Posts Tagged 'patient experience'

In the Frame for October 2013

As the new Community Engagement Officer here at Bethlem, writing my first In the Frame post seems like a somewhat daunting task.  I’m lucky enough to have had some previous experience of the collections here but, with around 1,000 artworks to choose from, there is still so much more to uncover and explore.

I first came across the pottery of Bibi Herrera in 2008 while curating an exhibition at the Museum of Croydon.  Bibi’s pots come in a wide variety of shapes and sizes, all with colourful and eye-catching designs.  I particularly like ‘Electric’ as the vibrant lines and colours to me seem to signify life, growth and positivity.  In many of Bibi’s works, you can see the influences of her time studying Chilean Indian art in Santiago at the age of 16.  Reflecting on this experience, Bibi speaks of how this reminds her of the importance of colour in life and how everything is not always black and white.

Electric, Bibi Herrera

Electric, Bibi Herrera

The beauty of Bibi’s art speaks for itself, but the journey she took to become a ceramicist, for me, makes her work even more powerful.  While studying in Santiago, Bibi became a member of the Young Communist Party and a supporter of the left-wing President, Salvador Allende.  On 11 September 1973, her life was overturned by a military coup, which resulted in the establishment of Augustus Pinochet as President of Chile.  On the morning of the coup, Bibi was arrested at her father’s printing works.  She was detained for three and a half years, during which time she was interrogated, tortured and raped.

In 1977 Bibi was released into the hands of the UN and came to England as a political refugee.  Initially she had no-one to talk to about her experiences and could find no outlet for her distress, which led to her first suicide attempt in 1979.  She was treated at Bethlem for a short period of time, but tried to commit suicide again in 1993.  This time she was offered the chance to talk to a psychologist about her experiences and pottery was suggeted as a form of occupational therapy.  However, the failed suicide attempt had led to Bibi losing the use of her left hand and left her frustrated with the fact she was still alive.  It wasn’t until one day when she chanced upon the sight of another patient working the clay with one hand – while smoking a cigarette in the other – that she felt encouraged to try pottery for herself.

Pottery is still Bibi’s lifeline today and she now uses her experiences to help others.

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Curatorial Conversations XIV

The last essay included in Catherine Coleborne and Dolly MacKinnon’s volume Exhibiting Madness in Museums (our ‘conversation partner’ on this thread over the past year or so) is written by Fiona Parrott and begins: “Studies of psychiatric collecting have tended to focus on the material and visual traces of institutional environments of the past, rather than privileging the traces and presence of patients inside these institutions”.1 On a casual reading, this looks like a criticism, an accusation of bias either on the part of the psychiatric collections or those that have studied them . Yet there is a perfectly innocuous explanation for this tendency. When patients leave hospital – any hospital – they generally take their property with them, and their collections stay private as a consequence. In this regard the exhibition The Lives They Left Behind: Suitcases from a State Hospital Attic is the exception that proves the rule. (Interestingly, Fiona Parrott’s essay describes the reluctance of today’s medium secure unit residents to decorate their rooms with possessions or even put posters on the walls, saying things like “I don’t want to make it look like I’m here for a long-time”.2) As a result, psychiatric collections, artefactual or archival, tend to consist largely of institutional records, which rarely contain unmediated accounts of the attitudes of patients, or of the general public, towards mental healthcare.

At first glance, the collections here at Bethlem are of this institutional nature. Indeed, the Archives & Museum is appointed as a place of deposit for the public records of the NHS Foundation Trust of which it is a part and its antecedents. Yet a little digging shows that the perspectives of patients are never far from the surface, even in the unlikeliest of places. Amongst the building records for the third hospital at St George’s Fields, for example, lie a set of plans and descriptions by the patient James Tilly Matthews, “probably for the first time ever, designs by a lunatic for a lunatic asylum, conceived not from the perspective of the doctors who will manage it but [from that of] the patients who will live in it”, according to Matthews’ biographer.3 There are, of course, more obvious places in our to look in our collections for patient perspectives. This blog’s In the Frame thread is an ongoing reminder of the breadth of our holdings of service user art.

Bethlem’s Victorian medical records open yet another window onto first-hand experiences at the Hospital. Contained in large casebooks, the majority of the record is written at one remove from the patients by Bethlem doctors. However, included in these books from time to time are letters from patients (and sometimes their relatives) to the Hospital, written during or after their stay. A wide range of modes of negotiation is represented here – complaint, threat, entreaty, gratitude. This is a valuable primary source for the patient side of the doctor-patient encounter, one which we hope to utilise in displays planned for our new museum. Though the curatorial conversations that are preparatory to our relocation are continuing, we have decided to close this particular thread of our blog, if only to make way for the discussion of other topics. Research into patients’ letters has already prompted more than one blog post, and we trust that it will prove a rich seam from which we can draw for future posts.

