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Living in
the margin
David Appleman
It was about nine years after the closure of the old wards at Woodilee
psychiatric hospital, while walking in the disused grounds that I remembered
and finally understood the words of Wilbert Rideau "The Wall Is Strong".
The wall is strong refers to the metaphorical walls that psychologically
incarcerate the human mind and its will. Even though this institution
had closed, its walls still held its captives. The institutional wall
was indeed strong, too strong for any individual.
The holed roofs and the bricked up windows of the dilapidated hospital
buildings did little to mask their previous role, if at all, the buildings
looked even more intimidating. I sensed that the boarded window frames
and sealed up doorways were a poor attempt to silence the buildings'
chaotic past. Continuing by these old ward buildings I could still hear
the sounds of daily life going on inside. Having assessed the structure,
taking account of its unworthy state, it screamed at me for some reassurance
for its uncertain future.
As a child my father would take myself and my brother for Sunday walks
in the nearby countryside. Across from our house was the "Wudlie"
as folk called it. Our walk would start by passing through the massive
green gates that acted as a sign of demarcation and announced; you are
entering a hospital.
On every walk we quickly detoured to avoid the main hospital, I would
break away and climb up a steep embankment, which would bring me to the
RH wards. Creeping up slowly to the lime green huts (everything in the
hospital was green) and by skilfully stretching myself an inch or two
above the window, I was able to peer inside and steal a glance at the
forbidden world. As soon as I had done so, I was tearing down the hill
in fits of excitement and puzzlement. "Dad" I asked, "why
are all those beds in the same room? Who lives here?" I could not
understand why everything I had just seen was identical. The beds, pillows,
sheets and towels, even the lockers were positioned uniformly. My brother
and I were identical twins; we also shared the same bedroom. I can remember
my side of the room looked so different from Stuarts. I thought to myself
that the people in that grey room must have been all the same.
Strolling home, we gazed at the regimented façade of the main hospital
complex. Flanking the stolid buildings and running the entire length of
the hospital grounds was a sea of rhododendron bushes, which the whole
hospital appeared to float upon.
We never stopped nor spoke with those who lived within. On the brief occasions
I did see the people, they looked terribly sad. I wondered if it was because
of where they lived, not having things like houses, shops, cars, children,
cats and dogs; all the things that I knew so well. I thought that if I
had to live here without these things, I too would be sad.
As I grew older, the Wudlie and its people remained frozen as if in a
time capsule. It stayed like a film set of a late 19th century town: an
institutional municipality.
When Erving Goffman wrote Asylums (essays on the social situation of mental
patients and other inmates) in 1961, the "mental hospital" was
already over 200 years old. In its various shapes and forms the "total
institution" has in time become the stalwart appliance of the mental
health profession. Hidden from sight and rarely spoken of, the institution
has become symbolic of society's failings: the ultimate deviation
from the norm. For the men women and children whose lives were shaped
by physical/ mental disablement and mental illness or whose social circumstances
made them disadvantaged; an institutional life would reinforce the stigma
felt by many against those with a prevalent social disposition and disability.
To truly understand the institutional system we must examine the ideology
of those who created them. In medico-social history, the path walked by
those diagnosed with a mental handicap or a mental illness has often been
traumatic. The ancestry of the intentions in those charged with the care
of the "afflicted" have long been rooted in fear and mistrust.
Within our hieracachial, social spectrum, some of the most excluded groups
were those labelled as mentally handicapped or mentally ill*. The negative
attitudes, mostly homogenous in nature have been transferred down through
the ages by social interaction. Cultures at any period in history, have
in some manner or form, abused those who have a mental or physical disability.
Few of us are familiar with the internal system and workings of a total
institution. The majority of us would not be comfortable in an institution
because we would not recognise it for the world we know. To understand
the institution and its ways, one must ask; where did the hospital institutions
originate and why were they built?
Towards the middle of the nineteenth century the ruling (Victorian) classes
began to feel some responsibility towards those misfortunate in society.
