The Last Asylum discussion of mental health care in Britain, past and present - Tuesday 18.3.2014

The Last Asylum. A memoir of madness in our time Penguin. 2014 - Buy your copy

Barbara Taylor's journey through mental illness and the psychiatric health care system. A survivor historian's account of her battle with mental illness, set inside the wider story of the end of the UK asylum system.

A discussion page based on the launch event which was a public discussion of mental health care in Britain, past and present, featuring Peter Barham - Peter Campbell - Annette de la Cour - Antony Garelick and Barbara Taylor herself.

Link to video with variable sound track

The Platform Cast

From left to right: Annette de la Cour, Peter Barham, Antony Garelick, Barbara Taylor, Peter Campbell. Far right: Norma White converting speech to text, which we have used with other sources in preparing this summary.

Barbara Taylor

Professor of Humanities at Queen Marys (University of London) and author of The Last Asylum (2014). Her other publications include her mould-breaking Eve and the New Jerusalem. Socialism and feminism in the nineteenth century, published in 1983 before her breakdown. She published "Mary Wollstonecraft and the Wild Wish of Early Feminism" in History Workshop Journal in the Summer of 1992, Mary Wollstonecraft and the Feminist Imagination in 2003, On Kindness (co-written with Adam Phillips) in 2009 and History and Psyche (co-edited with Sally Alexander) in 2012. Barbara is a member of the Survivors History Group.


I am Barbara Taylor and I wrote the book that we are here to publicly launch this evening

I am Professor of Humanities at Queen Mary, also the Director of The Raphael Samuel History Centre, which encourages the widest possible participation in historical research and debate. I will not tell you all about it that evening, but it is a wonderful project and I hope you will support it.

The Last Asylum

In 2003 I published a short article in the London Review of Books under the pseudonym 'Eve Blake'. It described a visit I had made the previous year to Princess Park Manor, a glitzy residential development in the north London suburb of Friern Barnet. The Manor is a celebrity address, home to football stars and pop idols, including the boy band One Direction. In the 19th century it enjoyed fame of a different sort, as the Colney Hatch Lunatic Asylum, England's largest and most advanced psychiatric institution. In the seven score years of the asylum's existence - before it closed down in 1993, to be resurrected as Princess Park Manor - tens of thousands of people with mental disorders passed through its doors - including me in the 1980s.

In 1981 I had a breakdown and the following year I went into psychoanalysis. This analysis was very painful and I did not manage the pain well, relying increasingly on alcohol and tranquillisers to dull it. In July 1988 I ended up in Friern. I spent a fortnight there, followed by two further admissions the following year, totalling some eight months. Between and after these stints in Friern I attended a day hospital and then a day centre, spending altogether nearly four years in one or other psychiatric institution. I lost my home and moved into a hostel for women with mental disorders.

All during these years I continued my psychoanalysis and in 1990 it went through a crisis which proved transformative. In 1992 I was discharged from the mental health system and the following year I got my first university job.

These years as a mental patient saw me caught up in a psychiatric revolution, as hospitals everywhere closed and their inhabitants were decanted into the so-called community. Friern, the day hospital, the day centre: all these are now gone. The asylum system which dominated mental health services in Britain for a century and a half is now history. My book explores this transformation from the inside, setting the experiences of my madness years inside a historical account of the rise and demise of the asylum system. It concludes by asking how someone in my position would fare in today's post-asylum world.

I attribute my recovery to my psychoanalysis, and the book tries to show how this came about. Like all psychotherapies, psychoanalysis is an up- close treatment which works, when it works, through a partnership between patient and therapist: a partnership, which unlike most forms of psychiatric treatment, directly implicates the therapist's own psyche in the treatment process (an approach described by one leading therapist as "mak[ing] your mind available to somebody else, to help them recover").

My analysis was a pretty ferocious affair. I wanted to feel better but I did not want to change - was terrified of change - and I fought my analyst hard. He put himself on the line for me, and the toll on him was often apparent. "To open oneself fully to the tortured feelings of the deeply mentally ill is very disturbing," the leading British psychiatrist David Clark wrote in 1996, at the end of a long and challenging career.

