Barbara Taylor, an historian, academic and award-winning author, spent 21 years shuttling between an asylum, psychiatric day services and intensive psychoanalysis before she managed to reach a state of good mental health.
If it happened to her now, she’s not so sure she would have made it.
Taylor’s book The Last Asylum: A Memoir of Madness in Our Times feels particularly resonant following the tragic story of Charlotte Faux, the social worker who committed suicide because she thought she was going to be discharged from a mental health ward against her wishes.
From a liberal, educated Canadian family, Taylor came to the UK as a young scholar, but it wasn’t until she was in her thirties that she began to succumb to overwhelming anxiety and destructive thoughts. She embarked on a path of increasingly disordered thinking, self-medicating with alcohol, drugs and promiscuous sex while being haunted by violent dreams and urges. Eventually, she could no longer hold down a job, living in a haze between each near-daily and extremely painful psychoanalysis session.
She was admitted to Friern Hospital, formerly the Colney Hatch Lunatic Asylum, in North London in 1988—the so-called “twilight years” of the asylum system, and five years before the hospital closed its doors forever.
“Although I felt very desperate, the reality was I was surrounded by people who were trying to help me. I was very fortunate, not just compared to people now, but even compared to other people in my world [at the time],” Taylor says. She is acutely aware that, despite her suffering, she had social privilege, a privately funded psychoanalyst and a strong support network of friends on her side—unlike many people going through the mental health system.
Her book is both a memoir of her own experiences and a history of the rise and fall of the asylum system. In writing and promoting it, she has spoken to hundreds of people who have shown her the system now is very different to the one in which she became ill, and eventually healed, more than three decades ago.
The twilight years
While acknowledging many of the flaws of the old asylums, which were often fraught with abuse, Taylor remains highly critical of the current system with its emphasis on community care.
If she found herself getting into difficulties now, she would in extremis most likely be admitted to a mental health bed on a hospital ward, possibly up to 300 miles from her own home, before being stabilised and discharged—sent out into the community alone, armed with meds to sink or swim.
Despite best intentions, Taylor believes the mental health system as it exists today “flies in the face of everything we know about human nature.”
“I was told by many patients as well as people working in community care that it was impossible to build relationships because people kept getting shunted from team to team.” The ability of a professional then to give consistent personal care and respond to the needs of people in distress over sustained periods of time is “programmatically refused and repudiated” she says.
Everyone needs a sense of consistent support
“Everybody needs a sense of consistent support to a greater or less extent, but the things we find acceptable in people who we call ‘normal’…somehow when it comes to people who are vulnerable and distressed we expect them to manage with much more fragmented relationships. I think this is unconscionable.
“The whole idea of a therapeutic relationship seems to me to have fallen by the wayside…any kind of open-ended, sustained relational care is [seen as] a bad thing.”
Taylor identifies a hypocritical disparity between the way people talk about de-stigmatising mental illness, and the reality of how some practitioners really see people with mental disorders. When she asked why, in the wake of the asylum closures, there hadn’t been more day services set up, many practitioners she spoke to dismissed them as “ghettos”.
“Something that really struck me is there’s all this language about treating people with respect, but when NHS managers talk about people with mental disorders hanging out with other people with mental disorders, it’s always seen as a bad thing. And they don’t hear the contradiction.”
Flies in the face of human nature
Taylor says it was the friendships she made in various psychiatric provisions that proved her saving grace. She believes the need for heavy medication goes down when people feel supported.
Taylor is in no doubt that there are still many highly committed practitioners working in mental health, but cuts, the running down of psychotherapeutic services and the prioritising of the cheap and the quick has clipped a lot of wings.
She’s heard managers saying they don’t think long-term care which involves relationships between practitioners and clients is a good thing, because people become dependent when they should be learning to “stand on their own two feet”.
“There’s been a complete collapse in confidence in what institutions can do for people. It’s like the only way for people to get better is to be out there in the community behaving like ‘normal’ people. But most of us for quite a lot of our lives require an institution to make us feel like we have a sense of belonging in the world,” she says, whether that’s a school, university or workplace.
Taylor believes the bottom line is government trying to scrimp and save at the expense of what is really in people’s best interests. This often means the real, hard, long-term work of getting someone back on their feet through building relationships, tolerating conflict and understanding someone in their own historical context gets overlooked. It’s not a vote-winning move for politicians to say—good mental health care might mean containing and supporting someone within the state for as long as it takes for them to make the arduous journey back to health.
“It’s hard not to imagine sometimes that this government doesn’t have a policy of literally driving people mad,” she says. “The deprivation of people with long-term mental health conditions of benefits, of basic needs, under the guise of tackling scroungers is absolutely inexcusable.”
Arguments about money don’t interest me
In her time in Friern, and subsequently in a series of day centres and psychiatric hostels, Taylor saw people on the road to recovery be completely unseated by delays in their benefits. People who were doing well could go into psychotic states under such high levels of stress.
“The arguments about there not being any money don’t interest me,” Taylor says, adamant that any government should have basic care as a spending priority, something that could be funded by “claw[ing] back all those billions that have been stolen from the exchequer” by people involved in tax evasion or avoidance.
Taylor believes a middle-ground on mental health should not be some utopian dream, nor is it rocket science.
Her proposition is a network of community mental health centres across the country which are integrated with physical health centres, have day facilities, occupational therapy, employment workshops and some small-scale residential provision.
“Community care can work, but it has to be backed up by the possibility of residential care. People need to feel that when they’re in crisis and they are not safe, they have somewhere to go.”
Because Taylor knows from bitter experience that at the depths of her distress, the thing she needed was the containing and protective “stone mother” of the asylum, she writes: to “hold me for as long as I required it”.