As society in general continued to progress, the need for social institutions
to facilitate this advance became apparent. Government legitimised a wave
of social reform bills and in tune with this development two principals
of welfare legislation were created, which in turn would have a lasting
effect on the fortunes of mental welfare provision. In August 1845 the
Scottish poor relief laws were amended by Parliament to give new Parochial
Boards authority to build pauper lunatic poorhouses. In England Lord Shaftsbury
introduced a series of bills (1845), which paved the way for the erection
of lunatic asylums throughout the counties. With its dual role, the poorhouse
asylums, unable to cope with the demands of both the destitute and the
lunatic, had by 1855 fallen into disrepute. A Royal Commission report
drew attention to the inadequacy of all Parochial Board asylums. In 1857,
the Lunacy (Scotland) Act set up a General Board of Commissioners. The
General Board of Commissioners along with the Poor law Guardians in England,
decided that separated and specialised asylum were required for the care
of the mentally ill. From the 1870s onwards, institutional lunatic asylums
were built outside most major cities. This offer of fervency was not all
that it seemed. Hidden behind the pretext of assistance to the vulnerable,
was the desire by the elite to control and eliminate the weak from society.
The state viewed these lower classes, especially the physically deformed
and the destitute insane, as the vehicle to penury, poverty and madness.
As with all diseases, if allowed to spread it would in time contaminate
the decent man. The institutions, an extension of the dreaded workhouse,
now began to fill up with those deemed unfit to live in society.
The Victorians' use of ideological purity to justify a conviction
to punish imperfection had more than laid the foundations for the lasting
institutional matrices; upon which mental-health care would develop its
role. Shortly before his death, the ailing Lord Shaftsbury, who had tirelessly
campaigned for the rights of the individual, was politically overpowered.
Lord Salisbury, aided by powerful governmental allies introduced the Lunacy
Act of 1890, which, claims an historian of the lunacy laws, "was
to hamper the mental health movement for nearly seventy years".
Its important for us to have an insight into the origins of the institution
for this allows us to further question: why have we retained a system
which today is over a hundred years old and has its legitimacy firmly
attached to the exclusion of certain social groups? Did the institutional
system work so well as a medical model, that a lasting example remains
apparent today?
When I first began to research the subject of psychiatric/ mental handicap
hospitals, I had expected the project to revolve around a main theme,
that of the individual. The reality of institutional life I have so far
discovered is about control. Controlling minds, bodies and lives. It is
this simple. The politics of a whole organisation which will take you,
from birth if need be, and throughout your life, whilst overseeing every
single experience you have, has at its heart the need to control.
On arriving at the institution, and in an attempt to arouse the opposition.
I looked at every corner of the building. As an individual with my own
identity and my own personality, I felt no match for the institution's
multi-faceted disposition. As I approached a psychological confrontation
ensued. "Can I protect myself?" I find reassurance in the fact
that I'm six feet tall and around thirteen stone. The door to the
dentist at Woodilee hospital is around eighteen feet high and half as
wide again. One gets the impression that the institution remains at all
times larger than the individual.
I was directed by a sign, which told me which way to go to find the wards.
"What if I don't want to go this way, what if I chose my own
route?" The institution reminded me to follow the sign. I conformed
and followed the sign, as if the whole world depended on it. Standing
in front of a red brick building, I felt menaced by its small, square,
uniform windows, which like numerous suspicious eyes seemed constantly
aware. The building's architecture was confused. From the front it
looked like an army barracks, but the sides resembled a church. I later
found out it was the patients' cinema.
This was such a large institution even walking quickly around its perimeter
would take over an hour. All the buildings looked so identical, it must
have been really difficult to remember exactly which ward was which. At
night with no one around it would have been deadly quiet. A shout or a
cry probably would not have received an answer, yet if one had searched
the darkness, eight buildings stood back to back like mirror images.