Many twenty-first century psychiatrists prefer medicating tortured feelings to becoming embroiled in them, and who can blame them? But it is worth considering what possibilities may be sacrificed by these drug-based regimens: for deep psychological change, for a healing that involves inner transformation rather than symptom suppression. This at least was certainly my experience, and I know I am not alone in this.

However, change of this sort takes time, and care. In my case, it also took an asylum, a place to hold me - a 'stone mother' as some describe it - while I was struggled to survive. What happens to people now, who need this sort of care? I suspect some of them are dying, as I might well have died. If so, that is a terrible thing to contemplate. So, on that rather sad note, I am going to turn over now to our speakers for this evening.

Peter Campbell

Peter Campbell is a mental health system survivor. He has been receiving mental health services for 45 years. He was a founder member of Survivors Speak Out (1986) and Survivors' Poetry (1991). Since 1990 he has worked as a freelance trainer in the mental health field and has made many written contributions to books, journals and magazines. He has Honorary Doctorates in Education at Anglia Ruskin University and The Open University. Peter is a founder and the chair of the Survivors History Group.


I would like to thank Barbara very much for inviting me to participate in this panel tonight. I would also like to thank her for giving me a copy of her book, which I very much enjoyed reading.

When I am teaching and I say I have been receiving services for forty seven years students ask "what has changed?", in expectation that I will say a lot of things have changed.

I actually think that although some things have changed an awful lot has remained the same, but I am going to say a little bit about two things that have changed.

The first thing and perhaps the most important thing is we now have a survivor movement.

In the 1960s and 1970s survivors were on the fringes of things. There were survivor groups like the mental patients unions but there were not a lot of them and they had a limited impact. Things have certainly changed since the 1980s. Now there are hundreds of groups across the UK, in England, in Wales, in Scotland and in Ireland.

Survivors are involved in almost everything. It is not really possible to have a debate about mental health issues without involving survivors in some way.

So, survivors are involved in consultation about the planning and monitoring of local services. Survivors are involved in education and training of mental health workers.

I worked from 1990 as a freelance trainer, basically working with mental health workers putting forward the survivor perspective on what it is like to live in the mental health system.

Survivors are heavily invoved in research. Just recently, in fact, a survivor was made professor of user-led research at the Institute of Psychiatry.

So survivors are involved in a widespread manner. Survivors definitely have a voice and are listened to.

What does it all add up to? What does this talking and listening really add up to? Are survivors really empowered by all this involvement? I think that is a question that needs to be asked.

Many of the things that survivors were wanting in the 1980s when I first became involved have not been achieved. Less medication - not achieved. Phasing out of ECT - not achieved. Less compulsion - not achieved. In fact we have got more compulsion. Non-medical crisis houses - not achieved.

So, there is plenty of involvement, and that is good, but I think we need to be a degree of scepticism about what that involvement is actually achieving, certainly the more radical demands of survivors have not been met.

The second thing I want to mention that has changed is the closure of the asylums and the arrival of community care

These issues are dealt with quite a bit in Barbara's book.

When I first entered the mental health system everything was asylum-based, acute care, rehabilitation, everything went on behind the walls of the asylum. Within the wonderful gardens and behind the walls of the asylum. Now the asylums have almost disappeared, certainly in England. It has been a shock to the system. I think it has been a shock to some mental health workers and I think it has been a shock to some survivors as well. I think many survivors and many mental health workers were bereft by the closure of the asylums, so I think we should not underestimate the impact that we are still feeling from the closure of the asylums.

Personally I say good riddance to the asylums, I am not sorry to see them go. I spent a lot of time in asylums, they are not a good place to be, the care they offered was not good care. The gardens may have been wonderful but the ward were intimidating. I am quite happy to see the asylums go and I ca not see how people with a mental illness diagnosis can have an equal citizenship if they spend a lot of their time shut up in asylums.

But a big question remains about whether we have got rid of what I will call the asylum mentality. I would raise particular doubts about acute care which I would say has not changed significantly over the last fifty years.

I think people recently have talked about acute care as not being a therapeutic environment, I think survivor activist were among the first to point this out. Often they are not safe places usually they are not a creative space, nothing happens. I think if you were to go into a day room in the 1960s it would look very much like a day room in the 2010s rather. Nothing happening, people sitting around doing nothing.

