Mental Illness in a Changing World

A few years before the last war a young doctor took over a practice in a London suburb. He was a smooth man, plump as a schoolboy and urbane as any house-agent’s clerk; painstaking and efficient His reputation spread and his practice flourished. Yet he has recently lost many of his patients to a partner who joined him a few years back. The significant fact about this partner is that he came fresh from experience in a mental hospital and when examining his patients’ physical ailments he never forgot to probe their mental upsets.


A few dry-as-dust statistics will show that this attitude of the partner towards his patients is not unreasonable. The Mental Health Research Fund recently stated that 10 to 20 per cent. of all who consult their general practitioner suffer from some neurotic condition rather than a physical illness. More than a quarter of industry’s absenteeism is due to some form of mental illness—which exceeds the common cold. The Medical Officer of Health for Salford has said that one baby in every 19 will spend some time in a mental hospital and that one in 12 will one day suffer a mental breakdown.


Psychosomatic Diseases


Apart from the purely mental complaints, the psychosomatic illnesses—more easily known as physical disorders which are caused by mental upset—have become disturbingly common since 1939. A million men in Great Britain suffer from peptic ulcers, which are said to be mainly the result of emotional and constitutional disturbances; large employers such as the G.P.O. and London Transport find these ulcers to be the commonest form of prolonged ill-health among their staff. Coronary thrombosis is another psychosomatic disease; deaths from this have increased frighteningly. Coronary diseases were responsible for 37,000 deaths in 1947—by 1951 this figure had swelled to 58,000.


It is thus not wonderful that the mental hospitals are so busy. The Hospitals Year Book for 1954/5 states that of about 482,000 hospital beds in England and Wales nearly 142,000 are occupied by cases of mental illness—later reports suggest that this figure is, if anything, rather an underestimation. The Ministry of Health Board of Control reports that in 1954 mental hospitals were overcrowded to the extent of 18,932. According to the Manchester Guardian (31/10/55) a recent article in the Lancet on mental hospitals made them sound more like concentration camps, with underfed inmates and nurses struggling to keep charge of as many as 100 patients apiece. The Board of Control comments in an earlier report that “The steady increase in the number of admissions to mental hospitals does not appear to be the result of any gross increase in the incidence of nervous and mental illness in the general population . . .” but is due to the fact that “. . .  old prejudices are dying and there is an acceptance of treatment in hospital where it is available . . . ” Whether or not that is true, it is sobering to reflect that we are yearly setting up records in mental hospital admissions, despite over a century’s development of knowledge and experience in treating diseases of the mind.


Ignorance and Cruelty


The care and treatment of the mentally ill was cruelly neglected until well into the 19th Century. The insane were thought to be possessed of a demon and fully responsible for their actions. Consequently their treatment was harsh in the extreme; they were heavily chained, beaten and tortured. The madhouse attendants were ignorant and corrupt brutes who cared nothing for their charges’ well-being and often left them confined for days in their own filth. Chillingly suggestive was the remark of one visitor to a madhouse, who, when asked whether the patients he had seen were men or women, could only reply, “ Women, I think, but I am hardly certain.”


One of the most famous of the early madhouses was Bethlem, or Bedlam, which stood in London on the site now occupied by the Liverpool Street Station. Here were scenes of sickening uproar and confusion, which gave the word “bedlam” to the English language. For a penny or twopence any sufficiently sordid London citizen could watch the antics of Bethlem’s inmates, one of whom for example—although apparently quite sane and rational—was confined in an iron apparatus for nine years, and released only to quickly die of advanced tuberculosis. In the White House at Bethnal Green thousands of bugs paraded the walls at night and 30 or 40 rats at once squirmed over the gangrenous legs of the patients: yet a House of Commons Select Committee reported that this establishment was “. . .  considered as good as the generality of Licensed Houses where Paupers are received . . . ” And it was not only pauper lunatics who were ill-used. A contemporary account tells us that George III in his madness was ” . . . encased in a machine which left no liberty of motion . . . sometimes chained to a staple … frequentlv beaten and starved and at best he was kept in subjection by menacing and violent language.”


Such attempts as were made at systematic treatment yielded nothing better than shocking the unfortunate patient by abruptly plunging him into cold water, or weakening him with drastic purgatives, vomits and copious bleedings.


Tuke’s Retreat


In 1791 a woman called Hannah Mills died in disquieting circumstances at the York Asylum. Her death roused the interest of a thoughtful Quaker called William Tuke, a tea and coffee merchant, to whose family the history of the great Rowntree fortunes can be traced. Tuke persuaded the Society of Friends to open at York “. . .  a retired Habitation with necessary advice, attention, etc., . . . ” for the insane where “. . .  a milder and more appropriate system than that usually practised might be adopted.” This habitation was opened in 1796 under the name of the Retreat—it explains the origin of the old saw which dubs York “the city of lollipops and lunatics.”


