Some reflections by a retired nurse on asylums old and new

8 Jan

Vintage psychiatric nurse novels 4

 

Earlier this evening, I had a fascinating conversation with a relative who’d trained as a learning disability nurse in the 1960s. She shared her memories as a nurse, visitor and  patient at Coldeast Mental Deficiency Colony, Littlemore Asylum, Digby, Langdon, Tone Vale and other hospitals.She had some interesting observations on the differences between the old asylums and modern psychiatric hospitals.  It was hard to tell if it was pensioner nostalgia or if things really were, on balance, much better in the old asylums. But that was her clear view.

She spoke about the old asylums, on the outskirts of town, each having a home farm where patients would work, have a purpose, be outside and contribute to the life of the institution. Of patients cleaning the wards, nurses helping too, of real hands-on nursing, of vocation, of the matron closely supervising the ward, of strict hygiene standards that meant, for instance, never sitting on a patient’s bed. Of food cooked on the wards, and nurses trained in cooking too in case there was no one else there to do it. Of the value of good routine, of having to boil the needles and bandages, of having to manage patients without drugs, of highly-trained staff.

She spoke of parents being persuaded to abandon their ‘mentally retarded’ children, to leave them behind and get on with their lives. Of how wrong that was and of how people could contribute so much to society if they had routine jobs. That seemed her one regret from those times.

She spoke of nurses needing to get at least two years’ experience before they could go on the wards with the more difficult patients. Of how patients would be matched to particular nurses, as some patients could be violent from time to time and you had to know how to relate to them. Of how the experienced staff, strict routine and a pride in their work created a secure and stable environment for patients and staff alike.

And she spoke of how things had started to ‘go down the pan’ in the 1970s when, for the first time, staff could use drugs to ‘keep patients quiet’. Of how younger staff were recruited, how routine slipped, how patients were left to do as they wanted, neglected and ‘drugged up to their eyeballs’. Of seeing the nurses’ pride in their job dwindling, of staff having affairs with each other, of hygiene standards slipping. She’d seen this in residential and nursing homes too: residents drugged to keep them quiet, one perhaps two staff on overnight, and little care.

And then she compared her time working in the old institutions with her recent experience of care in a brand new psychiatric hospital. She said, when she was a patient herself, the staff were ignorant about mental health, and some nurses were ‘really nasty’. Staff congregated in cliques or in the staff room. They didn’t mix – ie care for – patients. At night, nurses would be on their smart phones and would brush her away when she tried to talk to them. Of how the ward phone was kept locked in the nurses’ office, so patients couldn’t contact the outside world except with staff permission. (That’s a recipe for abuse behind closed doors, if ever there was one.)

She spoke of there being no facilities for exercise – and, when she went in, she was used to walking miles. How she got fatter & fatter. That there was a small internal courtyard but she wasn’t allowed in it in case she ‘climbed over the wall’ and escaped. How she was finally, after several weeks, allowed into the courtyard and would then walk round and round and round. How there was a swimming pool and gym elsewhere on the hospital site, but the nurses wouldn’t take her there. How she badly missed activity. How she came out of hospital far more unhealthy than when she went in, physically.

How nursing had become more technical, and nurses had more status now, but had lost the basic hands-on skills. How nurses nowadays had lower hygiene standards and no idea about cross-infection control. How hospitals needed highly-trained staff but how the staff who’d treated her didn’t have sufficient training. How nursing was just a job now, not a vocation.

It was fascinating listening to her experiences as staff, visitor and laterly patient starting in the 1960s and running right through to the present day, and the comparisons she made.

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3 Responses to “Some reflections by a retired nurse on asylums old and new”

  1. alicerose91 9 January 2015 at 3:11 am #

    Really interesting reading! I actually used to be a support worker in a residential supported living care home and one woman I used to care for spent time in Coldeast. When she did talk about her experiences, you could tell it was a very traumatic experience for her, but this would have been during the 70’s/80’s. My personal hospital experience was completely traumatic, my friend removed me before any treatment as it was so awful. Thank you for sharing this, let’s hope in the future the NHS might remember some of this old values.

  2. savemefrombpd 9 January 2015 at 12:13 pm #

    I wish that I knew what would be the ideal psychiatric hospital/ward thesedays. My experiences have been pretty bad and included the types of abuse you mentioned and a lot more. I do feel traumatised from previous hospitalisations.
    But I wont go in to that. But now I am in hospital for a short stay but I am drugged up to the eyeballs and I feel it and it is very unpleasant.