I think we have got custodial care and we have inherited that from the asylums. 40% of in patients are detained, threat is used, restraint is used. So we have custodial care, we also have observation without interaction. Nurses, if they are on the ward at all, observing what is going on, but not participating.

I remember in the 1970s nurses would sit in the day room reading a newspaper. You might think that that has gone. It has not gone. It has changed. I spoke to a friend of mine who was in acute care last year and she says, "You know what the nurses all do? They play with their mobile phones, with their smart phones." I think those phones should be banned, I do not think a nurse has any business having a smart phone in their possession when they are working. So we have gone from newspaper reading to smart phone playing, but we have not got any interaction.

The other thing that people will always say is that the nurses stay in the nursing office all the time and they are not on the ward, not in the day room. That is not something new. That has been going on ever since the 1960s, since I first went in to the system. It is part and parcel of asylum mentality.

So I would say, in conclusion, the old asylum mentality is alive and kicking and we need to get rid of it.

I think it has proved easier to take the mental health worker out of the asylum, then it is to take the asylum out of the mental health worker.

So the final thing I would like to say is that I had one wish, it would be that acute care, in mental health services, would actually be care that meant something.

Thank you for listening.

Peter Barham

A psychologist and a social historian of mental health. He lived for a while in the Kingsley Hall asylum. His book Schizophrenia and Human Value (1995) is based on field work at Winterton Hospital in Durham between 1969 and 1972. From the Mental Patient to the Person (1991) is based on field work with ex-patients living in the community. He has also written Closing the Asylum (1997) and Forgotten Lunatics of the Great War (2004). He is a Fellow of the British Psychological Society. Peter is a founder member of the Survivors History Group.


Barbara has written a brave and arresting book that asks searching questions about the post asylum landscape.

The scale of the upheaval that has taking place is seismic. By the turn of the millennium more than 100 of the 121 large mental hospitals, centrepieces of the Victorian asylum landscape, that were still open in 1986 had closed.

So why did all these asylums have to close?

One answer is that for the post-war generation brought up under the Welfare State , mental hospitals seemed paternalistic and authoritarian. They seemed like Poor Law institutions under a different name. One may have found compassion and good fellowship there, but even so this was an exclusionary universe in which patients were seen as children and not as equals by the staff. It was above all this lack of equality that critics found most repugnant.

The Victorian asylums were not originally intended as repositories for the excommunicated but that is what they became. This did not alter much in the course of the twentieth century.

The anthropologist Elizabeth Bott wrote in 1976:

"Having an illness absolves the patients of responsibility and entitles them to care. But the stigma is enormous, and admission to the hospital, especially for the first time, is a catastrophe. It alters one's sense of self irrevocably, a fact that people who work constantly in mental hospitals tend to become almost unaware of."

The post-asylum challenge - Patient to person

The challenge in closing the asylums is awesome. As I and Robert Hayward argued in From the mental patient to the person (1991), the challenge is not just about buildings, or moving patients or creating an alternative network of services. It is about a much more systematic revaluation of how we think about people with a mental illness diagnosis, challenging the negative context in which they live and the legacy of a public psychiatry which had become the science of regulating paupers.

As much as anything, this an ethical project: forging a new language and paradigm for talking about an engaging with mental distress The actual closure of mental hospitals was only the first step in what is turning out to be a long journey. Though the 'failings' of community care have been much aired, arguably the policy has never been properly applied. Instead it has been led by an agenda based largely upon the politics of fear.

Jake and the politics of fear

Are we in a good place today, Barbara asks. Well, there are a number of different conflicting things I could say in answer to this, but overall, no, I do not think we are. I am just going to give you one example that was brought to my attention quite recently of what troubles me.

On YouTube you can find a video of Jake talking about his experiences of working for a year or so as an independent mental health advocate at the Maudsley Hospital supporting inmates to understand and exercise their rights .

This passage, referred to from the floor later.

