Sunday, 15 February 2015

Mental Health History in The North West: Exploring Through Writing

This is an article written regarding ‘Experiences of an Asylum Patient’, a document written by Rachel Grant-Smith and published in 1961. The document largely takes the form of an eyewitness account over 12 years of incarceration in what were then called ‘asylums’ in The North-West of England. The writing in itself is an attempt for Ms Grant-Smith to argue against what she regarded as her mistreatment and the misconstruing of her mentality – to the extent which she was prepared to come in front of a Royal Court. It is through the exploration rather than examination of the lives of those like Rachel Grant-Smith who were not given a voice at a time of mental anguish, that an important history of mental health treatment can be uncovered.
As Virginia Woolf once reflected:

“I can only note that the past is beautiful because one never realises an emotion at the time. It expands later, and thus we don't have complete emotions about the present, only about the past.”

It could be seen that in taking the emotions of the past into account, we  can make better preparation for emotional care in the future, the history of mental health uis often kept secluded, patients involved in the ‘asylums’ often viewed as fading into some undocumented existence. However, through careful research and the account ‘Experiences of an Asylum Patient’ this article seeks to highlight especially how we can, in regards to mental health especially, learn from the language of the past, to shape the terms of the present.  It is my belief that language and its usage can be used constructively within mental health care. For example, as this piece highlights, although the term ‘asylum’ was once used, now ‘psychiatric unit’ is appropriated. The changing of language use and the discussion of mental health is important – a point Grant-Smith urges in her writing itself.

A model of the old infirmary - Piccadily Site
February has seen the growth of incentives to encourage the discussion of mental health – such as the ‘Time to Talk’ campaign launched by the charity, Mind. This is partly, and rightly, in response to a history of mental health discussion thwarted by stereotypes and false classifications. In this case, words can be both culprit and constructive. Through words we can limit people, yet they also serve as vehicle for expression. In turn,  in order to elaborate on the factor of history and mental health, this article will explore the  words of Grant-Smith who was interned at what was called ‘ Manchester Lunatic Asylum’ (later ‘Cheadle Royal Asylum’) and how her writing holds such relevance today.
Manchester Lunatic Asylum opened in 1766, with the hospital database suggesting an ‘unknown location’ from 1763 to 1850. A common suggestion in regard to situation is  Manchester Piccadilly, part of the same site as the Infirmary which existed there from 1752 to 1909. After all, a letter from 1804 by a James Jackson is addressed to the ‘trustees of the Manchester Infirmary, Dispensary, Lunatic Hospital; & Asylum’ suggesting that the infirmary and psychiatric services thus shared the same site. In 1850 the ‘Lunatic Asylum’ diverged to  location of what is now 100 Wilmslow Road, Cheadle SK8 3DG, though ultimately kept many of its Lancashire connections and patients.  By 1870, George W. Mould was the Cheadle Superintendent.

In 1900, a patient was admitted as a boarder under the name of Rachel Grant-Smith. Yet it is interesting that her location on census in 1902, despite her being in the hospital, is described as ‘Musgrove’ – a pseudonym. This use of language highlights an attempt to disguise the reality of mental health problems and services. It  is interesting  that there could be considered a slow extent of progress over the next 50 years, in terms of an article by W.V Wadsworth in the Lancet, part of conducting investigations into mental health  units. "In 1959 he [Wadsworth] invited Gordon Cross to come from the Bristol Day Hospital to open a similar one at Cheadle. This developed as a therapeutic community and in association with the industrial unit helped in the rehabilitation of both neurotic and psychotic patients." (Munks Roll)

Yet in Rachel’s’ case, not only is her location ‘Musgrove’ a pseudonym, but her name itself.  It is this name which signs the haunting ‘Experiences of an Asylum Patient 1922’ based on her  mental health treatment in the North-West from 1900.  The document now contains an introduction, which presents the ‘Experiences of an Asylum Doctor’, by Montagu Lomax. Initially, this writing proceeding Rachel’s  invites an extent of scepticism – is this the assertion that those deemed ‘medical professionals’ at the time still held the ultimate authority when it came to written expression? After all, who gave Rachel her name, attempted to construct her identity? Interesting them, is how the doctor appears to defend Rachel’s writing  itself, asserting the ‘Truth’ which lies within it – quite definitive language for the time. A particular point of language is that  Lomax writes ‘the personal pronoun ‘I’ looms very large in all lunatic asylums’ – suggesting an awareness that is the patients themselves and their words, which form their identity.

Words contribute to identity and can be used constructively. For those suffering from illness, mental or physical, words can often appear like a condemnation or a fetter – in the form of diagnosis or a letter. However, this piece of medical literature is especially important in regards to mental health and its history as highlights the beginning of awareness that words can be used for constructive expression – like discussion. It is in the main body of ‘The Experiences of an Asylum Patient’, that Rachel describes her difficulty as ‘once tainted with a certificate of madness.’ This includes  grotesque mistreatment which she alludes to ‘terrible acts of brutality’ in a ‘vicious circle’ over ‘twelve long years incarceration’. Although Lomax in the introduction suggests that Rachel provides a ‘simple’ narrative – this statement perhaps does not appear altogether accurate. After all, the pathos of Rachel’s writing as just aforementioned conveys  an extended articulation of human suffering.