The methods applied at the Retreat were a tremendous advance for their time. Chains and terrorization were discarded and replaced by a serene family atmosphere. No one was punished for failing to control his actions; self-control was encouraged by putting him in charge of small animals, such as rabbits or poultry. No effort was spared to make him feel a normal, usefully active person. These methods became famous and Tuke’s Retreat prospered. It stands to this day and is still a centre of advanced treatment of the mentally sick.


Many efforts were made during the early 19th Century to reform the laws governing mental institutions, but most came to nothing. In 1816, 1817 and 1819, successive Bills designed to ensure the inspection of private madhouses passed through the Commons but were rejected by the House of Lords. “There could not be,” said Lord Chancellor Eldon in 1819, “A more false humanity than an over-humanity with regard to persons afflicted with insanity.” Fortunately their Lordships’ views were customarily behind the times and in 1828 came the first comprehensive laws on the certification of the insane. Soon afterwards the County Asylums arrived to carry on the work of the pioneer establishments. The most notable of these asylums was at Hanwell. where a thousand patients were accommodated and Tuke’s system of the minimum of restraint was extended to the complete absence of mechanical restrictions. Hanwell Asylum is now St. Bernard’s Hospital, a puddle-coloured building on the Uxbridge Road, where the red ’buses whizz to and fro, watched by the patients standing on benches behind the high wall.


Uncomfortable Fact


Throughout the early 19th Century the movement for lunacy reform gathered strength, culminating in the Lunatics Act of 1845, with which Lord Ashley (later the Earl of Shaftesbury) was closely concerned. This Act brought all types of institution under the supervision of a national inspectorate. The Lunacy Act of 1890 consolidated the 1845 Act; most of its provisions still apply to certified mental patients. The 1914/8 war provided an abundant crop of cases of physical disturbances attributed to mental stress and an opportunity to test the theories of the new schools of psychiatry. The Mental Treatment Act of 1930 allowed the new categories of “voluntary” patients, who could enter and leave a mental hospital at choice and the “temporary” patient who was expected to recover within a few months. The National Health Service Act of 1946 place the treatment of the mentally disabled on a par with that of the bodily sick.


Yet we are still faced with the uncomfortable fact that mental illness is more common than ever and tends to increase. Improved methods of diagnosis and a generally more enlightened approach could account for part of the increase but still leave a large lump of it unexplained. What are the reasons for the mental and associated illnesses flourishing so unhealthily? Why is it that, as the Lancet has remarked rather sadly, having spent so long encouraging the mentally sick to enter hospital there are now nevertheless so many of them that measures must be taken to keep them out or curtail their stay? It is true that mental illness is most frequent in those countries which we are pleased to call the most civilised; for this reason many are content to lay the blame upon modern society. Lord Boyd-Orr has said (Manchester Guardian, 23/7/55): “Such simple things as a motor car in a street or a radio, with its exciting news, could give a shock to the nervous system that was unknown 50 years ago. The stress and strain of modern life . . . were causing an increase in disease, particularly of the heart and nervous system.”


True as that may be, it is only part of the story, for it takes no account of the real nature of the strenuous problems which goad so many into a nervous breakdown. It is not the radio of itself which worries the nervy, but the fact that it brings the word of war and unhappiness into the home. Among the causes of nervous people we can point to the need to work overtime (often foregoing part of a Summer holiday) to work off a Hire Purchase debt or a mortgage on a house; the press of inadequate housing; the battle of travelling to and from work on overcrowded transport; the high accident rate on congested roads; the after-effects of the war and the threat of its hydrogen-bred successor. None of these are a necessary part of society; they are products of the essentially competitive nature of the modern Capitalist world, with the hurry and worry and scurry of its struggle for survival at its fiercest in the great sprawling cities.Way Out
What of a way out of our problem? We have come a long way since the days of witchcraft trials and the cruelty and tumult of Bedlam. The force which changed the face of Tuke’s England, which built the cities, the railways and the factories—which has suppressed some diseases but has nourished the nervous complaints—has had its part in altering mens’ ideas on many things, including mental illness. We are now up against the fact that the tensions of modern Capitalism are washing out the efforts of the mental health reformers. The only effective way of dealing with mental illness is to go for its roots— that means the social system which measures human activity not in terms of its usefulness but on whether its results can be sold in a shop or on a market. Until we get rid of that rock-bottom insanity there will always be people who are mentally sick, as testimony to the impossible strain of trying to live like a human being in an inhuman world.