He speaks to camera for almost half an hour, some of it in the corridor against the backdrop of the nameboard for Douglas Bennett House and the Jim Birley Unit, flagships of the Maudsley's much esteemed social psychiatry provision. The story he tells, in a low-key but very convincing way, is a very disturbing one of coercion and restraint. All the clients he has worked with have been put on antipsychotics. Many people

"have good reasons for objecting to the drugs but their objections are ignored. As soon as the patient disagrees with the medication they are coerced into taking it. If you question the diagnosis that is seen as part of their illness and is used to justify forced treatment. As soon as you disagree with the professionals you're in trouble basically."

People think that restraint is only used when the person is being aggressive or needs to be controlled, but all the restraints Jake has witnessed happened because people were given a depot injection & objected to this.

'When the people object to it they are held face down, and injected with the medication'.

Most of his clients do not see themselves as mentally ill, Jake reports.

"There are all these debates publicly about the meaning and reality of mental illness, but once a patient on the ward starts debating, they tell you that you lack insight. ... I think once the person is labelled mentally ill and has got into the system, that person in a way is kind of pensioned off.... The labelling just destroys the communication between the client and the professional ... everything the client has to say can potentially be silenced on the basis that they don't know what they are saying..."

Jake asks:

"shouldn't we be looking at this as emotional distress or a social problem.... "no I'm not mentally ill, I had a crisis and bad things happened to me but I'm not a sick person who needs to be drugged"...

It is not my intention here to necessarily endorse everything that Jake says, but he certainly comes across as a sincere and convincing commentator. This is a troubling portrait of a demoralised and dysfunctional psychiatric culture in which psychiatry seems to be in danger of losing its legitimacy if it has not already done so. It resembles what anthropologists Jocelyn Marrow and Tanya Luhrmann (2012) call a zone of social abandonment, in which the subject's communication is stripped of intention and meaning by those with whom the subject interacts and he or she loses normal relational reciprocity. But with the added twist that in this instance the zone of social abandonment is situated at the heart of the hospital.

Is this the new social psychiatry in action, we may wonder?

Critical resources for the disaffected:

Marková and Berrios

So are we in a good place?

Well I want to answer finally that when it comes to the availability of critical resources for the disaffected, yes I do think we are.

To given you an example that bears very directly on what I have just been saying. There is an important recent discussion by Ivana Marková and German Berrios (2012), two very distinguished psychiatrists and historians of psychiatry, about the knowledge base for a regenerated psychiatry, about a new epistemology of psychiatry

In psychiatry the language of description (i.e. descriptive psychopathology) was constructed before 1900. It has changed little since. The so-called science of mental illness that we have inherited from the nineteenth century may no longer be fit for purpose. We may need a new language for talking about the contemporary realities of madness.

Significantly, Marková and Berrios use the term madness in preference to that of mental illness. What kind of legitimacy does psychiatric knowledge possess and how stable and enduring it it? Psychiatric objects - mental disorders and mental symptoms - , they answer, are hybrid objects that are deeply embedded in contexts spanning the wider societal, cultural, and political spheres. By definition these contexts are not static. Take 'homosexuality' for example which was once regarded as a mental illness. This and other examples illustrate very clearly the constructive powers of social and historical forces in determining what counts as pathological.

This discussion links very directly with what Jake was saying on behalf of his clients. Jake's complaint was precisely that, for most of his clients, context had been stripped away, thus disabling them from being able to make sense of their experiences and the power relations they are embedded in. Jake, and Marková and Berrios, throw light on each other. There is a potential dialogue between them. They are moving in the same path.

Resources from survivors movements and their allies.

There is now an accumulating body of critical resources, mobilised very largely by the Survivors Movements and their allies, though also in adjacent fields such as Queer Studies and Disability Studies.

In the last year alone two fantastic collections have appeared that address psychiatrisation, madness and the oppression and agency of mad subjects:

Mad Matters: A critical reader in Canadian mad studies (2013) is a collection from survivors' points of view edited by Brenda A. LeFranĉois, Robert Menzies, and Geoffrey Reaume

Mainly from allies, but including some survivors, is a British compilation

Madness Contested: Power and Practice (2013), edited by three clinical psychologists, Steven Coles, Sarah Keenan, and Bob Diamond.