 Her writing opens with an account of her life prior to internment. It was the death of her husband in 1900, which Rachel alludes to as leading her to ‘nervous breakdown’ with overwhelming feelings of ‘anxiety’. It is with the support and suggestion of her family, interestingly, that she entered the Cheadle Royal asylum voluntarily. Yet here we see a dramatic shift in tone, hence why the writing is so important and haunting. She alludes to glimpses of positivity before the internment as she sought the company of her family ‘it was good with me, being with my people and without drugs’ - the repetition of ‘with’ suggesting that Rachel was making real effort to  sustain connection with society. This was a connection significantly compromised as her brother encouraged her to in effect, sign herself over’ to the hospital with the ultimatum ‘it is too late’ before she had even signed. Rachel’s citing of this particular phrase is interesting, highlighting an environment in which even the autonomy of her signature, her identity, was removed from her. In this light, her effort of writing her ‘Experiences as an asylum Patient; could be seen as a triumph and suggestive of the restorative power of writing. Importantly also, the profundity with which she emphasizes the phrase ‘it is too late’, highlights the importance and lasting effect of language, especially in regards to mental health. It can only be imagined how this triggered the constant anxious questions – too late for what?

Rachel’s account of her time incarcerated is composed of a combination of narrative and reflection.  Her comments such as  ‘I should have as a sensible woman, be able to reason with myself’ shows reason in itself, yet also a guilt – a cruel sensation which often still goes under-addressed in mental health care. Here was not only a woman blaming herself for her confinement, but blaming herself for what she  feels she ‘should’ have done. In terms of writing ‘should’ screams in its modality – it is selective, it indicates choice. This is what could be considered especially important in mental health care – that people have both choice and a voice, a seemingly appropriate rhyme. It appears Rachel, and doubtless many others, lacked this at a time they were meant to be receiving ‘treatment’.

Phrases may appear simple on the surface, but the implications they hold can be profound – ‘it is quite easy to get into an asylum, but terribly difficult to get out’. Here the  compound sentence expresses a concision of reason. And Rachel’s writing provides the haunting evidence – especially in regards to how mental health was made inaccessible by language. In retrospect, she alludes to her situation as ‘monstrous’, trapped by the terms of a doctors combined verdict that she was ‘melancholy and depressed’. As this was the time following the death of her husband, it could be anticipated that Rachel would feel low I mood – a logical emotional reaction to personal trauma. Here she writes of an experience which still pervades in unhelpful stereotypes today – that ‘depression’ is treated as a feeling, a reaction. In many cases, depression is alienating, a lack of feeling, a sense of suspension away from the world.

That Rachel’s writing highlights misconceptions which still continue today in regards to mental health is both shocking and illuminating. In turn, I have been driven to write about in the awareness that writing can change things, an awareness Rachel seemingly shared as she went before a Royal Commission in an attempt to draw attention to  her treatment.

An interesting link in regards to writing, especially in terms of mental health, is the poetry of Edna St Vincent Millay, a poet active, although in America, at the time Rachel was living. It is Rachel’s narrative that she berates not knowing who the ‘’visitors’’ are – the exaggerated apostrophes highlighting an environment in which people were ascribed with names rather than holding them intrinsically. This is often still the case in mental health treatments, people allocated as ‘’experts’’ or ‘’working in your best interests’’ when the actuality of those statements are potentially very much debatable. In Millay’s poem ‘A Visit To the Asylum’ a speaker is employed who appears to reflect upon her childhood experiences of the inmates of an asylum, and her lack of understanding of the reality of people’s internment. For example, the final stanza ends with "Come again, little girl!" they called, and I/ Called back, "You come see me!" – highlighting how quickly dialogue can be exchanged, without understanding. Rachel likely felt subject to this position – at the end of treatment from people who did not understand the reality of her situation. And this tragically still continues in regards to mental health. For example, the lack of distinction between using ‘depressed’ as a feeling and ‘depression’ as illness leads to people placing exaggerated expectations on people suffering from mental health problems – varying from ‘they are not bad enough’ to ‘they cannot do anything at all’. Making valid judgment involves facts and facts require listening and evidence.

Cheadle Royal Infirmary

It is the appropriation of limiting language terms to people, pressing them into categories, which creates a fight for identity. What is particularly evident is that Rachel’s writing is fraught with this friction, profoundly unfair, as seen in the imagery she uses to express it. The description  that in a ‘drugged condition I appeared before my mental execution’ highlights that institutionalisation of people for mental health problems was often treated as a kind of incrimination. It in turn makes one hope profoundly that such attitudes have changed, both inside and outside the treatment of mental health. Rachel alludes to how she was greeted with the phrase ‘You would like to go to bed’ – nurses assuming an identity and autonomy for her in language, This is enough to make anyone all the more passionate that  this is why today, every day, we should see language is essential to the autonomy with each individual.

People should be allowed to express themselves, converse – whether through reading, writing, speech, or action. So many in the past were denied this opportunity, and it is from the incredible accounts of those who incredibly kept up the strength to write – showing not only needed to change now, but what even now can be changed for the better. During her internment at Cheadle, upon which this article focuses, Rachel did not understand the definition of the ‘’Visitors’’. Perhaps it is our task, as readers of the future, to make ourselves as ‘visitors’ felt – to highlight our experience, however brief or intense, with mental health. Talk about it, encourage others to talk about it, write it down, read about it. It is through words which change can happen.
Thank you.

Grant-Smith,Rachel. Experiences of an Asylum Patient. London: George Allen & Unwin Ltd.,1961 -