1 F.R. Parrott, The Material and Visual Culture of Patients in a Contemporary Psychiatric Secure Unit’, in Catherine Coleborne and Dolly MacKinnon, Exhibiting Madness in Museums: Remembering Psychiatry through Collections and Display (Routledge, 2011), page 178.

2 ibid., page 181-183.

3 Mike Jay, The Influencing Machine: James Tilly Matthews and the Air Loom (Strange Attractor Press, 2012), p. 186.

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A glimpse inside a medium secure unit bedroom

First Person Narratives 4: ‘One Good Year’ Part 2

The remainder of Jackie Hopson’s account, One Good Year: Being an in-patient in the Charles Hood Unit, Bethlem Royal Hospital, 1974 -1975 follows (to read part one, click here):

Something new for me, after the long, inactive days in county asylums, was occupational therapy, of which there were four sessions each week, one of them being entitled, “Social Skills”.  I particularly remember the well-equipped pottery workshop (I still have a dish I made at Bethlem by my bedside, 35 years later).  There were two gruelling but productive afternoon sessions on Wednesdays and Thursdays: these were Psychodrama (role-play, improvisation, reading dramatic texts and dance), led by the inspirational Miriam Plummer, and Art Therapy.  On Fridays, there was a large meeting of all patients and staff (medical, OT and social work) together in the big room.  We who were patients were involved in decision-making.  On one evening each week, one or two patients would collaborate to cook an evening meal for all patients and those staff who could come, which often included the consultant psychiatrist.  All of this was very different from the “them and us” set-up of the county asylums, where the staff members were, on the whole, more like prison wardens, who most certainly didn’t fraternise with patients or relate to us in any way that wasn’t disciplinary.

Because we lived in a hostel, slightly apart from the main hospital, I didn’t feel like an in-patient.  We went out to the supermarket, the pub (sometimes meeting escapee alcoholics from another Bethlem ward) and to the shops in Croydon.  Friends visited us in the hostel, sometimes staying overnight (though I never discovered the official policy on guests, if indeed there was one.)  All of this normality within our hospital experience made the transition to post-discharge life outside much easier.  We were in charge of much of our own lives, within the safe and tolerant setting of the hospital.

I remember several noteworthy events, some terrifying and others positively joyful.  The freedom and lack of hierarchy could be scary.  After one of us being permanently thrown out of the unit for violent behaviour, the rest of us, alone in the big room, smashed the entire supply of dinner plates against a brick wall.  This was both liberating and very frightening: the nurses left us alone in the ward.  We felt both powerful and scarily uncontained.  Another, more positive, day saw the whole group of eight patients (no staff!) setting off to London to celebrate the 21st birthday of one of our number.  We went to a great restaurant in Greek Street and had enormous fun on the way home, encouraging everyone on the tube train to sing, “Smile, though your heart is breaking.”  (Not many passengers joined in – they clearly thought we were bonkers!)  We were high on normal life and it was wonderful.

Sometimes we behaved like unruly children.  One day in the pottery workshop, the OT potter having left briefly, we had fun throwing lumps of clay at each other and the ceiling.  The OT leader returned to shout, “It’s bloody bedlam in here!” which, of course, increased the hilarity.

I am aware that we were a very privileged group, specially selected and given a most unusual opportunity to receive a rather experimental form of treatment.  My overwhelming memory is that we were considered as human beings with futures that we might realise, rather than psychiatric dregs to be confined, drugged and, at all costs, to be kept away from the “healthy” population outside.  The Charles Hood Unit at Bethlem set me off on a path to believing it might be possible to live.  When I left (I discharged myself, having become impatient with my life being on hold), I felt I was leaving a safe home, better able to cope in the outside world.

First Person Narratives 3: ‘One Good Year’ Part 1

Following on from two recent pieces on first person narratives (here and here), we are extremely grateful to the author of Through the Wasteland, Jackie Hopson, who has written us an account of her experiences at Bethlem’s Charles Hood Unit, entitled One Good Year: Being an in-patient in the Charles Hood Unit, Bethlem Royal Hospital, 1974 -1975, to be posted in two parts. She writes:

Winning a place in the Charles Hood Unit at Bethlem Hospital in 1974 was harder than getting into university and felt to me like a greater achievement.  There were two long and demanding interviews, each time with a roomful of doctors, nurses and social workers.  After the first interview, they sent me away with what seemed an insuperable task: to finish university, get a job and survive for a few months.  I sat down on the platform at King’s Cross Station and cried.  Some months and the second interview later, I was given a place.