The Disability Studies Reader was first published by Lennard Davis in 1997 and published in a fourth edition in 2013. Its first chapter is "Constructing normalcy: the bell curve, the novel, and the invention of the disabled body in the nineteenth century" by Davis himself, who is interested in the way that normalcy is constructed to create 'the problem" of the disabled person. In place of the normal he proposes to create a new category based on the partial incomplete subject whose realisation is not autonomy and independence but dependency and interdependence. "Dependence is the reality and independence grandiose thinking", he writes.

In 1968 Mary McIntosh published a celebrated article called 'The Homosexual Role' which asked an entirely new question, not the question posed from the late 19th century onwards, "what are the causes of homosexuality", but rather, why are we so concerned with seeing homosexuality as a condition that has causes? By positing homosexuality as a social category rather than as a medical or psychiatric one, Mary McIntosh helped to open up a whole new agenda. It seems to me that that is very much where mad studies is now. Perhaps the day is not far off when the collective will of the Survivors Movement will follow the lead of the Gay Movement in giving the two fingers to conventional psychiatry.

Annette de la Cour

A mental health social worker and family therapist who worked in London mental health services for over two decades, including in the first community crisis intervention service based at Napsbury Hospital. She was a Mental Health Act Commissioner from 2004 to 2011 (seven years) and has been an Associate Hospital Manager for Worcester Health and Care Trust since 2008.


I would like first of all to pay tribute to Barbara's courageous account of her years of mental illness, journey to recovery, and her reflection on the history of asylums in Britain and the state of mental health services as she experienced them in the 1980s and how they are now.

I also think we can all be grateful to her for the contribution she is making to stimulating debate over the current state of our mental health services of which this evening is a part.

How would Barbara fare today?

Barbara poses an important question in her book, how would she fare in today's mental health system were she to be unwell now?

I would say the answer depended then, to a degree, on good fortune. It depends on it now to a far greater extent, and infinitely more than it should on where you happen to live. There do exist places of truly excellent care, but they are now few and further and further between.

I will not dwell on the nature and scale of the crisis in community mental health care. We know about the cuts and closures, lack of beds and increasing coercion by the use of the Mental Health Act.

The state we are in is not what we was envisaged when a policy to close the old asylum was a supposed to be coupled with better, more humane, less socially excluded care provided in the community. The scandal of institutional patients, languishing in backwards and lying there was to be no more and neither would be the horrors associated with all these old institutions.

What went wrong and what does it tell us now about what needs to be done to put things right.?

It is clear that the true cost of post asylum mental health care is far greater than was thought. Closing the asylums clearly became an opportunity to save money and since that time services have been subject to cuts at different times, and never more than under the present government. So much for the promise of parity between services.

Three features contributing to our problems.

However, money is only part of the story, important though it is. I would like to highlight three features of what has happened since the asylums closed which I feel have contributed to many of the problems we now face and which need to change if we are to develop the kind of services users need and want.

Firstly community care

After the asylums, it was community mental health services which were meant to form the corner stone of service provision. However, based on no particular coherent or consistent model, but instead developed in response to the latest government policies, a bewildering array of different teams has come into being throughout the past thirty years, characterised mainly by a lack of co-ordination and poorly understood by service users and their carers.

Typically, with each mental health trust, such as my own one, there will be a crisis team, home treatment team, assertive outreach team, early intervention team, recovery team and a general community mental health team, each with their own entry criteria and assessment procedures. Service users journey forwards and backwards through these teams, even during a single episode of illness and often many times as their mental health needs vary, subject to frequent assessments and equally frequent changes of personnel. This is not a system of care, but more one of people processing. It places no real value on relationships and is devoid of psychological thinking.

Care takes place between people in the context of relationships between service users and mental health workers which are allowed to develop and exist over time. Sadly, resolving mental health problems takes not days or weeks, but often months and even years, and continuity of care is fundamental.

Our current fragmented services, and the state of flux on the agenda, serves to mirror the fragmented state of service users themselves, and so utterly fails to offer the emotional and psychological containment that people need in order to recover and to remain well. Given the absence of the walls of the asylum - in Barbara Taylor's memorable phrase, "stone mother" - and our failure to provide any meaningful virtual containment, small wonder so many service users feel abandoned and carers neglected and that hospitals cannot cope with the resulting, ever increasing pressures on beds.