I thought about this and a wave of immense detachment swept over me. The
weather was poor, and as the rain started, the hill side mist had also
lowered to enshrine the institution completing its isolation. The only
comfort now was the hospital's architecture. Its dark flat shapes
had receded into itself further, thus allowing its architectural insincerity
to become openly visible. To avoid the rain, I entered a ward. The corridor
of the ward was long and wide. Large swing doors with safety glass segregated
the many rooms, which branched off in opposite directions. As I passed
through the doors, my nostrils were filled with a strange smell. It's
not a human smell, as one would naturally expect. This is the smell of
an institution. It's the unique odour of a chequered linoleum floor,
which has been religiously polished. It's the starched scent of the
floral designed DHSS fire proofed curtains, which after treatment in the
hospital's laundry are often hung up in a different ward from whence
they came. It's the impenetrable, icky fullness of three daily meals,
which although dished in the servery, invade and occupy the dayroom like
a constant unwelcome smell. It's also the aroma of a human life contained
within the dry temperate limits of just four walls. Existence as a substitute
for a life, which now cornered, reverberates between the floor and the
high ceilings. All this, and the rest, is encapsulated by the institution,
which monitors the living space. These wards were not attached to the
main hospital, but seemed to exist as separate, subservient identities.
By comparison, Gartloch hospital had a maze of corridors, which branched
out like bony fingers reaching to infinity. I felt as if the real world
itself has been exiled from the premises, the clinic had taken over in
its place. It was sterile to the point that its totality had excluded
all ordinary life.
Looking at the day room, with its large square domain, lit up by a front
facing panel of windows, it is here that I remember, (how can I forget
?) the whole room packed with patients. It was not Bedlam as you may have
thought. There was no wailing or visible distress in those that sat here.
Instead around thirty adults with mental and physical handicaps sat grouped
together. It was a sea of chrome contraptions illuminated in the summer
sun. Walkers, wheelchairs, sticks, and other specialist equipment, some
I had never seen before. If a patient wished to move around within the
confines of the room, it was inevitable that a collision would ensue.
Those alone, not seeking companionship would pace the passageways or attach
themselves to their favourite nurse. Those who could not walk sat. Those
who could not sit down, because of agitation, walked. Those who could
not speak sat silent. Those who could not stay silent made noise. It was
a complete jumble of individuals with so many varying degrees of needs,
that it would appear difficult to direct any form of constructive care
towards them. And so the people sat, walked, talked or did nothing that
day and the next.
My mind moved quickly away from this and I entered the bedroom. The male
bedroom is on the left and the female bedroom is on the right of the building.
This was a single length dormitory, divided into individual cubicles.
Each bed space was separated by a single partition to its right side.
There was no screening to the front. At night the inhabitants of the ward
slept here. There was no privacy and little peace and quiet. One's
personal property would be borrowed, moved, lost and stolen. The individual
accommodation differed only in its décor. The single wallpaper
borders traced a multitudinous coloured line that changed as it passed
each bed. A metaphor of the system: one of these bed spaces had fallen
between a window; the partition allowed each patient a half share of the
window.
I now entered a locked ward, these were located at the periphery of the
hospital. After ringing the bell, a face peers through the window of the
inner security door. The door was unlocked and I entered an environment,
which did not conceal its gloominess. The dim, glow from the ward lights
were quickly evaporated by the dark, blue carpet beneath. The corridor
and day room were virtually empty, suggesting they were sparsely furnished,
would have been a total exaggeration. Not even the reflection from the
blue shiney walls created any stimulation. There was little, if any feeling
of human attachment in this place. It was also deadly quiet.
I immediately noticed, sitting on the floor, a young, "child like"
woman who was naked from above the waist. I didn't know whom to feel
more embarrassed for, her or myself. The two male members of staff were
sitting smoking and talking, they seemed totally unaware of this woman's
predicament. Maybe she didn't want to wear clothes, maybe they were
tired of re-dressing her; maybe that's what she did: that was her
life. It seemed that everyone who entered the bare incarcerating walls
of this ward, would in time, like the ward, also become naked. The metamorphosis
of the medical paradigm was now complete, the individual had become the
institution.
Today the institution is empty of the individuals it contained, if it
could ever have been described as having contained true "individuals".
This was where it happened. This was where thousands and thousands of
people over the last umpteen decades were literally processed through
a medical machine: diagnosed, prognosticated, treated, cured or not cured,
passed on to another institution, or just kept for ten, twenty, thirty
years or more. Ironically in a building sterilised and bereft of emotions,
today this is such an emotional place to be. There are very few places
that generate these types of emotions. Prisons and concentration camps
also contain this ambience of sadness and despair. One can see the connection,
it's all to do with people and the fact that so many impersonal acts
went on in here.