    It’s frightening and worrying where all of this is going. How there isn’t enough money going in to mental health services and therefore sick people are not getting the help they so desperately need. And the wards are short staffed and that causes many problems. Like me being strangled by a male patient and not having enough manpower/nurses to get him off of me and general chaos. The nurses that were there were overworked and it made them act nasty because they were under so much stress.

    Anyway, I said I wouldn’t get in to a of that. But there is so much more I could write about.

    Gives me the chills. It really does.

  3. Liz Thackray 9 January 2015 at 2:39 pm #

    I find I have very mixed feelings about mental health care and psychiatric hospitals.

    My mother trained as a psychiatric nurse in the 1930s and post-war she was matron of a psychiatric hospital in the south of England. From my earliest days, I can recall her speaking of her hospital experiences – and there was warmth and care in how she spoke of many of her patients, but also there were things that concerned me when she spoke of the introduction of different forms of treatment, many of which were at best abusive and led to people losing their sense of personhood. There were also clear abuses in the employment of patients as servants (for senior staff) and gardeners at little or no pay – and no hope of every leaving the asylum.

    By chance, my first job was as a social work assistant in a large psychiatric hospital in South Lancashire. This was 1968. The hospital had 3 sections – an acute hospital, a long stay annexe, and a neuro-psychological clinic. Patients were admitted to either the clinic (if they were high enough status and not overly disruptive) or to a locked admissions ward in the acute hospital. Many patients in the clinic had suffered a so-called nervous breakdown or were being treated for homosexuality – those were the days of aversion therapy, using electric shocks. Patients admitted to the main hospital tended to be fairly rapidly drugged and could find themselves in padded rooms or side wards if they did not conform to the hospital regime. Chemical coshes were common and the hospital tended to act as a container rather than to offer much by way of treatment. Patients tended to be discharged as soon as possible after admission, usually on a hefty dose of medication or following a course of ECT treatments.

    One of the ideas beginning to take shape was that of assessing the patients in the annexe – the back wards which housed 1500 people – with a view to determining whether any might be able to be prepared for discharge into the community. Many of the folk in those wards had been in the hospital 20 or 30 years. I encountered one woman, then aged 68, who had been admitted to hospital in 1905 as a 5 year old and never discharged or provided with any education. The ward sisters and charge nurses generally regarded talk of discharge as cruel – the hospital had institutionalised patients, given them very little contact with the outside world, apart from what they saw on TV, left some of them disabled by the various drug and other therapeutic regimes, and generally ensured many were unfit to live in that frightening place that existed beyond the hospital.

    A couple of years later, while studying for my social work degree, I spend a further 12 weeks working in another psychiatric hospital – this time as a nursing assistant on a male ward where most of the patients were older men most of whom had lived in the hospital for many years. The daily routine involved getting folk up in the morning – most slept in a ward with no personal space and minimal space between beds. Some of the men were allowed to shave themselves, but most were shaved – I got quite expert with a safety razor. Following breakfast, the men went to a workshop where they did woodwork or made baskets, returning for lunch and again late afternoon. Following each meal there was a medicine round, when drugs were doled out. Once a week each man had a bath – they were allowed no privacy and often naked elderly men were lining up for their baths. Two men remain in my mind – one a man in his early 60s who I chatted to quite a bit. He had only been in the hospital a couple of years and really efforts should have been made to discharge him in my opinion but he was rapidly becoming scared of being anywhere other than hospital. The other was an older man who was diagnosed as ‘manic-depressive’ and for the majority of my time on the ward was quite charming – but then he had a manic episode. Was bundled into a side ward, filled with drugs and transferred to an acute ward.

    I have no sense of those hospitals representing the good old days. Maybe they were a moderately benign environment for those who had nowhere else to go, but they specialised in control, abuse and a general lack of any positive treatment.

    However, I am concerned when I see what we are doing today to people who may have lived in asylums in the past – not providing appropriate care and accomodation, not enabling people to work, and allowing too many people in need of care to live sub-human existences on the streets or in hostels.

    In my opinion we still haven’t worked out how to provide adequate care for folk with long term mental health conditions.

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