If all my years as a social worker on the frontline, so to speak, of community mental health services have taught me anything, it is never, ever, to underestimate the value to service users of simply being there and being known to be there, whether or not needed at any particular moment. This we have largely lost and the consequences, as we have been hearing, speak for themselves.

Secondly risk

This brings me to my second point, which is about risk. Mental health services are full of it nowadays, measuring it, evaluating it and managing it: Risk is at the top of everybody's agenda. However, never before has risk felt so risky. It is why the use of the Mental Health Act continues to rise inexorably and why it was felt necessary to introduce community treatment orders. Undoubtedly the reasons for this situation are many and complex. The shut down of the range of housing and social care facilities has a huge part to play, but the ones that are to do with the nature of the services that do exist are often overlooked. Good risk management requires trust and sadly there is not nearly enough of it around. It is my belief not only that the fragmentation of the services which I have described increases levels of risk in users due to absence of trusting relationships between them and staff, but also it is far harder for doctors, nurses and others working in the community to tolerate acceptable levels of risk when they themselves do not know their patients well enough, only have responsibility for them for segments of time and, very importantly, are often not working collaboratively in stable and supportive teams.

Working in these conditions understandably leads to a flight to safety, and this I believe is an important aspect of what we are seeing now.

Thirdly the biomedical model

The years since the closure of the asylums have seen the growing dominance of the biomedical model, within mental health services, despite the absence of evidence to prove it. Barbara Taylor describes in her book how it came to increasingly influence British psychiatry from the first world war onward and how that affects effective treatment, at least in some parts of system. Now, symptoms, diagnosis and medical treatment matter most, whereas personal history, social context and individuality count for little. Understanding is not necessary - only treatment to eradicate the symptoms.

Following this medical model, the alternatives offered to the old asylums are based on the same model as physical healthcare: Patients only require brief in-patient stays, quick fixes were to be the order of the day and still are. To me one of the most damning and disheartening features of the post asylum world is that, as a result of this medicalised approach, we are still creating new generations of chronic patients at a dismaying young age, leading lives frequently damage by the sometimes life threatening physical and mental affects of long-term treatment. This is not what was anticipated by those of us who argued for the asylums to be closed. As long as services adhere to this flawed model we will not achieve the provision of services which will enable users to recover, in the true meaning of the word, and lead the lives that they would wish for and for as long as the rest of the population.

Due to criticism and pressure brought to bear, particularly by the service user movement, mental health services have responded more recently by adopting the recovery approach. Consequently, while some parts of services now march to the drum of collaboration, choice and shared decision making; in others, even within the same Trust, the ethos is still one of expert, patient, doctor knows best, compliance and the treatment pessimism of much diagnostic labelling.

What, one wonders, are service users to make of this extraordinary conceptual muddle and fundamental contradiction which now lies at the centre of our services?


In conclusion I would say that, in mental health services particularly, no one size fits all. This is the situation we have been heading towards, based on the prevailing paradigm of care and treatment. What works for one person is not the same as what works for the next, and it varies over time. Service users need a range of services available to them to cater for a variety of needs at different times of what is often a long journey. These include housing, financial, social, therapeutic and medical services. The need for containment and refuge has not gone away, but is rarely to be found in our over-crowded acute wards nor, as I have indicated, in the care provided by our community mental health teams or in the other few services left.

This need existed in Barbara's time and as in hers so still in ours.

Antony Garelick

Antony Garelick, who trained at the Maudsley Hospital, is a Consultant Psychiatrist/Psychotherapist who worked for 25 years at Claybury Hospital in Essex, one of the largest therapeutic communities in the UK. He was the first Clinical Director at Claybury, and was heavily involved in its eventual closure and the reprovision of its services. He is now an Associate Dean of MedNet (London Deanery), a consultation service for doctors based at the Tavistock Clinic in London.


This text is being edited.

Given what we heard earlier about the Maudsley and psychiatry, I have a difficult task addressing you, because I trained at the Maudsley and I was a psychiatrist for a long time.

I worked psychoanalytically through the whole of my professional life. Barbara's book talks to me. It encapsulates my professional life and my experience. I want to mention Barbara's courage in actually opening a window to what it is like to have a breakdown and to the suffering.