Bethlem was very different from the county asylums where I had earlier spent many months.  I felt safe and settled at Bethlem: in other psychiatric hospitals I had felt punished, a prisoner, alert for possibilities of escape, fearful of ever-worsening, harsh, physical treatment and drugged into stupor.  Our time-table at the Charles Hood Unit was demanding but, with a small, supportive group of patients and a very informal, non-hierarchical atmosphere (all staff and patients were known by their first names), life was pleasant and felt pretty normal.  Some eight or so patients lived in a “hostel”, a large, comfortable house called “Winchelsea”, which was, I believe, the former Hospital Governor’s residence.*  We were all roughly between 20 and 35 years old and, almost without exception, well-educated, though some members had dropped out of higher education because of illness.  Every morning, we walked across the field to the Charles Hood Unit, where most of our activities (it didn’t feel like treatment) took place in a huge, light, high, wood-ceilinged room, comfortably furnished and with an adjoining kitchen.  We had lunch provided here by the hospital; breakfast and supper we made for ourselves at the hostel from an in-patient stipend of £4 per week.  This meant we had to shop in the local area and cook, together or individually.  We did our own cleaning and laundry in the house – and had to deal with the tensions that arose among the “tenants”.  We were given no psychotropic medication whatsoever.

As members of this therapeutic community, we had a full, five-day timetable, which ran from 0915 to 1600, except for Fridays, when we finished at 1400.  Many patients then went away for the weekend to friends or family.   Three times each week we sat on the floor in a circle in a small room for a ninety-minute group therapy session which was tape-recorded.  Normally a registrar and a senior nurse were present with the patients, sometimes two nurses; and these staff members might interject personal material, as well as helping us along with frequently very painful issues.  In addition, there were two one-hour hostel group meetings each week to deal with domestic problems, again with staff present: the small group of patients was together pretty much round the clock, so there were difficulties sometimes.  Each of us then had a 45-minute session of individual psychotherapy every week.

*Actually the former residence of the Hospital Steward

In the Spotlight: Antonia White

Philip O’Connor, the writer highlighted in last month’s In the Spotlight, wrote of his sense that “a thick glass pane…had been fixed between [him] and the world” upon his departure from the intense, even ‘intellectual’ environment of the Maudsley Hospital.

To another author of the same generation, who experienced the equally heightened atmosphere of the wards of Bethlem Hospital, the divider that mattered most was not a metaphorical one that separated her emotionally from others, but the window pane of her room at hospital, through which “she could see into a garden” in which “women and nurses were walking…like figures cut out of coloured paper”.

“And she could see birds flying across the sky, not real birds, but bird-shaped kites, lined with strips of white metal, that flew on wires. Only the clouds had thickness and depth and looked as clouds had looked in the other world. …They would take shape after shape to amuse her, shapes of swans, of feathers, of charming ladies with fluffy white muffs and toques, of soldiers in white busbies.”

Upon her departure from Bethlem, her perspective was reversed to that of someone on the outside looking in. “She no longer belonged to the world beyond the glass. There were moments when she almost wished she did. … Beyond the glass, however agonising the nightmare experiences, they had had a peculiar intensity.”

These quotations are from Beyond the Glass, the last novel in a trilogy of autobiographical fiction written by Antonia White (1899-1980). Nine months’ residence at Bethlem in 1922-23, when the hospital was located in Southwark, is vividly represented in this novel. This is not the place to attempt a summary either of the work or the life of its author. The dust-jacket of Jane Dunn’s 1998 biography of White promises a study of a “single parent and working mother” who “wrestled with the large questions of faith … Catholicism … being a woman and an artist”, not to mention “the threat of madness” (Antonia White: A Life). This is sufficient reason, we think, to read White’s novels (maybe Dunn’s biography too). In them White gives evocative, and at times searing, accounts of her experiences in and out of hospital.

Then for the short story ‘Surprise Visit’ (published in an anthology entitled Strangers), White drew upon her experience of returning, out of curiosity, to the Southwark site of her hospitalisation, some time after Bethlem had relocated to Beckenham and the Imperial War Museum had moved in. There White attributed to her protagonist the “peculiar satisfaction” she no doubt felt “to measure how far and how successfully she had travelled since that deplorably bad start”.

Antonia White

Used by kind permission of the National Portrait Gallery

In the Spotlight: Philip O’Connor

In last month’s In the Spotlight, we wrote of the oft-supposed link between ‘genius’ and ‘madness’ that “without ever coalescing into a testable hypothesis, …finds anecdotal support within both popular culture and academic discourse”. An example we might have cited is that of the bohemian writer and poet Philip O’Connor (1916-1998), who (in his autobiographical Memoirs of a Public Baby) admitted that at one time he had shared the “prevailing scientifically ignorant conception of neurosis as the unemployed, wasted part of imaginative talent”. O’Connor’s own experience of psychological imbalance and hospitalisation must have contributed to his eventual rejection of such an easy identification. He was diagnosed with schizophrenia and admitted to the Maudsley Hospital at the age of twenty on 21 September 1936, declaring (according to his autobiography) that, whilst willing to be there, he had no hope of changing.

