonies from some of the patients. They’re both torturous and heart-rending, and introduce us to a great gamut of torment.

Some patients have strange, phantasmagoric notions about either the shape or the surface of their own bodies. They warn those around them to be careful not to impale themselves on the spiny branches protruding from them. “Do not sit that close,” one patient tells Eva, “so that I do not unwittingly injure you when turning on the chair.” Others perceive themselves as so fragile that they cannot bear even a handshake. They believe that a concentrated gaze can cause them injury.

One patient is terrified of blank spaces. “Every blank space has to be covered with something,” he says. “I cannot stand to look at a white page, I cannot live in a room with white, empty walls, I cannot look at a clean sky, I cannot wear clothes without ornaments. I hate spaces between words and letters. I cannot be alone.”

Another simply offers a litany of terrors:

Fear of own body
Fear of small, narrow spaces
Fear of being watched
Fear of children
Fear of colours
Fear of clowns
Fear of falling asleep
Fear of closed doors
Fear of birds’ wings
Fear of being forgotten in a room
Fear of too many memories

Leaving Kot’átková’s installation behind, the main body of the exhibition goes on to focus on one establishment: Bethlem Royal Hospital in London – preserved in popular imagination as “Bedlam” – perhaps the oldest institution of its kind in the world. Founded in 1247 by the London alderman Simon FitzMary after a pilgrimage to the Holy Land, it offered charity to the needy, especially those referred to at the time as “lunaticke”. Then in 1676, after the Great Fire of London, it was relocated to a new building on the edge of the city by London Wall. Glass lantern slides at the exhibition portray a magnificent building – but they only show the outside. Behind the façade the cells were gloomy and grim. A Hogarth print (above) depicts two well-to-do ladies visiting a chaotic ward in Bethlem, though whether they are moved by charitable duty, or simply looking for entertainment, it’s not clear.

The art of medicine
Dr Alexander Morison, painted by his patient Richard Dadd

By the end of the 18th century, public attitudes to the treatment of madness were becoming more humane – when James Hadfield attempted to assassinate George III at Drury Lane Theatre in 1800, he became the first person to be found not guilty by reason of insanity. In France Philippe Pinel demonstrated the value of listening to patients and involving them in their own cures. A painting in the exhibition by Tony Robert-Fleury commemorates Pinel releasing the inmates of Salpêtrière hospital in Paris from their chains. When the conditions of patients at Bethlem were exposed, it led to a public scandal. One inmate, James Norris, was found to have been kept chained to the wall by his neck for ten years. A picture shows him sitting riveted to an upright bar hollow-eyed with misery.

In 1810 a new Bethlem opened on the south bank of the Thames, and there was a gradual move to involve patients in occupational therapies, like painting. Perhaps the most striking single item in the exhibition is a sinister portrait (above) by the artist Richard Dadd of his doctor Sir Alexander Morison (Dadd had been committed to Bethlem after stabbing his father to death, believing him to be the devil). Morison is gaunt and grey, with a thin mouth, and an expression that is both intense and distant. Next to him, by way of contrast, is Van Gogh’s portrait of his doctor, Paul Ferdinand Gachet, who treated him after his release from San-Rémy asylum. Gachet, who is smoking a pipe, looks affable and sympathetic. He was, Van Gogh said, “A ready-made friend and something like a new brother”.

A new model
An asylum designed in collaboration with sufferers of mental illness

In 1930 Bethlem moved to a new site in a rural setting: the 270-acre Monks Orchard estate near Beckenham. And there it remains to this day. It is possibly unique in having endured so long. “For the great majority of these establishments there is no appropriate further use,” pronounced Enoch Powell, Britain’s minister for health, in 1961. It would be interesting to know what led Powell to this conclusion, but the curators simply quote his words. Possibly it was the recent development of ECT, coupled with the discovery of Chlorpormazine (Largactil), an anti-psychotic drug, which had enabled many patients to go home. Whatever Powell’s reasoning, asylum treatment, in his view, was costly and unnecessary, and needed to be phased out. The mental-health care of the future would consist of beds in general hospitals, with care in the community preferred wherever possible.

But care in the community often proved ineffective, and while the words “bedlam” and “asylum” have become associated for many with chaos and cruelty, there are those who would welcome their return. A final exhibit shows a model asylum created through conversation with sufferers from mental illness (above). It is an idyllic looking place where everyone enjoys both private and communal space. And there’s no siren.

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theresawilliam - April 3rd 2017

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leslief - September 29th 2016

It is true that we forget that the purpose of the asylum was to protect the people inside from the people outside. And for a time that worked. The outbreak of World War 1 cause great damage to the asylums. Committed staff went to war and their replacements were often less able, compassionate or committed. In the '20s and '30s there could be a fine line between social and clinical reasons for committal. People were committed because they were "troublesome" rather than mentally ill. A "wild" young woman who has a had a child or children outside of marriage, with no signs of remorse, could well find herself detained within the asylum walls. Often staying there until she was so institutionalised, that discharge was almost impossible. When Powell said that they were no longer needed, the system was well past its heyday, and in a time of changing social attitudes. Of course it was also true that the asylums were all in poor condition, and required lots of money to bring them up to standard. This when there was very little money for anything, and certainly not for mental health provision. Over the next 30 years or so as the large long-stay hospitals, finance continued to undermine the provision of good quality care in the community.