I am going to divide what I have got to say into two sections. I will look at what I consider to be the important points about what is therapeutic and I will say something about asylum and asylum closure from my perspective as an insider at Claybury Hospital, one of those that was closed.

What is therapeutic?

I will read you an extract from page 152 of Barbara's book, because, for me, it encapsulate something about therapy. Barbara says,

"On my second admission I met Magda, the blanketed lump I had seen the nurse trying to rouse on my first morning in Friern, Very soon we were fast friends. 'Get up!', Come and talk to me!' I would plead to Magda. 'I'm lonely, I can't stand it out there - you have got to get up an keep me company.' Magda suffered terribly from black depression yet nearly always she would pull herself together to be with me. Usually I did the same for her. The obligations of friendship trumped madness - and this in it self could be a form of healing."

That graphically describes the pain, the compromise, the capacity to use verbal communication, the power of relationship. That is quite fundamental for us as human beings. It is intrinsic in therapeutic ventures.

I have jotted down a few things about what is therapeutic. I think

  • it is being listened to

  • it is being respected or valued, and

  • it is an attempt to understand and make emotional contact.

    Emotional contact is very complicated. It is essential for psychic health and yet when you are ill it is something that can be intolerable and something you want to avoid because of the pain, fear, paranoia and other feelings it can generate. So it is very complex.

    The essence of work in any talking therapy is a therapeutic alliance. As a therapist you are entirely dependent on the fact that the patient who comes to you is somewhere in the corner of their mind committed to struggling with their problem. Quite often, in a severe breakdown, patients are just gripped by a fury, rage, suicide, nihilism. It is very difficult to actually achieve a therapeutic contact.

    Therapeutic contact is about survival. Survival not only of the patient, but survival of the therapist. Here I come to what Peter Barham said about medication. This is a very, very complicated issue. I disagree with a good deal of what he said, but am sympathetic with other aspects. Doctors give medication because they feel helpless. There is a total lack of omnipotence: They want to try and reduce psychic pain and they do it unconsciously to protect themselves as well. It is a dyad, when you are working it is a dyad. However much the analyst or the therapist is in a particular stance, the emotions and what we call the 'projections', get inside one and have to be held in check. Now, the power of this affects the capacity to think, not only in the mind of the patient but in the mind of the therapist.

    So it is - the other thing about thinking, I do not know, it is an attack on thinking, thinking can cause pain. One way to actually cope with pain is to abolish thinking. So there are fundamental things that one is struggling with when somebody is in a severe state of illness and broken down. In order to do that one needs time and a protected space, what I call an asylum. Asylum does not have to be concretely manifested in institution. It is a protected environment which I will come to in a minute.

    The other thing I wanted to say, it is intrinsically a relational, emotional undertaking, One will need to differentiate between psychoanalysis as treatment and psychoanalysis as metapsychology. The metapsychology gives us a framework of understanding, an intellectual measure that we need to try and cope with the confusion and the complexity of the situation, but it needs to be differentiated. It is a framework for how we maintain our analytic stance.

    I am going to a say a couple more things about the therapeutic side, that is to talk about the development and developmental pathology. Barbara says in the book, it is a cryptic statement, there is no such thing as a baby, what she is saying, as describes, a baby does not survive without a primary carer, if there is not a mother or a mother substitute to feed the baby, the baby will die.

    So actually, that is intrinsic for our survival and therefore relationship and biology come together, the idea of a separation between nature and nurture is nonsense really. Of course when you are looking at these complex interactions, they are extremely complex, you have the social, biological, the constitutional, you have all these in a tremendously complex interplay. We struggle, if we talk about mental illness and psychiatry, I would say our level of knowledge is somewhere, akin to what it was in medicine in the 18th century. We are right at the beginning. I think it is hard, I mean, it is harsh to be too critical if you, I mean you are historians, I am not an historian, if you look at some of the periods and what was done, it was cruel and terrible. The motivation was to try and be useful or actually try to understand something. So I think we need to be humble, we are just that beginning.


    I just want to say something about asylum and I want to mention William Tuke who founded the York Retreat in 1792. What he described and the idea was, that was to treat pauper lunatics, as that is their official title, by removing them from bad moral influences, giving them fresh air, healthy environment, hard work, exercise, prayer and spiritual guidance the shattered brain might mend, it was a very humane bliss and it was the prototype.