 

O’Connor despised his doctors: “I couldn’t believe them capable of understanding me, and certainly didn’t want them to…They appeared to me desperately on the outside of a world they’d give their world to enter; I treated them as unprivileged gate-crashers.” Yet of the Maudsley he wrote: “I liked the place very much, being allowed more or less to do as I pleased, painting, writing and not having to ‘work’; and certainly having my psyche seriously considered wasn’t, in a coarse way, unflattering”. The atmosphere on the ward he found “normal” but “heightened”. Of one memorable night, that of 30 November 1936, he wrote “I awoke as from a trance, and, in the glare of the Crystal Palace which was burning – we could see it from the veranda where we slept – I caught a snap-glimpse of other patients, some dressed, and felt them, from their clothes mostly, to be thrillingly contemporary, of today, absolutely, and I imagined an element of cure in this experience…”

 

O’Connor’s recovery, though sufficient to warrant his discharge on 20 March 1937, did not serve to lift his spirits. “I left…with the consciousness of having become a grubby, conventional ‘intellectual’; and that a thick glass pane, as is proper to such ‘intellectuals’, had been fixed between me and the world”. If the Maudsley was O’Connor’s university, he certainly rued his graduation. “I felt old, cynical, departmentalised, my mind in its sensory remove from the world working much harder and more consistently, but lacking the original spurts and ‘inspirations’, and on a thinner diet”.

 

Nevertheless, the Maudsley seems to have been the accidental crucible of O’Connor’s future career. On admission, his occupation was given as ‘painter’, and he is the one person included in this series of posts whose artistic work features in the collections of the Archives & Museum. As part of an experiment conducted by Drs Eric Guttman and Walter Maclay (which was recently the subject of a temporary exhibition at the Bethlem Gallery) O’Connor was given the drug mescaline and asked to represent its hallucinogenic effects in his art (an example of which is given below). Yet O’Connor’s first piece of published poetry was written while he was in hospital, and seeing his name in print set him on the literary course for which he subsequently became known.

There is more about Philip O’Connor in Andrew Barrow’s Quentin and Philip: A Double Portrait (MacMillan, 2002).

Lovely (2)

In the Spotlight: Dennis Lillie

In introducing this series of posts, we wrote that since mental distress is no respecter of persons, one would expect a small percentage of our historic hospital admissions to have been of those in the public eye. Into this statistical commonplace many have wanted to read a causal link: Isn’t there something about mental ill-health that gives rise to talent or celebrity, or perhaps vice versa? This type of speculation is expressed most persistently in terms of ‘madness’ and (often artistic) ‘creativity’. Without ever coalescing into a testable hypothesis, it finds anecdotal support within both popular culture and academic discourse.

There is a fresh version of this argument in extracts from Tom Griffiths’ Slicing the Silence: Voyaging to Antarctica (Harvard UP, 2007) recently published in an Australian newspaper:

“At least three of the crew of Ernest Shackleton’s Endurance were “mentally deranged” by their harrowing escape from the ice. Did Antarctica make these men “go mad” or did it attract people with a certain extremism in their personalities, not just looking for the edge but already near it? Whatever your state of mind, Antarctica can be destabilising, it can be life-changing.”1

One of these polar explorers was Dennis Gascoigne Lillie (1884-1963). Cambridge-educated Lillie (not to be confused with the similarly-named Australian cricketer of the 1970s) served with distinction as a marine biologist on Robert Scott’s ill-fated Antarctic Expedition of 1910-1913. His observational studies on birds and whales, and his caricature sketches of fellow members of the expedition, were subsequently published and much sought after. Along with other expedition survivors, he was awarded the Polar Medal. He served as a military bacteriologist during the First World War, whilst objecting to combat duties on grounds of conscience.

Lillie’s mental health failed in 1918, and he was admitted depressed, delusional and suicidal to Bethlem Hospital in February of that year. The content of his medical notes suggests that the state of mind that brought him to hospital was entirely unrelated to his experiences of 1910-1913. Indeed, they report that “on the whole he felt better during this time”. In consideration of financial suppport given by the Captain Scott Memorial Fund, Bethlem waived its usual twelve-month limit on residence. Lillie was discharged recovered in January 1921, and commenced lecturing at Cambridge, but relapsed and was admitted to Buckinghamshire Mental Hospital in October of that year, before returning to Bethlem a month afterward. This time his equilibrium did not return, and in April 1924 he was transferred to Salisbury’s Old Manor Hospital. According to Tom Griffiths, Lillie “did not recover his sanity”1; but, pace Griffiths, he did not lose it in the Antarctic.

1 Tom Griffiths, ‘Madcap icecaps’, The Age, May 12, 2007.

Lillie

Used with permission