In bringing together so many people, the one way to govern and regulate
the life of the individual was via the architecture of the institution.
They were built to hold a lot of people and they did contain a lot of
people. The total institution was the unaccountable authority, and the
primary starting point from which every activity that followed would catalyse.
Contained within the institution, was an ideology. It was this institutional
ideology in which the system was contained. It was an ideological system
that far from representing the patient represented its own identity. The
institution was the authority and the authority was contained within the
institution.
During the early 1980s, the medical profession knew that the institutional
regime, being deficient, was failing patients terribly. As the decade
drew to a close, the system had progressively deteriorated to the verge
of near collapse. When the Government's large financial life-lines
ceased, the health service found itself disconnected. It wasn't just
the hospital services which had been left. Thousands of patients languished
in various institutional settings, which looked more like antiquated country
houses rather than modern hospitals. The reality of the situation, which
had been slowly lumbering up on the institutions, finally delivered its
blow around 1989.
The medical profession, like the added transitional eras of the psychiatric
and mental handicap hospital, has finally, in partnership with the institution,
turned in on itself. The bureaucracy which once removed those with mental
handicaps/ mental illnesses, and who now returns the individual to society
are one and the same. Modern psychiatric and psychological medicine is
telling us that it does not have the answer. It tried, it failed and now
it's someone else's turn.
The new focus is on supported care in the community. The contradiction
in terms between living in one's own home, with one's own identity
or living as part of a NHS industry with a shared identity could not be
more opposed to each other. In saying that, the concept of independence
is heavily circumscribed in political manipulation: community care was
the cheaper alternative to the expensive and morally bankrupt "total
institution". The remaining hospital institutions now have target
datelines to decant or discharge as many patients as is practicable before
the hospitals close.
With this and other closures, an exodus of institutional legacies will
follow. Society will inherit thousands of people who were products of
a medicalized system. It was the hospital institution which facilitated
the opportunity for medicine to attempt to create perfection. Housed in
special units, the handicapped and the mentally ill were tested and experimented
on. From scientific research, and its own generated hypotheses, medicine
provided society with possible solutions.
In the future, the politics of social control will be raised again. Society,
no longer having the reliance of the custodian institution, will look
to the advancements of medical science to perform these tasks. Through
the harnessing of eugenics, physical and mental disability resulting from
a medical condition will now be socially engineered out of existence.
The new institutions will be laboratories, the test tube and the petri
dish replacing the hospital ward. Human genetic matter, not human beings
will be trained and controlled for life within society. Society will be
able to select the healthy and reject those it does not desire.
As this century draws to a close, the psychiatric/ mental handicap institutions
will be quietly allowed to slip away into history. It will be remembered
by many for its levels of dysfunction, substantiated by its inability
to cope with the short falls of its own model of pathology. A pathology
model wholly obsessed with function and illness, which turned people from
real life individuals into curios of nature and conditions in textbook
references.
Today there are still mentally handicapped and mentally ill adults shut
away in the old style institutional hospital. It is not a world they chose
to be part of, but a world we have placed them in. To be locked up in
a world of one's own body or mind, is pain enough. To be removed,
locked up, and kept excluded from society is unforgivably cruel.
By the year 2002 the last of the large institutions in Scotland (Lennox
Castle Hospital) will have been closed by order of the Secretary of State
for Scotland.
*With the new culture of change "mental hadicap" is now termed
"learning disabilities".
Bibliography
Woodilee Hospital 125 years, Guthrie Hutton Greater Glasgow Community
And Mental Health Service 1997
Shaftesbury, G.F.A. Best, Chapter 2: The afflicted in mind, B.T Batsford
LTD 1964
Pioneers Of Social Change, E. Royston Pike, Chapter 10: The lunatics'
friend Shaftesbury's fifty years of devoted service, Barrie Books
Ltd 1963
Report Of The Mental Welfare Commission For Scotland, 1985: Deficiency
of Care, 1986: Deficiency of Care, 1988: Deficiency of Care-Lennox Castle
Hospital.
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