    What I want to say about what has evolved from that is that the proponents of community care at the time of the closures were rather mirroring that type of thinking, accept that the Quaker ethic had been replaced by a contemporary materialistic ethic and a more conventional medical type model, the idea behind it in some ways, if you provide pleasant surroundings and a good environment all will be well.

    There was a parallel between the rapports of the 18th and 19th-Century and the planners who planned the reprovision, they both desired to improve the mentally ill, but in the 18th and 19th-Century they built the asylums and now we are demolishing, them, we have moved into fragmentation of care, teams, short-term intervention, no long-term relationships. The model of healthcare right across the board is a fit person who needs to have a hernia operation, who can go, choose where they want to go, have it as a day patient and go back to work. That is the model. Anything to do with vulnerability, long-term care is shunned. That has always been the problem, yeah. The reason why there was warehousing in the mental hospitals was partly financial because the central taxation paid for people in hospital and council tax pays for people in the local authorities, the local authorities did not want to take them, all right, they flex votes, a lot of political social things. I have lost my train of thought I was going to say something about warehousing. Do not forget in terms of pauper lunatics, coming from the work houses the conditions in the hospitals were far better than outside in society, there were discussions if you look at select reports, what to do, how can you discharge people back into poverty and no sanitation, historically. There are major problems which are still there. .


    Dave Harper from Asylum magazine:

    I just wanted to mention Asylum magazine, which is produced collaboratively by activists, experts by experience, critical professionals and academics. Google it: (

    The great thing about this evening has been that there has been a debate with different ideas being presented about how our response to mental health can be improved. Outside of this meeting, in the media for example, many of those whose views are represented are professionals like me. However, one of the problems here is that professional bodies represent their 'guild interests'. Thus organisations of psychologists or psychiatrists argue in the media that what mental health services really need is more psychologists or psychiatrists etc.

    As a result, it is quite hard to get any sort of decent debate going in relation to more fundamental questions. For example: what do we think are the causes of mental health problems? Why are rates of prescription of psychiatric drugs continually rising? Why do we spend so much money on such drugs compared with other forms of help? Perhaps both the increasing rates of mental health problems and our increasing choice of solutions like medication is driven by that rather out-of-fashion word: capitalism? There is relatively little debate about how we increasingly see mental health in an individualised way - being prescribed individualised solutions like therapy or medication. Perhaps we need to think of more collective ways of dealing with the causes of income inequalities which seem to be a major cause of distress? I would like to see us having debates about these kinds of issues more often."


    Cheryl Prax of Speak Out Against Psychiatry

    You can see my story, I am "Cheryl" on our website. It tells you what happened to me. Peter Barham spoke about the video featuring Jake Sebastian. Jake was one of the founder members of Speak Out Against Psychiatry.

    Speak Out Against Psychiatry also has an e-petition to abolish Electro Convulsive Therapy.

    I have tried to get on a few government committees but it is very difficult because the people who say who is going to be on the committee are psychiatrists and they do not want to choose people who will rock the boat. So I have not managed to get on so far.

    Just what can we do? How can we get in there and get our case across, because it is just going round in circles?

    Speak Out Against Psychiatry does demonstrations, street theatre, things like that, we really need to get to the general public. I was a member of the general public until, one day, I was carted off to the loony bin!

    I spent one awful week in there. My arm was broken on the first day.

    I was shocked. A law abiding member of the public, I Was shocked at how I was treated. I could not believe it!

    That turned me into an activist. I even got myself voted in as a governor on my local Mental Health Trust because I was so shocked.

    Thank you.

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    From the platform:

    Two survivor accounts:

    Barbara Taylor

    "In my case, it took an asylum, a place to hold me - a stone mother..."

    Peter Campbell

    "Personally I say good riddance to the asylums..."

    Three professional reflections:

    The academic historian:

    Peter Barham

    The social worker:

    Annette de la Cour

    The psychiatrist:

    Antony Garelick

    From the floor:

    Dave Harper from Asylum magazine

    Cheryl Prax of Speak Out Against Psychiatry

    The platform's last word: